Part IV
Part IV Status Update
In 2021, an adjustment was made to the Part IV Exam, moving the Diagnostic Imaging (DIM) section to the Part III Exam Test Plan. This is part of the Part IV Advancement and Development Project.
Each student has their own unique course study progression and test history. In order to best serve all examinees, both versions of the Part IV Exam (with/without DIM) are available. When you apply for the Part IV Exam, you will automatically be assigned the version of Part IV you are eligible for. If you have questions or concerns, you may contact support@nbce.org.
The NBCE Part IV Exam Status Update:
Two versions of the exam:
- Without Diagnostic Imaging – Updated Version
- With Diagnostic Imaging (DIM) – Original Version
- You will automatically be assigned the version of Part IV you are eligible for when you apply
Part IV – UPDATED Version (without DIM)
The updated version of the Part IV Exam consists of two sections – Chiropractic Technique and Case Management. Here is a detailed outline of what you can expect for each section of the exam.
The NBCE Part IV UPDATED Exam (without DIM) consists of two sections and each of the sections is divided into stations.
The Two Sections Are:
- Chiropractic Technique
- Case Management
Chiropractic Technique
The Chiropractic Technique Exam will consist of five stations with five minutes allotted to complete each station. You 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.
– At each station, you will be provided with a written description of two vertebral or extremity listings. The instructions will include the two chiropractic techniques to be demonstrated, points of performance that will be evaluated, the required patient position, doctor hand contact and segmental contact.
– You 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 listings described in the written instructions.
Note: Following each adjustment, you will be required to interact with the examiner to verbalize your line of drive.
– You will be evaluated by an examiner (licensed chiropractor) on the points of performance described in the written instructions.
Case Management
The Case Management Exam consists of 20 stations (10 Simulated Patient Encounters and 10 (PEP) Post-Encounter Probes), in which you will be required to carry out certain activities or answer questions related to a clinical case. You will have five minutes to complete each station. There will be a one-minute and 30-second passing time between each station. You must complete each of the 20 stations in the allotted time. At each station, you will be required to perform one or more of the following activities:
- Perform a brief (focused) case history
- Perform a brief (focused) physical examination
- Perform a brief (focused) orthopedic/neurological examination
- Choose the most likely diagnoses and/or clinical impressions
- Choose the most appropriate case management procedures
- Choose the most appropriate orthopedic/neurological tests to perform
– At stations where you are asked to perform a case history, physical examination, or orthopedic or neurological test, you will be observed by an examiner (licensed chiropractor). You will perform these tests/procedures on a patient who has been trained to simulate a clinical condition. You will be evaluated on your clinical skills, as well as your ability to communicate with the patient. You will be expected to treat the patient as you would treat a patient in your own practice. You will respect the patients’ dignity at all times.
– The case history stations are case specific. You will be evaluated on your 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 you to form a clinical impression and to rule in or rule out conditions of a similar nature or with similar presentation.
– The examination stations involve demonstration of clinical tests and procedures on patients who exhibit physical signs and symptoms of specific conditions. You will be evaluated on your ability to perform these procedures within the context of a specific case, and your ability to elicit all necessary clinical signs and symptoms from the simulated patient for each of the procedures demonstrated.
– Certain stations may require you 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. You will perform the procedure on the simulated patient and then follow the instructions for the verbal component.
– At the Post-Encounter Probe (PEP) stations that immediately follow the simulated patient stations, you will be required to answer two questions related to the clinical condition exhibited by the patient. At these stations, additional clinical information related to the case will be provided.
Time is very important in the Case Management Exam. Five minutes will be allotted to complete the required tasks at each station. One minute and 30 seconds will be allotted to pass from one station to the next. You will move from station to station upon hearing an audible/verbal signal. When the signal is given, you will immediately move to the next station.
Note: Success in this exam will depend on your efficient and skillful performance of the required tasks, as well as on the effective use of the allotted time.
Part IV – Original Version (with DIM)
The original version of the Part IV Exam includes Chiropractic Technique, Case Management and Diagnostic Imaging (DIM). When you apply for the Part IV Exam, you will automatically be assigned the version of Part IV you are eligible for.
The NBCE Part IV Original Exam consists of three major sections and each of the sections is divided into stations.
The Three Sections Are:
- Diagnostic Imaging (DIM)
- Chiropractic Technique
- Case Management
DIM consists of 20 stations which are allotted two minutes per station. During the DIM portion, you will be viewing diagnostic images on a monitor and answering two questions related to the images.
Chiropractic Technique consists of five stations with five minutes allotted to complete each station. During the Chiropractic Technique portion, you will be required to read instructions and set up for spinal and extremity adjustments.
Case Management consists of 20 stations with five minutes allotted to complete each station. You will be asked to perform a case history, physical examination, orthopedic, or neurological test. Following each patient encounter, you will be asked to answer two extended multiple choice questions.
The Chiropractic Technique section and the Case Management sections are given together and require approximately two hours and 45 minutes of testing time, but may require an additional five hours of sequestration in a building.
Who Can Take Part IV?
- You are eligible to apply for Part IV if you have passed all subjects of Part I.
- You must also be within six months of graduation or a graduate of an eligible chiropractic college.
- See additional eligibility requirements if you have graduated, or are retaking Part IV.
What Topics Are Included In Part IV?
The NBCE develops every exam based on a test plan. The detailed Part IV Test Plan includes detailed descriptions of each section of the Part IV Exam.
Test Sites and Test Site Rules
NBCE Part IV administrations are offered at chiropractic colleges across the country twice a year.
Each test site is limited in the number of examinees it can accept, so submit your paid application early. When you submit your application, choose your top four test site locations in order of preference. You may update your site preferences until the application deadline. Site assignments are prioritized based on your completed application submission and the date payment is made for the exam. All assignments are final. If all your site choices have reached capacity, the NBCE will attempt to assign you to the closest available site. The assigned location may be cancelled until the withdrawal deadline. See the complete list of Test Sites, and Test Site Rules.
Exam Administration Dates
The next Part IV exam is scheduled each May and November. Approximately eight weeks before the exam, the NBCE will post a confirmation that includes your testing schedule. Look for this on your MyNBCE account under My Exams, Exams then scroll down to the Part IV application.
| Administration Dates | Application Deadline | |
| May 20-21, 2023 | February 23, 2023 | |
| November 11-12, 2023 | August 17, 2023 | |
What Is A Passing Score For Part IV?
The NBCE recommends a passing score of 375 or above on the Part IV Exam. Each state has the authority to establish and recognize its own standard for passing Part IV. If a passing score is not achieved, confirm your rescheduled exam and you may request a written performance analysis.
Fees
| Part IV | $1,585 |
Withdrawal / Cancellation Policy
Exam Withdrawal
The NBCE will accept your written request to withdraw and issue a full refund if your request is received by the exam withdrawal deadline. Please contact the NBCE at support@nbce.org for more information.
The NBCE will not accept withdrawal requests after the published deadline. You must submit a completely new application with correct fees when you apply at a later date.
I understand that I will not be refunded any of my exam fees if I change or cancel my testing appointment within 29 days of the first day of my scheduled testing weekend, or fail to appear for my exam.
Irregularity/Emergency Cancellation Policy
In the event of an emergency or administrative irregularity, the NBCE reserves the right to make adjustments in exam administration procedures, to withhold the reporting of scores, and/or to order the re-administration of an examination.
An emergency or administrative irregularity might include, but is not limited to, any natural disaster (hurricane, flood, tornado, earthquake, fire, etc.), power failure, technology malfunction, or other facility breakdown, which, in the opinion of the NBCE, could affect the validity of examination scores.
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