In looking back, 25 years seems like yesterday, and yet so much has changed. I salute the 25th anniversary of Dynamic Chiropractic, a journal with undoubted influence and credibility in framing and reporting the critical issues over the past 25 years.
Graduates 25 years ago certainly had the opportunity to sit for Part 1 (Basic Science) and Part 2 (Clinical Science) exams while in a chiropractic program. It was in the early 1960s that the Federation of Chiropractic Licensing Boards recognized the need for an independent credentialing exam that would be unique to the chiropractic profession and supported the development of an independent examining board.
In 1963, the NBCE was born with the mission to create written exams to ensure that prelicensure doctors of chiropractic would have the opportunity to demonstrate their knowledge of the basic and clinical sciences. Students could take Parts 1 and 2 while in school. However, to complete the licensure process, they often had to travel to individual states for further examination prior to licensure. Exams were often given by state licensing board members with the very best intentions, but their exams lacked the basic and necessary ingredients of testing. The tests were not developed according to psychometrically sound principles or fairly administered, and thus were not legally defensible. Moreover, it was not uncommon for the graduating doctor of chiropractic to have to wait six to nine months prior to completing licensure testing and entering practice. The NBCE's development of Parts 1 and 2 and physiotherapy exams freed state licensing boards to concentrate on important issues of regulation and discipline.
These exams gave the states and the general public confirmation that chiropractic colleges were providing adequate training in basic and clinical sciences, even though states had slightly different scopes of practice. It became the NBCE's charge to identify and test on a common domain of minimal competencies.
The profession's necessary transition to national testing for licensure ensured psychometrically sound and unbiased testing with the additional benefit of greater interjuridictional mobility for the practicing chiropractic physician. The NBCE exam process was designed to meet the requirements of all of the individual state licensing boards and guarantee the smoothest transition into licensing and practice.
It was in the 1980s (25 years ago) that the NBCE began to truly understand the profession's need for long-term support through standardized testing. It began to understand the board's unique role in collaborating with other organizations to be a cohesive force for the profession. The NBCE began to understand that it needed to become a leader in guiding the future of assessment and testing of the chiropractic profession. The NBCE Board of Directors developed budgets for research and development in the testing area.
Just after the NBCE's own 25th anniversary in 1983, the Part 3 (Clinical Competency) exam was introduced to test competency in case history, examination techniques, diagnosis and case management. In 1996, the NBCE introduced its own national practical exam with the administration of Part 4. With this exam, a full complement of prelicensure exams for the chiropractic profession was complete.
The NBCE has been successful in developing an exceptionally rigorous battery of examinations to meet or exceed the highest standards of the chiropractic profession and the testing industry. The NBCE exams have proven to be valid, reliable and defensible. They also standardize the exam process for licensure.
The past 25 years have found the National Board to be ever vigilant in updating test development and testing methods. The NBCE has responded to the needs of the state licensing boards, not only with Parts 1, 2, 3 and 4, but also with the Special Purposes Exam in Chiropractic (SPEC), utilized both for reciprocity and disciplinary reassessment. The NBCE has more recently introduced an Ethics and Boundaries (E&B) exam, as well as an elective exam in acupuncture. These elective exams are available for those states that need certification to use acupuncture in practice.
The NBCE is continually working to ensure that all exams assess minimal competencies to ensure safe practice. With the onset of NBCE standardized exams, every prelicensure candidate has an equal opportunity to pass, regardless of the CCE-accredited school they attended. Standardized exams also give doctors unprecedented mobility to move from state to state by passing only one battery of exams.
The most important aspect of national testing has been the benefit for entry into practice following graduation, along with the benefit of access to multiple states with one exam. Another benefit has been the respect that standardized testing has garnered from state legislators, other health care professions and the general public. National testing ensures the most appropriate way to guarantee competencies in the chiropractic profession. Doing so allows the public to feel secure when choosing chiropractic care for themselves or their family members. Any health care profession is dependent upon the confidence the public has in them.
Not only have we seen changes in competency assessment, but we've also seen the changes in chiropractic institutions and students over the past 25 years. We have watched the profession and the student body mature. In our dialogues with other organizations, we have realized that our future will be dependent on this profession's ability to speak with one voice and one vision. We commonly agree that the changes in the health care marketplace over the next 25 years will continue to change our responsibilities. As a united profession, we must ensure access to the people in need. As a divided profession, we will find ourselves to be outsiders, unable to agree with each other or with those who are developing a new health care delivery system.
Chiropractic is sitting at a crossroads. How will chiropractic be practiced in the future? I am encouraged when I see what is happening in the chiropractic profession. I am encouraged by the summit meetings between the ACA, the ICA and other groups, who are recognizing and discussing that the only way this profession will survive and grow is to see with one vision and to speak with one voice. We have watched as the student leaders and organizations such as the Students of the ICA, American Black Chiropractic Association, Students of the ACA, and World Congress of Chiropractic Students talk about unifying this profession. They discuss common issues and the future of chiropractic. It has become apparent that we must stop allowing individuals or small groups to attempt to define chiropractic. This profession is already defined by scope of practice, scope of education, and responsibilities outlined by licensing boards and defined by the profession. If we can stop being our own worst enemy and work together to form a long-range plan for this profession and its appropriate place in the health care system, then the future will be promising and the need for chiropractic care will grow along with our aging population.
As for the NBCE's next 25 years, our future looks promising. Current exam administrations and projections support our belief that enrollment in chiropractic colleges has stabilized and is slowly increasing. We know that testing techniques will continue to advance and delivery methods will change, and our task will be to continue ensuring the very best assessment methods for the chiropractic profession.
From a personal perspective, I certainly have great hope and confidence in this profession. I have seen the profession grow and accept responsibility. If we are to take our place in the global health care market, we will have to coordinate our education, practice patterns and message. Of vital importance, health care reimbursement policies must change to reflect the public's demand for alternative forms of health care. If we come to understand that change can be good and that we can no longer live in the limited past, we will see our profession grow and a larger percentage of the population utilizing chiropractic for its health care needs.