The National Board of Chiropractic Examiners (NBCE), at the behest of the Federation of Chiropractic Licensing Boards (FCLB), is in the process of developing the fourth and latest component of its examination sequence. Part IV will be an objective structure clinical examination (OSCE) format test, the intention of which is to replace the need for individual state licensing examinations and to provide for easier and less complicated licensure throughout the nation. Who could argue against that? The issue I would like to address is not what is being done, but how it is being done.
In the mid-1980s the NBCE developed a new phase of the testing sequence that was known as the Written Clinical Competency Examination (WCCE). The goal of this effort, as it was related to the Association of Chiropractic Colleges, was to eliminate the need for individual state board examinations. The concept was simple: graduates would take their degrees, applications, and Parts I, II, and III to a given state, and they would be licensed. Very neat, very clean, and quite efficient. The only problem is that it sold like a Beta format VCR! Very few states latched onto the idea. One of the early and the few to do so was Illinois.
In the mid-1990s, Part III of the NBCE sequence has become a requirement for licensure in many states, but it has failed to accomplish the goal of eliminating the need for individual state boards. The result has been the development of Part IV of the NBCE sequence: the answer to replacing the need for individual state board examinations. New York state is to be applauded for accepting the examination in this format. But the problem remains with individual state boards, and in some instances this problems may be getting worse.
At the moment there are regulatory changes pending in California that would require license candidates applying after July 1, 1996 to have completed Part I, II, III, and IV and to then take a state licensure examination offered by the Board of Examiners to include "jurisprudence and other subjects as may be determined by the Board." The more things change, the more they remain the same.
Let's return to the issue of "how it is being done" rather than "what is being done."
Development of Part IV The National Board has proceeded with the development of the Part IV examination, per the reasons outlined above. The test has been administered one time in five locations and has received mixed reviews as to its structure and content.
Implementation of Part IV
The FCLB has urged states to adopt Part IV of the examination process. This was done while the examination was being developed, and in many instances before the examination had ever been administered. Information relative to the examination has been scant and considerable confusion has existed over the examination.
Institutions and individual students have found it difficult to obtain answers about the examination, its utility and its structure.
It is my opinion that in their enthusiasm for standardization processes, the Federation has urged or forced the National Board to move prematurely relative to the administration of this examination. Further, this premature implementation of the examination and its adoption on a state level has placed students, recent graduates, and colleges at a disadvantage, if not at risk.
All Things Exist in Mutual Relationship to One Another!
The impact of new requirements or procedures such as the National Board Part IV causes a ripple effect, that, rather than dissipating at the periphery, builds the farther out it goes. We have long since passed the days when requirements such as this could be reasonably or fairly changed with short, little, or no notice. We must understand the proposed impact that changes such as this create on all levels. For example, what does the presence of Part IV do to student loan default rates? What does a requirement such as contemplated by California do when state board eligibility is coordinated with passing Parts I, II, and III, and IV to be followed by an examination offered by the state?
The state boards throughout the country got along for a long time without Part IV of the NBCE sequence. What's the hurry? Why do states need to move to this examination before the examination is perfected? Why do states need to move toward this examination in a time-frame that is damaging to students and provides little or no advance notice of the details associated with the examination? Why do states need to implement Part IV in a fashion that delays the ability of recent graduates to obtain licensure?
The student is absolutely powerless in these matters. States are going to do what they want to do. The National Board is going to develop any examination for which there is a real or perceived need. The Federation is going to advance its efforts to control and regulate the licensure process and the licensee. Why must it all be done in a fashion that harms the most vulnerable in the process?
Gerard Clum, DC
President, Assoc. of Chiro. Colleges
President, Life Chiropractic College West
Licensing and Regulatory Viewpoints on Part IV
Robert Vaughn, DC, president of the Federation of Chiropractic Licensing Boards: Thirteen states are registering their commitment to accept or require the Part IV exam... They do this enthusiastically, and advisably ... to offer the best possible examination to protect the public and to be fair to the candidate.
Chiropractic regulatory boards have been deeply involved in the Part IV practical exam of the National Board of Chiropractic Examiners (NBCE) since its inception.
A Federation resolution in 1989 laid the foundation for the NBCE to develop a model for a practical exam, based on its final step, a comprehensive job analysis. The more than 5,000 respondents to this survey revealed common factors underlying their chiropractic practices, similarities which transcend both geographical and philosophical borders.
From its first pilot administration in 1993 in Minnesota, to the January 1996 administration at four sites, the boards have been active in both the selection of exam questions and the administration of the tests. State laws are well served by the Objective Structured Clinical Examination (OSCE) format of Part IV. This model is no stranger to the students, as it is used by the majority of the chiropractic colleges and the medical and optometric professions. It has broad acceptance as the most appropriate means to evaluate an individual's practical skills.
Thirteen states are registering their commitment to accept or require the Part IV exam in their licensing procedures: Arizona, Iowa, Kansas, Kentucky, Massachusetts, Missouri, Montana, New York, North Dakota, Texas, Utah, Virginia, and Wyoming. They do this enthusiastically, and advisably, knowing that they still maintain involvement in the process, but now have the resources to offer the best possible examination to protect the public and to be fair to the candidate.
As the state boards and the Federation look ahead to the next year, we anticipate the number of test sites will increase in response to the positive experience of the chiropractic community. On first glance, the logistics of this plan are staggering: a minimum site team involves about 100 people, not including the staff resources the NBCE invests in the development and preparation of the test. But the cooperation of our colleges and regulatory boards and the commitment to excellence by the NBCE has overcome these technical obstacles very effectively.
It is the responsibility of the regulatory boards to protect the public, not to promote chiropractic. We are called to present the highest possible minimum standards, not the lowest. The incredibly positive feedback from the examinees and the site staff on the required formal assessment surveys testifies in a clear voice that a demonstrated need is being filled, and well, by the Part IV exam. The Federation is supportive of having such a vehicle available for licensure evaluation purposes.
The benefits to the candidate are many: one application process and fee, reduced travel costs for multiple board examinations, minimized stress in sitting for one test rather than several. The exams are statistically equated to guarantee that candidates form one administration to another have an equal opportunity to pass. The May-November schedule provides for candidates the ability to fulfill their entire National Board examination requirements prior to graduation if they wish.
This is a healthy and interactive process. It goes far toward our Federation's goal of providing more unified standards in licensing and regulation. It comes closer to unifying our profession than any other tool has done in recent years: by basing assessment on our common approaches to healing, yet recognizing a state board's rights to accept or require the examination, or not to.
Entrusting this aspect of our sacred responsibility to protect the public to professional testing expertise frees our boards to pursue the goals outlined by the U.S. Inspector General's office in 1989: to focus on credentials verification, regulation, and discipline matters of our doctors, thus insuring the safety of the patient public, and to delegate the testing program to a third-party standardized test agency such as the National Board of Chiropractic Examiners.
For more information about the specifics of the Part IV Exam, please contact the NBCE at (970) 356-9100. For information about regulatory processes as they relate to the practical exam, please contact the FCLB at (970) 356-3500, 9 a.m. to 3 p.m., mountain time.
Robert Vaughn, DC
President, FCLB
Dr. Gerry Clum served as president of Life Chiropractic College West for 30 years. He also is a former founding board member and president of the Association of Chiropractic Colleges and World Federation of Chiropractic. Currently, he is a member of the executive committee of the Foundation for Chiropractic Progress.