Dr. Paul Townsend, D.C. Director of Practical Testing, Research & Development

1. NBCE Part IV Practical Examination Duties of a Part IV Examiner Dr. Paul Townsend, D.C. Director of Practical Testing, Research & Development Dr. LeRoy Otto, D.C. Part IV Chief Examiner, NWHSU Test Site

2. Part I – Basic Sciences Examinations • Part II – Clinical Sciences Examinations • Part III – Written Clinical Competency • Part IV – Practical Examination for Licensure NBCE Battery of Pre-licensure Examinations

3. To provide a testing format in which the candidate demonstrates his or her ability to perform occupational tasks in a clinical setting: Part IV Examination Purpose

4. Developing Test Items • NBCE Workshops • Chiropractic College Clinical Instructors • Technique Instructors • Certified Content Experts • Staff Consultants Part IV Test Development

5. Cases and questions selected by state licensing board representatives Part IV Test Committee Meeting

6. A panel of experts • State Licensing Board Representatives • Content Experts Setting Pass/Fail Score

7. Hierarchy of Clinical Skills DO PRACTICE PART IV SHOW HOW KNOW HOW PART III PARTS I & II KNOWLEDGE

8. Content Areas • Diagnostic Imaging • Chiropractic Technique • Chiropractic Case Management NBCE Practical Examination

9. Content Weighing TEC 17% DIM 16% CAM 67%

10. 10 Four-minute Stations • Candidate identifies radiological signs on plain film x-rays • Candidate determines most likely diagnoses • Candidate makes most appropriate initial case management decisions Diagnostic Imaging

11. 5 five-minute stations • Candidate demonstrates two adjusting techniques per station • Cervical spine • Thoracic spine • Lumbar spine • Sacroiliac articulations • Extremity articulations Chiropractic Technique

12. 10 five-minute patient encounter stations • 10 linked post-encounter probe (PEP) stations • Candidate performs focused case histories • Candidate performs focused physical examinations • Candidate evaluates patient clinical database • Candidate makes differential diagnoses • Candidate makes initial case management decisions Chiropractic Case Management

13. Use of standardized patients • Use of OSCE format and protocols Key Features of NBCE Practical Examination

14. Successful candidates use organized approach while obtaining case history information • Successful candidates communicate effectively with patients • Successful candidates respect patient dignity • Successful candidates elicit adequate historical information Case History Stations

15. Perform a Focused Case History

16. PEP Station information

17. Post-Encounter Probe Station

18. Putting It All Together

19. Part IV Candidate Numbers

20. Part IV State Acceptance

21. Logistics of part iv 14 Test Sites 78 Key Personnel 308 Chiropractic Examiners 280 Proctors 364 Standardized Patients 140 Chiropractic Technique Patients 70 Maintenance & Security Personnel 1254 Total Administrative Personnel

22. Total Candidates TestedSince January 1996 44,419

23. Part IV provides a highly reliable assessment of the chiropractic clinical skills required for licensure • The dependability of the pass/fail decision is consistently at or above .90 • The inter-rater reliability across the 15 rated stations is .93 - .96 • The key to these high correlations is adherence to NBCE scoring protocols and consistent performance by the Part IV examiners Part IV Performance

24. Must have been in licensed chiropractic practice for a minimum of 5 years • Chiropractic license must be in good standing with the FCLB (vis a visCin-Bad) and with the state chiropractic licensing board • There cannot be any outstanding actions against the chiropractor’s license • Chiropractors serving on state chiropractic licensing boards may be nominated by their boards to participate on Part IV test committees or as chiropractic examiners during Part IV exam administrations • Part IV examiners may not be currently serving on Chiropractic College Boards of Trustees, be chiropractic college faculty members, or serve as preceptors for students enrolled in the Part IV exam Chiropractic Examiner Professional Requirements

25. Reports to the Chief Examiner • Follows instructions of the Chief Examiner • Conducts himself/herself in a professional manner • Strives to be fair and objective in the assessment of examinees • Does not prompt or give unfair advantage to any examinee • Has no contact with students/examinees prior to or following the exam • Avoids any appearance of impropriety or conflict-of-interest • Consults with the Chief Examiner when any question about the exam or exam content arises • Accepts the Chief Examiner’s decision as final Part IV Examiner Duties & Responsibilities

26. Part IV Examiners must: • Attend the Friday evening Examiner Orientation & Training • Examiners receive training in areas that impact test site personnel relations and examinee assessment • Sexual Harassment • Gender and Racial Bias • Examiners receive training in candidate skills assessment and checklist marking • Examiners receive feed back on errors made in previous exam administrations • It is absolutely essentially essential that examiners understand the NBCE scoring protocols, and how examiner errors affect student scores • It is absolutely essential that examiners adhere to the standards set by the NBCE Part IV Examiner Training

27. Friday night training 50.00 3 Saturday rotations @ $125/rotation 375.00 3 Sunday rotations @ $125/rotation 375.00 $800.00 Part IV Chiropractic Examiner Compensation

28. Currently 47 states including Washington, DC recognize participation in the Part IV for CE credit • CE credit ranges from 12 to 30 credits per year • Letters are mailed to participating examiners by the NBCE Department of Practical Testing • Examiners must keep these letters on file in case they are audited • If the letter from the NBCE is not received within four weeks following the exam, the examiner should contact Debora Beeman at dbeeman@nbce.org or call 1-800-964-6223 Ext. 154 Continuing Education (CE)Credits

29. Questions? If you would like to know more about the NBCE Part IV examination, contact Paul Townsend, D.C. at ptownsend@nbce.org