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Part IV Exam Description

The Part IV Exam is a culmination of your years of training, rather than a measure of textbook learning. Therefore, a thorough review of the subjects and techniques described on this website is the most appropriate preparation for this exam.
Part IV 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


  1. The DIM Exam will consist of 20 stations. You must complete all 20 stations within the allotted time (two minutes per station).
  2. A question booklet will be provided, along with a scannable answer sheet on which you will mark your answers. Each station will have two multiple-choice questions concerning the condition. Each question will have four choices and you will be required to select the single most correct choice.
  1. 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.
  2. 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 and points of performance that will be evaluated. The instructions will include the required patient position, doctor hand contact and segmental contact.
  3. 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 case scenarios.
    Note: For students who are taught an assisted/resisted model of technique, all of the set-ups on this portion of the Part IV Exam should be for assisted methods of adjustments.
  4. You may also be required to demonstrate static and/or motion palpation techniques, and to describe joint-related anatomical landmarks and/or normal joint motion.
  5. You will be evaluated by an examiner (licensed chiropractor) on the points of performance described in the written instructions.
  1. The Case Management Exam consists of 20 stations 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.
  2. 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 neurological signs most likely to be present
    • Choose the most appropriate orthopedic/neurological tests to perform
  1. In those 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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, several pages of additional clinical information related to the case will be provided, as well as patient imaging.
  7. 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.