The National Board of Chiropractic Examiners (NBCE) is a non-profit national and international testing organization for the chiropractic profession that develops, administers, analyzes, scores, and reports results from various examinations. Examinations are offered to students at chiropractic colleges accredited by the Council on Chiropractic Education (CCE). The NBCE maintains its headquarters in Greeley, Colorado. The organization was established in 1963 to standardize chiropractic testing requirements as opposed to each state having its own board exam. Since 1963, all but one of states have adopted the passage of Parts I-IV; however, each state has its own licensing requirements in addition to the NBCE exams.
ABSTRACT Objective The purpose of this study was to evaluate the alignment between chiropractic educational outcomes, the National Board of Chiropractic Examiners (NBCE) prelicensure exams, and the Council on Chiropractic Education (CCE) meta-competencies. Methods A qualitative thematic analysis was performed between January 2024 and December 2024. A detailed coding framework was used to systematically assess coherence among the content of NBCE prelicensure exams, the competencies from 4 sample chiropractic educational outcomes, and the CCE meta-competency framework. Data were analyzed to identify the presence and depth of key professional domains. Results The thematic analysis revealed a substantial degree of alignment between the NBCE exams and the CCE meta-competencies. The essential domains included assessment and diagnosis, patient case management, disease prevention, communication and documentation, professional ethics, jurisprudence, spinal adjustment and manipulation, interprofessional collaboration, clinical reasoning, and practical skills. Conclusion This study provides valuable insight into the degree of alignment among chiropractic educational outcomes, NBCE exams, and the CCE meta-competency framework. The analyses offer a detailed evaluation of the extent to which NBCE exam content reflects the knowledge, skills, and professional behaviors outlined in the CCE competencies. Collectively, the findings contribute to a deeper understanding of how exam standards support the preparation of competent, entry-level chiropractic practitioners.
Accreditation of healthcare provider training programs ensures graduate competency and provides a means for programs to improve. Accreditation consistency assures the public that healthcare providers have similar basic training across world regions. Currently, it is unknown if chiropractic accrediting agencies have congruent standards globally. Therefore, the purpose of this study was to investigate similarities and differences in student competencies and program standards among four chiropractic accreditation agencies worldwide. A quantitative content analysis was performed on accreditation standards from regional international accreditation agencies responsible for accrediting the majority of the world’s chiropractic degree programs. Agencies included the Council on Chiropractic Education (United States), the European Council on Chiropractic Education (Europe, United Kingdom, South Africa), the Council on Chiropractic Education Australasia (Australia, New Zealand, Malaysia), and the Council on Chiropractic Education Canada (Canada). The contents of the accrediting standards were coded using a standardized coding list. A modified Delphi technique was used by 21 international experts from December 1, 2023, to April 18, 2024. After four rounds of consideration to achieve consensus, the contents were analyzed for frequency and congruence of coded items across the accrediting agencies’ standards. A two-way analysis of variance was conducted to identify if there were any differences among the accreditation agencies. Neither student competencies [F(3,8) = 0.007, p > .05] nor program standards [F(3,4) = 0.002, p > .05] differed significantly across the accrediting agencies. The statistical relationships between accreditation agencies and coding frequencies remained stable across all coded items, with no single code exhibiting differential performance depending on the accrediting body. The overall model showed R2 = 0.96 for student competencies and R2 = 0.87 for program standards; thus, the models’ predictions align with the observed data. The study findings demonstrate congruence for student competencies and program standards among chiropractic accreditation agencies across multiple geographic regions. The patterns of content were stable and consistent across the four accrediting agencies, with no evidence of differential effects among the agencies. In addition, this study provides essential details and standardized codes for agencies’ documents, which may facilitate dialogue and comprehension among agencies, educators, regulators, governing officials, and other stakeholders in chiropractic education. The study protocol was prospectively registered with Open Science Framework on November 30, 2023 https://doi.org/10.17605/OSF.IO/259WC .
Objective: The main objective of this study was to evaluate the validity of grade point average (GPA) for predicting the National Board of Chiropractic Examiners ( NBCE) Part I exam scores using chiropractic GPA. Methods: Data were collected during the January 2019 computer-based testing administration of theNBCE's Part I exam. The sample size was n = 2278 of test takers from 18 domestic and 4 international chiropractic educational institutions. Six regression models were developed and tested to predict the Part I domain scores from chiropractic GPA while controlling for self-reported demographic variables. Residuals from the models were disaggregated by pre-chiropractic GPA. Results: Chiropractic GPA revealed a positive, statistically significant correlation with sex. The chiropractic GPA was found to be a significant predictor of the Part I domain scores. A different perspective was obtained when residuals (observed minus predicted) were collected and split by the pre-chiropractic GPA. Very good students tended to be underpredicted, while other students were overpredicted. Conclusion: This study builds on the cascading evidence from educational literature by providing additional results suggesting that undergraduate (prechiropractic) GPA as well as the GPA obtained in doctor of chiropractic programs are related to the future performance on the NBCE Part I exam. The results provide a first glance at the connection between the standardized test scores, which are often used for instructors' and institutional evaluation and the GPA obtained in a doctor of chiropractic program.
The objective of this paper is to describe changes made to chiropractic national board examinations in the United States, including methodologies in test scoring, and to discuss future directions in test development and administration being considered by the National Board of Chiropractic Examiners (NBCE). Additionally, this paper serves as an introduction to the articles written by the NBCE staff and published in this issue of the journal. Statistical perspective on the properties of a test are presented, and reasons for the NBCE moving to item response theory for test scoring are described. NBCE consideration of on-demand testing and changes implemented in the Part IV practical examination are also discussed.
OBJECTIVE This article introduces changes made to the diagnostic imaging (DIM) domain of the Part IV of the National Board of Chiropractic Examiners examination and evaluates the effects of these changes in terms of item functioning and examinee performance. METHODS To evaluate item function, classical test theory and item response theory (IRT) methods were employed. Classical statistics were used for the assessment of item difficulty and the relation to the total test score. Item difficulties along with item discrimination were calculated using IRT. We also studied the decision accuracy of the redesigned DIM domain. RESULTS The diagnostic item analysis revealed similarity in item function across test forms and across administrations. The IRT models found a reasonable fit to the data. The averages of the IRT parameters were similar across test forms and across administrations. The classification of test takers into ability (theta) categories was consistent across groups (both norming and all examinees), across all test forms, and across administrations. CONCLUSION This research signifies a first step in the evaluation of the transition to digital DIM high-stakes assessments. We hope that this study will spur further research into evaluations of the ability to interpret radiographic images. In addition, we hope that the results prove to be useful for chiropractic faculty, chiropractic students, and the users of Part IV scores.
