Important Changes Coming to The National Board of Respiratory Care (NBRC) Credentialing Exams

The NBRC has instituted new changes to the Clinical Simulation Examination (CSE) (opens in a new tab)”>Therapist Multiple-Choice Examination (TMC) and the Clinical Simulation Examination (CSE) starting on January 15, 2020. The new TMC Detailed Content Outline can be accessed here and the here for the Clinical Simulations Exam  This article will review the changes that have been implemented on the Therapist Multiple-choice Exam (TMC) and the Clinical Simulation Exam (CSE) starting in 2020. The cost of the TMC is $190.00 for New Applicants and $150.00 for Repeat Applicants. The cost of the CSE exam $200 for New Applicant and $200.00 for Repeat Applicants. 

Scoring Changes

According to the NBRC the Score Report, in order to give a more accurate indication of a candidate’s “mastery of necessary knowledge”, will be removing the sub-score reporting on the score reports. This is happening in order to do two things. First, credentials are given based on the total score achieved by the candidate. Thus, one score is more reflective of the actual comprehension and vital knowledge of Respiratory Care. The second reason is that a total score gives the candidate an opportunity to increase their “overall knowledge and ability” instead of having them focus only on areas where they were weak in the “less accurate sub scores.” If a candidate does not pass the exam they will be directed to a location where they can obtain a breakdown and guidance about their test scores.

Waiting Periods

The NBRC also feels that it is not in the best interest of the candidate to attempt the examination again right away. They have instituted a waiting period between exams. According to the 2018 Jimmy A. Young Memorial Lecture, there has been a policy of allowing unlimited attempts and with the ability to administer the test via computer, the waiting period was only days in many cases to retake the exam. This caused a problem with having candidates that may not be very knowledgeable, but good at memorization being able to take the exam multiple times in quick succession, memorizing the test content and passing the exam. The NBRC now requires a waiting period between repeat attempts, if the candidate has failed multiple repeat attempts. This allows the candidate time to remediate for the test and increases assurance that the candidate knows the material and brings us into line with the testing policies of other licensed professions. The Table 1 in the 2018 Jimmy A. Young article has the new attempts and wait times as follows: 

Examinations Attempts Without Waiting Days Between Subsequent Attempts
Therapist Multiple Choice  3 120
Clinical Simulation 3 120
Pulmonary Function Testing 2 180
Neonatal/Pediatric Specialty 2 180
Sleep Disorders Specialty 2 180
Adult Critical Care Specialty 2 180

Changes to the Therapist Multiple-Choice Exam (TMC)

An advisory committee on how to design and implement the changes to the examination decided that “task responses” to a study sample were valid indicators to making decisions about the design of the exam regarding Content Domain, Cognitive Levels and Patient Populations. For the Clinical Simulation design, they were valid indicators for Problem Types. The advisory committee developed 14 rules that they used to “systematically and objectively evaluate each task that could lead to potential examination content.” The committee reviewed 252 tasks of which 232 tasks were found to be fair when covered in the examination. These design changes are being implemented into both exams in 2020.  Content domains and cognitive levels will be emphasized on the exam. The biggest change is the addition of questions that may have the candidate take ethical considerations into account when answering the questions. There will be specific questions in ethics regarding neonates and children. The detailed outline content has been published to the NBRC document library., 2018)

Changes to the Clinical Simulation Examination (CSE)

Medical ethics will also be a consideration when choosing answers on the CSE. The advisory committee reviewed what patient conditions are seen most often by RT’s. This information has led to the including problems that involve the following areas: Disorders of Prematurity in place of Chronic Lung (Chronic Lung disease of Prematurity) Interstitial Lung Disease, Drug Overdose, Traumatic Brain Injury (TBI), Sepsis, Lung Cancer. These design specifications were made to questions that deal with these specific areas: Asthma-1 adult, 1 pediatric; Chronic airways disease management-1 invasive ventilation, 1 noninvasive ventilation, 1 diagnosis, 1 outpatient; Infectious disease-1; Heart failure-1; ARDS-1; Cystic Fibrosis-1; Neonatal RDS management, 1 resuscitation. (N.A. 2018)

The issues listed previously are 12 of the 20 problems on the examination. There will be less questions on Trauma, Neurologic/neuromuscular, Cardiovascular, Neonatal/Pediatrics. These will still be covered, there will just be less questions. Neonatal/Pediatric specialty questions have been reduced due to there being an exam specific to the Neonatal/Pediatric Specialty. 

New Resources for Candidates and Practitioners

Students can signup for Free Simulation practice here.

There are also now videos for candidates and practitioners to review. These videos can be found at These videos include information on the application process, why it is important not to share test information specific to what is in the exam, how to maintain their credential, accessing their personal dashboard to maintain credentials. The videos also have content on how the exam and the questions were created.


(N.A., 2019) TMC Detailed Content Outline, 2019. National Board of Respiratory Care (NBRC) 2019, Retrieved from

(N.A., 2018) The 2019 Jimmy A. Young Memorial Lecture: Changes to Examination Content, Design, and  Policies. Horizons, Credentialing for the Respiratory Care Profession, V48/N3, Third Quarter, 2018. NBRC National Board of Respiratory Care.

(N.A., 2019) Score Report Changes. NBRC, National Board for Respiratory Care, August 15, 2019. Retrieved from

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