Reviewed by Damon Wiseley, RRT-CPFT, B.H.S.c.
Short answer: Choosing between the CSE or RTE 2027 comes down to one thing — if you pass the TMC at the high cut score before December 31, 2026, you get a choice — take the Clinical Simulation Examination (CSE) through December 31, 2027 to finish the old way, or take the new Respiratory Therapy Examination (RTE) on or after January 1, 2027. If you don’t meet that condition, the decision is made for you: it’s the RTE. This post walks through how to choose if you do have the choice.
New to the changes? Start with our complete guide to the 2027 RTE exam for the full picture, then come back here to decide.
First, confirm you actually have a choice
You only get to keep the CSE option if both of these are true:
- You pass the TMC at the high cut score (the RRT-eligible threshold), and
- You do it before December 31, 2026.
Meet both, and the CSE stays open to you through December 31, 2027. Miss either, and you’re on the RTE path — which is not a bad place to be, just a different one.
The case for finishing with the CSE
- You’ve already prepared for it. If you’re deep into CSE-style branching-simulation practice and feel ready, switching formats means re-tooling your prep for scenario-based MCQs you haven’t drilled.
- It’s a known quantity. The CSE has decades of prep material, pass-rate history, and predictable structure. The RTE is brand new — no first-year pass-rate data exists yet.
- You’re close to the finish line now. If you can realistically pass the TMC at the high cut score in 2026, finishing under a system you understand removes uncertainty.
The case for switching to the RTE
- One exam instead of two. No separate CSE sitting to schedule, prep for, and pay for. Many candidates find the CSE the more stressful and harder-to-schedule of the two exams.
- Lower total cost. The single-exam RRT pathway runs less than paying separately for the TMC and CSE.
- Same-day results. You walk out knowing your preliminary outcome instead of waiting on CSE scoring.
- It’s the format the field is moving to. If you’re not already far along in CSE prep, learning the new scenario-MCQ reasoning is time better spent — it’s where everything is headed.
A simple way to decide
Ask yourself three questions:
- Can I realistically pass the TMC at the high cut score in 2026? If no, you’re taking the RTE — skip to how to study for it.
- Am I already well into CSE-style prep and feeling confident? If yes, finishing with the CSE may be the lower-risk move.
- Would I rather take one exam, pay less, and get same-day results? If yes — and you’re not already CSE-ready — the RTE is likely your better path.
There’s no universally “right” answer. The candidates who struggle are the ones who don’t decide and end up half-prepared for both. Pick a lane early and commit your prep to it.
Whichever you choose, train clinical judgment
Here’s the thing: the CSE and the RTE’s clinical-judgment section test the same underlying skill — reading a patient, gathering the right data, and choosing the safest next action. Prep that builds real clinical reasoning serves you on either exam.
Respiratory Cram covers both pathways during the transition — CSE-style simulations and RTE scenario-based MCQs with full rationales. See which prep fits your path → respiratorycram.com
Is 2027 really the last year for the CSE?
Yes. The CSE is available only through December 31, 2027, and only for candidates who passed the TMC at the high cut score before December 31, 2026. After that it’s retired entirely.
If I take the RTE, can I still earn the RRT?
Yes. Pass the RTE at the high cut score and you earn the RRT — no separate simulation exam required.
I haven’t passed the TMC yet. Which do I take?
If you won’t pass the TMC at the high cut score before the end of 2026, you take the RTE starting January 2027.
Source: National Board for Respiratory Care, “Examination Changes Coming in 2027 — New Details Added,” nbrc.org.
