The National Board for Respiratory Care has released new details about the biggest respiratory therapy credentialing change in decades. Starting in January 2027, the current two-exam pathway (TMC + CSE) will be replaced with a single comprehensive examination called the Respiratory Therapy Examination (RTE).
This change will significantly impact how future respiratory therapists earn their CRT and RRT credentials.
What Is Changing in 2027?
Currently, respiratory therapists follow this pathway:
- Pass the Therapist Multiple-Choice (TMC) Exam
- Achieve the high-cut score to qualify for the Clinical Simulation Examination (CSE)
- Pass the CSE to earn the RRT credential
Beginning in January 2027, the NBRC will combine these into one examination—the Respiratory Therapy Examination (RTE)
Instead of separate exams, candidates will take one comprehensive test that evaluates:
- Breadth of respiratory therapy knowledge
- Depth of clinical judgment and decision-making
Scores on this single exam will determine whether a candidate earns:
- CRT credential (lower cut score)
- RRT credential (higher cut score)
The CSE Is Going Away
The standalone Clinical Simulation Examination (CSE) will be retired.
However, the clinical judgment skills tested on the CSE are not going away. Instead, they will be integrated into advanced multiple-choice questions within the new exam
This means students must still master:
- Information gathering
- Clinical decision-making
- Patient assessment
- Ventilator management
- Emergency response
- Disease-specific treatment planning
The format is changing—but the expectations remain high.
New Respiratory Therapy Examination (RTE) Quick Facts
According to the NBRC update, the new exam will include:
- 185 total questions
- 160 scored
- 25 pretest
- 4-hour time limit
- Two cut scores (CRT and RRT)
- Exam fees
- $360 (first-time applicants)
- $300 (repeat applicants)
Will the New Exam Be Easier?
No.
The NBRC has made it clear that the goal is not to make the exam easier or harder, but to better reflect real-world respiratory therapy practice
In fact, future CRT candidates will now need to demonstrate clinical judgment skills that were previously emphasized more heavily on the CSE.
Important Transition Timeline
There is a key transition period to be aware of:
- If you pass the TMC at the high-cut score before December 31, 2026,
- You will still have until December 31, 2027 to pass the CSE
This gives current students flexibility during the transition.
What This Means for Respiratory Therapy Students
This shift signals a major evolution in how competency is measured.
Future exam success will depend more on:
- Clinical judgment
- Patient management
- Critical thinking
- Interpreting clinical data
- Making safe, real-time decisions
Memorization alone will not be enough.
How to Prepare for the 2027 NBRC Exam
Even though the exam launches in 2027, your preparation strategy should change now.
Focus on Clinical Decision-Making
Practice choosing the best intervention—not just recalling facts.
- ABG interpretation
- Ventilator adjustments
- Therapy selection
- Evaluating patient response
Master Core Content
The exam will still test broad respiratory therapy knowledge similar to the current TMC
You need strong fundamentals in:
- Mechanical ventilation
- Oxygen therapy
- Pharmacology
- Neonatal and pediatric care
- Pulmonary disease management
Develop Clinical Judgment
Expect questions that require you to:
- Prioritize care
- Identify deterioration
- Select the best next step
- Avoid unsafe interventions
Respiratory Cram’s New 2027 Exam Prep Launches This January
If the exam is evolving, your prep should too.
Respiratory Cram is launching a brand-new Respiratory Therapy Examination (RTE) Prep Platform this January—built specifically for the 2027 NBRC changes.
The platform is designed to match the new exam format by focusing on:
- Clinical judgment and decision-making
- Scenario-based questions
- Breadth + depth mastery
- Real-world RT thinking
What to expect:
- New-style RTE practice questions
- Clinical judgment analytics
- Performance tracking by weak areas
- Adaptive learning system
- Unlimited practice opportunities
If the NBRC exam is testing how you think, your prep needs to train you the same way.
👉 Start preparing now at
https://respiratorycram.com
Final Thoughts
The respiratory therapy credentialing system is entering a new era.
The CSE is going away—but clinical judgment is becoming more important than ever.
The RTs who succeed under the new system will be the ones who can:
- Analyze patient scenarios
- Apply respiratory care knowledge
- Make safe, effective decisions
- Think like real clinicians
If you adapt your preparation strategy now, you’ll be ahead of the curve when the new Respiratory Therapy Examination launches in 2027.
For updates, next-generation practice questions, and a prep system built for the future of the NBRC exams, visit
Respiratory Cram
Source: National Board for Respiratory Care. “Examination Changes Coming in 2027 – New Details Added.” NBRC.
https://www.nbrc.org/examination-changes-coming-in-2027-new-details-added/
