Vern Temple, D.C., has been part of the testing community for nearly thirty years, first as a member of the Vermont Board of Chiropractic Examination and Registration, National Board of Chiropractic Examiners (NBCE) delegate for the state of Vermont and, subsequently, as an NBCE Director for the past seven years, six years as District III Director and this past year as Director-at-Large. In May 2006, he was elected President of the NBCE.
"The Third-party assessment by the NBCE assures colleges, licensing boards, practitioners, and the general public that a practitioner is competent and ready to practice."
Dr. Temple is a 1977 graduate of Palmer College of Chiropractic, a Diplomate of the American Board of Chiropractic Orthopedists and has served as past chair of the Federation of Chiropractic Licensing Boards and past president of the Vermont Board of Chiropractic Examination and Registration. His private practice is located in Bellows Falls, Vermont, where he lives with his wife, Shelley. In his spare time, he enjoys running and bicycling, as well as building Stickley reproduction furniture—not that there is much spare time for any Director on the National Board.
In an interview with The American Chiropractor magazine (TAC), Dr. Temple expresses the role the NBCE plays in the regulating process of chiropractic, and how they have enabled chiropractors across the nation to achieve greater freedom in choosing the state in which they would like to pratice, while simultaneously elevating the minimal standards of the profession as a whole.
TAC: Dr. Temple, give us some background on the National Board of Chiropractic Examiners.
Temple: The NBCE was incorporated in 1963 in response to the needs of state licensing boards to standardize assessment of chiropractors. State boards, collectively, urged the Federation of Chiropractic Licensing Boards to commission a study group that eventually resulted in the organization and incorporation of the NBCE. Prior to that, licensure in states varied from state to state.
The NBCE is designated by the Internal Revenue Service as a 501(c)(6) non-profit corporation. Our corporate composition begins at the state/district level. States, arranged geographically into five districts, name delegates and alternates to attend the NBCE annual meeting. At that meeting, district delegates nominate a person to serve as district director; this nomination is then voted on by the entire delegate body. Two seats are appointed by the Federation of Chiropractic Licensing Boards and four seats are elected as Directors-at-Large by the Board of Directors.
The NBCE Board of Directors annually elects an Executive Committee, including Chairman of the Board, President, Vice President, Secretary and Treasurer. These officers act as the principal liaison between the Board and the management team. The President is the primary spokesperson for the Board.
The NBCE’s primary responsibility is to produce examinations of the highest caliber to assess competency so that state boards can rely upon the results for licensure. We currently deliver seven different exams. Pre-licensure examinations test basic science (Part I), clinical science (Part II), clinical competency (Part III), and Part IV assesses clinical practice in the areas of diagnostic imaging, adjusting technique and case management.
Let me pause a moment to say that the wide acceptance or requirement by fifty states for Parts I, II, and III, and forty-eight states for Part IV make me the most proud of the work of the NBCE. With passing scores in each of these exams, a doctor has unprecedented mobility to practice in the United States. Each year, the use of chiropractic increases in the United States, so the third party validation of chiropractic training assures the general public of safe and reliable care.
Two optional, elective exams are available and can be taken with the Parts I, II, and III written exams. Physiotherapy assesses physiological therapeutics and related areas while the acupuncture exam assesses techniques, basic treatment tenets and protocols, safety, hygiene and other areas in the field of acupuncture.
Two of the post-licensure examinations that we have produced at the request of state licensing boards are the Special Purposes Examination for Chiropractic (SPEC) Ethics and Boundaries (E&B). Occasions arise when it is necessary for state licensing boards to re-assess the clinical competency of licensed practitioners or to assess their knowledge of ethics and boundaries issues. At the request of a state board, a licensed doctor may be required to demonstrate proficiency in conditions generally encountered in chiropractic practice (SPEC). The E&B exam is useful when ethical misconduct, sexual misconduct or harassment have been encountered in practice and a state board needs assurance that the doctor is ethically fit to practice.
We will soon introduce an optional, computerized assessment test called Chiropractic College Assessment Test (CCAT) designed for students thinking of a career in chiropractic. CCAT will evaluate a student’s abilities in problem solving, quantitative reasoning, biology, chemistry and physics. There is a high correlation between passing the CCAT and successfully completing chiropractic college.
TAC: Tell us more in depth about the development of NBCE exams.
Temple: The NBCE Part I and II exams to test basic science and clinical science knowledge are based on the results of a Delphi study. Chiropractic college faculty from all schools are surveyed to obtain a consensus about the subject matter and emphasis to be given in these exams.
Content for Parts III and IV exams are determined as a result of the job analysis survey of practitioners, which is conducted by the NBCE every five years. This survey of randomly selected chiropractors provides information on the specific tasks they perform, the amount of time they spend engaged in a task, the importance of the task, etc.
The NBCE doesn’t only rely on surveys. Test committees meet regularly at the NBCE to participate in this process. Each exam has a well-defined test plan that serves as a blueprint for the topics to be covered. By the time a student actually takes an exam, it has been reviewed an estimated twenty times by professionals ranging from chiropractic college faculty to subject specialists, state licensing board members, on-site consultants, grammarians and statisticians.
The process doesn’t stop there. Even after the exams, questions are statistically analyzed; questions that don’t show a positive correlation between selecting the correct answer and selecting other correct items on the entire test are carefully researched. From all this, you can understand the complexity of test development and our responsibility to ensure fair, reasonable and legally defensible examinations. The bottom line is that we strive to make each exam as consistent and as perfect as possible.
TAC: What are your goals for the chiropractic profession?
Temple: The NBCE’s most important goal is to consistently administer exams of the highest quality, exams that are fair, and that are legally defensible if a challenge arises. The third-party assessment by the NBCE assures colleges, licensing boards, practitioners, and the general public that a practitioner is competent and ready to practice. The NBCE is widely respected for consistently meeting this challenge, not only in the chiropractic profession, but also among testing experts in other professions, such as the Association of Test Publishers.
In my first year as President, the Board has concentrated on creating a culture of transparency and accountability. Growing in our understanding of best practices in governance will provide the foundation for the NBCE to be a leader in non-profit organizations.
From a personal perspective, my goal for chiropractic is to see the profession mature and unify, thus building a stronger chiropractic profession and ensuring our appropriate place in providing health care to the public.
TAC: What are some of the most common complaints the NBCE has fielded with regard to their testing process?
Temple: The cost of the exams is probably the most common complaint from students; chiropractic colleges and state licensing boards are also interested in keeping the exams affordable.
Concerns about the costs of exams do not fall on deaf ears. The Board continually balances needs against the requirements of state licensing boards for state of the art chiropractic exams. That being said, the cost of test development, administration, fixed and variable overhead, etc., all influence fee structure. In comparison with other professions, such as dentistry, osteopathy and medicine, NBCE exams costs are among the most affordable.
Associated with concerns of cost are questions as to why the examinations have not yet been computerized. Investigation into computerization has shown that there would be a significant if not doubling of the costs and the benefits received have been determined to not be worth such a sizeable increase.
Another question from students is about the eligibility requirements for Part IV that require students to pass Parts I and II before they can apply for Part IV. The Board of Directors has explored this question and believes that the current requirements serve the needs of the greatest number of students, colleges and state boards. Current requirements allow most students to progress efficiently through the exam process and into licensed practice. These requirements enhance the likelihood that students are academically prepared for final stages of NBCE exams and give them the best chance of passing Part IV on the first attempt.
TAC: Acknowledging that the chiropractic profession has a very diverse array of opinions of what is happening in the Vertebral Subluxation Complex, how time relevant is the test material to what is being used in clinics today?
Temple: Again, NBCE exams reflect the scope of practice of the licensing jurisdictions of fifty states for Part III and forty states for Part IV. These exams are developed through a job analysis survey of current practitioners from every state, so we can be certain that students are being tested on material that is relevant. As I mentioned earlier, the job analysis survey is conducted every five years. Surprisingly, we find from the job analysis that the biggest factor that determines how a chiropractor will practice is not based on which school he graduated from or from his political association, but is most influenced by the scope of practice in the jurisdiction in which he practices, making the diverse array that you ask about actually much narrower.
Correcting the vertebral subluxation is tested in the technique section of Part IV. Again, this portion of the exam is constructed by technique instructors from all of the chiropractic colleges. The challenge for the NBCE is not the diverse array of opinions but the diverse array of nomenclature making it difficult to present test questions uniformly.
The NBCE is providing to state licensing boards and to the general public the assurance that the entirety of a licensed practitioner’s knowledge of clinical practice is sufficient, not just in the vertebral subluxation complex, but in every area of clinical practice.
TAC: Are there any plans to provide funding so that students in financial need may pay for NBCE exams rather than allowing the financial strain of exam taking to filter out those who cannot afford to pay?
Temple: Any plans that created a lending or grant relationship between the NBCE and examinees would be fraught with potential complications and ultimately result in increased costs to all other examinees.
Students often ask if costs of the National Boards could become part of their tuition. This would have to be an arrangement between the student and their college and could not involve the NBCE; however it is our understanding that the Federal student loan program does allow schools to request inclusion of exam fees.
The NBCE petitioned the Department of Veterans Affairs to cover NBCE exam fees. This lengthy process was an NBCE initiative that provides help to veterans.
TAC: What is the biggest problem or challenge you see in the chiropractic profession today?
Temple: Personally, I believe that chiropractic is a profession that has not unanimously defined itself or its role in health care. A profession is not and cannot be defined by just one or several people. We should not allow ourselves to be defined by individuals or characters that do not represent the entire profession. This needs to be agreed upon by the entire profession. When we all our very clear as to who we are, then we will gain the respect we deserve. At times when health care is changing so rapidly, we confuse everybody by having varying opinions about the scope and practice of chiropractic. Professional unity and respect within chiropractic is essential if we are to improve our image and acceptance in the public eye.
Another challenge is the funding of research to expand and document the benefits of chiropractic care. Research and funding at the academic, private and public organizations must be moved higher on the profession’s list of priorities.
TAC: Where do you see the future of chiropractic headed?
Temple: Double digit inflation of health care costs, an aging society, and a public that is truly demanding more ownership of their health care, using less invasive treatment and decreased use of pharmaceuticals, makes me optimistic and excited about the future and the kind of care we can deliver.
Globally, chiropractic is exploding. Through the NBCE’s establishment of the International Board of Chiropractic Examiners, we have pilot tested exams in Japan, Brazil and Cyprus. The future of the profession will be greatly enhanced by the standardized assessment of practitioners and the NBCE/IBCE is proud to serve in this endeavor.
TAC: Any final words for our readers?
Temple: Thank you for the opportunity to talk about the NBCE. I am extremely proud of our organization and grateful to the state licensing boards, associations, colleges and students who partner with us in challenging and building the future of this profession.
Visit www.nbce.org or call 1-800-887-4320.