Chiropractic Profession Marks 10th Anniversary of Practical Skills Exam.

GREELEY, Colo. -- During the past 25 years, the number of chiropractors in the United States has more than doubled. Since 1996, the standards for entering the chiropractic profession have also increased dramatically - thanks in large part to a practical skills examination produced by the National Board of Chiropractic Examiners (NBCE).

According to National Center of Health Workforce Analysis statistics, in 1980 approximately 25,600 chiropractors practiced in the United States. At that time, each chiropractic state licensing board developed its own test to measure a candidate's preparedness to enter practice. By the end of that decade, with more than 39,000 chiropractic physicians in practice, the Federation of Chiropractic Licensing Boards asked the NBCE, the testing agency for the chiropractic profession, to study the feasibility of a nationwide standardized skills examination. The result was the NBCE Part IV Practical Examination - the first exam of its kind to be administered nationally by any U.S. health care profession.

The NBCE has been in the business of producing fair, valid and reliable exams since 1963. The organization has developed a series of multiple-choice tests that measure examinees' academic proficiency and application of clinical knowledge.

According to NBCE Director of Practical Testing Paul Townsend, D.C., the Part IV Examination uses a different kind of format called an objective structured clinical examination (OSCE). In an OSCE exam, candidates undergo a series of mock patient encounters and perform procedures that would commonly be required on the job as a chiropractor. Examiners then evaluate their performance against a standard established by experts in the field.

Frank G. Hideg, D.C., is a member of the NBCE Board of Directors who chaired the Part IV Committee during the development of Part IV. Dr. Hideg points out that multiple-choice tests are objective and are economical to produce and administer. However, a multiple-choice test cannot address actual clinical behavior in an occupational setting.

"No one goes to their office on Monday morning and fills out a multiple choice test," says Dr. Hideg. "Instead, they see patients, evaluate clinical information, or review X-rays and lab tests. Those are the types of skills that Part IV measures."

Accepted testing industry guidelines suggest that the content of tests used for licensure purposes should be determined by a survey of those in the field. Therefore, before the NBCE could produce Part IV, it had to determine what conditions a practitioner would likely encounter in practice. In the early 1990s no one had ever compiled a study, or job analysis, of typical chiropractic practice. In 1993 the NBCE collected data from approximately 5,000 randomly selected chiropractors and compiled the results in the 1993 report Job Analysis of Chiropractic.

The NBCE has since released two updated reports, in 2000 and 2005. In addition to steering the content of NBCE exams, the job analysis has become a crucial tool that state boards use to accurately define chiropractic scope of practice, as well as to provide documentation and support to those negotiating insurance coverage.

Today there are between 65,000 and 70,000 chiropractors practicing in the United States. They can be found in every state and 48 of those states, along with the District of Columbia, accept or require the NBCE Part IV Exam before a candidate can enter practice. Thanks to the standards set by the NBCE Part IV Examination, consumers of chiropractic care can be assured that the treatment they receive will measure up to a national standard.