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TEST PLAN Part Four

Visit NBCE.org for the official overview brochure with current test dates and locations.

PART IV EXAMINATION DESCRIPTION

The Part IV Examination consists of three major sections:
-Diagnostic Imaging (DIM)
-Chiropractic Technique
-Case Management

Each of these sections is divided into stations. Candidates will move from station to station upon hearing an audible signal.

DIAGNOSTIC IMAGING (DIM)

1. The DIM Practical examination will consist of 10 stations. Each candidate must complete all 10 stations within the allotted time (four minutes per station).

2. At each station, the candidate will have the opportunity to view radiograph(s) and/or other diagnostic images of a patient. In addition, the candidate will have access to other clinical data.

3. A scannable answer sheet will be provided on which the candidate will mark the answers for the questions provided at the 10 stations. Each station will have two extended multiple-choice questions for the candidate to answer concerning the case. Each question will have 10 choices. The candidate will be required to select two of the most correct choices.

4. The candidate will be required to select findings that are presented on the radiograph(s), and that are consistent with the additional clinical data provided for each question at the station.

5. The candidate may be required to identify various types of special imaging, i.e., MR, CT, radionuclide bone scan or diagnostic ultrasonography.

CHIROPRACTIC TECHNIQUE

1. The Chiropractic Technique examination will consist of five stations with five minutes allotted to complete each station. Each candidate must complete each of the five stations within the allotted time. There will be a one-minute and 30-second passing time between each station.

2. At each station, the candidate will be provided with a written description of two vertebral or extremity subluxations. The instructions will include the two chiropractic techniques to be demonstrated and points of performance that will be evaluated. The instructions will include the required patient position, doctor hand contact and segmental contact.

3. The candidate will place the patient as instructed and set up for the adjustments in a manner that is consistent with the written instructions and appropriate for the vertebral or extremity subluxations described in the written case scenarios.

NOTE: For students that are taught an assisted/resisted model of technique, all of the set-ups on this portion of the Part IV Examination should be for assisted methods of adjustments.

4. The candidate will be evaluated by an examiner (licensed chiropractor) on the points of performance described in the written instructions.

CASE MANAGEMENT

1. The Case Management examination consists of a series of stations in which the candidate will be required to carry out certain activities or answer questions related to a clinical case.

2. The test will consist of 20 stations with five minutes allotted to complete each station. There will be a one-minute and 30-second passing time between each station. Each candidate must complete each of the 20 stations in the allotted time.

3. At each station, the candidate will be required to perform one or more of the following activities:

A) Perform a brief (focused) case history
B) Perform a brief (focused) physical examination
C) Perform a brief (focused) orthopedic/neurological examination
D) Choose the most likely diagnosis
E) Choose the most appropriate case management procedures
F) Choose the neurological signs most likely to be present
G) Choose the most appropriate orthopedic/neurological tests to perform

4. In those stations where candidates are asked to perform a case history, physical examination, or orthopedic or neurological test procedures, they will be observed by an examiner (licensed chiropractor). Candidates will perform these tests/procedures on a patient who has been trained to simulate a clinical condition.

5. Candidates will be evaluated on their clinical skills as well as their ability to communicate with the patient. They will be expected to treat the patients as they would patients in their own practice. Candidates will respect the patient´s dignity at all times.

6. The case history stations are case specific. Candidates will be evaluated on their ability to fully explore the parameters of the patient´s condition and to elicit specific clinically relevant elements of the history from the patient. This specific historical information enables the candidate to form a clinical impression and to rule in or rule out conditions of a similar nature or with similar presentation.

7. The examination stations involve demonstration of clinical tests and procedures on patients who exhibit physical signs and symptoms of specific conditions. Candidates will be evaluated on their ability to perform these procedures within the context of a specific case, and their ability to elicit all necessary clinical signs and symptoms from the simulated patient for each of the procedures demonstrated.

8. Certain stations may require candidates to interact with the examiner to explain the clinical significance of a procedure or to report the examination findings of a procedure. This will be specifically explained in the station instructions, and the notation (verbal component) will follow the named test or procedure. The candidate will perform the procedure on the simulated patient and then follow the instructions for the verbal component.

9. At the post-encounter probe (PEP) stations that immediately follow the simulated patient stations, the candidate will be required to answer two questions related to the clinical condition exhibited by the patient. At these stations, several pages of additional clinical information related to the case will also be provided, as well as patient imaging.

10. Time is very important in the Case Management examination. Five minutes will be allotted to complete the required tasks at each station. One minute and thirty seconds will be allotted to pass from one station to the next. Candidates will move from station to station upon hearing an audible/verbal signal. When the signal is given, they will immediately move to the next station.

NOTE: Success in this examination will depend on the candidate´s efficient and skillful performance of the required tasks, as well as on the effective use of the allotted time.

NBCE PART IV TEST PLAN

The Part IV Examination consists of three major sections:
-Diagnostic Imaging (DIM)
-Chiropractic Technique
-Case Management

DIAGNOSTIC IMAGING (DIM)
(10 Case Scenarios)

The candidate will be asked to identify radiographic features from the radiograph(s)
and/or other diagnostic images presented. A test committee will have selected the
cases according to the following criteria:

1. cases that are commonly encountered in practice
2. cases that present cautions or contraindications to chiropractic case management
3. cases that require early detection to preserve life/health of the patient

EXAMPLES INCLUDE:
NORMAL RADIOGRAPHIC ANATOMY
CONGENITAL ANOMALIES, SKELETAL VARIANTS & DYSPLASIAS
SCOLIOSIS & SPONDYLOLISTHESIS
INTERVERTEBRAL DISC DISEASE & SPINAL STENOSIS
TRAUMATIC SKELETAL DISORDERS (SPINE & EXTREMITIES)
ARTHRITIC DISORDERS (SPINE & EXTREMITIES)
TUMORS & TUMOR-LIKE PROCESSES (SPINE & EXTREMITIES)
HEMATOLOGICAL & VASCULAR CONDITIONS
BONE INFECTIONS & MISCELLANEOUS CONDITIONS

CHIROPRACTIC TECHNIQUE
(10 Techniques)

The candidate will be given two case scenarios in each of the five adjusting areas listed below for a total of 10 techniques. From the information provided in the case scenario, the candidate will demonstrate patient placement, doctor placement, hand placement, procedure, and the line of drive.

CERVICAL ADJUSTING
THORACIC ADJUSTING
LUMBAR ADJUSTING
PELVIC/SACRAL ADJUSTING
EXTREMITY ADJUSTING

CASE MANAGEMENT
(10 Simulated Patient Encounters and 10 Post-Encounter Probes)
There will be 10 patient stations which may be divided as follows:

6 - Orthopedic and neurologic examinations
3 - Case history taking
1 - Physical examination

The candidate will address cases that:

1. are commonly encountered in practice
2. present cautions or contraindications to chiropractic case management
3. require early referral to preserve the life/health of the patient
4. present significant diagnostic challenges

Each interaction between the case management candidate and the standardized patient is followed by a post-encounter probe (PEP) station. At the post-encounter probe station, the candidate is presented with a binder that contains additional clinical information, e.g., additional physical findings and laboratory results. There may also be radiographs and/or other diagnostic images pertaining to the case in the station.

Based on the candidate´s interaction with the standardized patient in the previous station and the additional clinical information, the candidate at the PEP station will complete two multiple-choice questions. Each multiple-choice question will have 10 choices. The candidate will be required to select three of the most correct answers for each question.

ADDITIONAL INFORMATION

STANDARDIZED PATIENTS
Ten of the Case Management stations will have standardized patients. These standardized patients have been carefully trained to simulate a given condition. The candidate will address or interact with the standardized patient as though that patient actually has the condition that he or she is simulating.

TECHNIQUE PATIENTS
These individuals will be at five of the stations. They are not trained to simulate a condition. The candidate will demonstrate the placement of the patient, the placement of the doctor, including the doctor´s hands, procedure, and the line of drive. No thrust will be applied.

DIM MATERIALS
There is a separate 10-station DIM portion of the Part IV Examination. Radiographs and/or other diagnostic images may also be at post-encounter stations, which the candidate will enter after interacting with a trained patient. The candidate will review radiographs at these stations. After reviewing the radiographs, the candidate will be asked to respond to questions pertaining to the radiographs and additional clinical materials that will be found in a binder placed in the post-encounter station.

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