TL;DR (for busy RTs & faculty)
- One exam replaces the separate TMC + CSE: The Respiratory Therapy Examination (RTE) launches January 2027.
- 160 MCQs total: 100 “breadth” + 60 “depth of clinical judgment.” A single total score determines CRT or RRT—no separate pass on each section.
- Same-day results begin Day 1. CSE remains available only through Dec 2027 for RRT-eligible candidates.
- First-attempt cost to achieve RRT drops by $30; repeat is $50 cheaper vs. today’s two-exam pathway.
- Content refresh adds ethics, team communication, SDoH, biologics/CFTR modulators, and more; removes lower-yield tasks (e.g., diagnostic percussion).
- 2024 job analysis (6,276 responses) drives the blueprint; 2026 cut-score study maps today’s CRT/RRT standards onto the new exam scale.
Quick Comparison: Current vs. 2027
| Feature | Today (TMC + CSE) | 2027+ (RTE) |
|---|---|---|
| Credentialing path | TMC determines CRT/RRT eligibility; CSE for RRT | One exam (RTE) awards CRT/RRT based on total score |
| Structure | TMC (MCQs) + CSE (simulations) | 160 MCQs: 100 breadth + 60 depth (clinical judgment) |
| Scoring | Separate exams | Single total correct score out of 160 (no separate section pass) |
| Turnaround | Variable | Score the same day of testing |
| Costs (first attempt) | ~$190 (TMC) + $200 (CSE) | $360 (≈ $30 less than current total) |
| Costs (repeat) | ~$150 (TMC) + $200 (CSE) | $300 (≈ $50 less than current total) |
| Transition | — | CSE still offered through Dec 2027 (optional) |
All details per NBRC’s 2025 “Unveiling the New Respiratory Therapy Examination” deck.
Why the Change (and why now)?
NBRC’s periodic job analyses showed merging scopes and evolving practice. After a major 2024 job analysis and advisory committee review (AARC, CoARC, BOMA represented), NBRC consolidated to one exam with modernized clinical-judgment assessment and streamlined candidate experience. A 2026 cut-score study will port today’s CRT/RRT standards to the new scale, preserving credential meaning while reducing friction.
Inside the New Exam
1) Breadth of Knowledge (100 MCQs)
Blueprint anchored to three content areas:
- I. Patient Data (25) — evaluate records, assess patients, gather/evaluate results, recommend diagnostics.
- II. Devices & Patient Safety (25) — assemble/troubleshoot, infection prevention, QA.
- III. Initiation & Modification of Interventions (50) — airway care, airway clearance/lung expansion, oxygenation/ventilation support, meds/specialty gases, care-plan changes, EBP, high-risk care, assist with procedures, team interactions.
Cognitive levels emphasize application/analysis, and medical ethics layers may appear across tasks.
Content adds you’ll notice:
- SDoH/health inequities; closed-loop communication; post-event debriefing; handoffs/transition of care; trauma-informed, culturally aware care.
- Pharmacotherapy expansion: antifibrinolytics, biologics for asthma (e.g., dupilumab), CFTR modulators (elexacaftor/tezacaftor/ivacaftor).
Content removed (lower testing yield): diagnostic percussion; performing peak flow (but interpreting/teaching PEF stays); performing hemodynamic monitoring (but interpreting hemodynamics stays); CPET (perform + interpret) out; assembling/troubleshooting for long-term O₂ therapy out; recommending aerosolized antibiotics (but how to aerosolize antimicrobials stays).
2) Depth of Clinical Judgment (60 MCQs)
NBRC is converting clinical-simulation constructs into MCQs with content layering at application/analysis levels. Each item names a patient type, a setting (in- or out-of-hospital), and asks for either the next information to gather (IG) or decision to make (DM). Items have been pretested with TMC candidates in advance to enable equating.
Distribution highlights
- Patient types (per form): ~50 adult (e.g., COPD/asthma/CF, trauma, cardiovascular, neuro/neuromuscular, ARDS, infectious, peri-op) + 10 children (6 neonatal with resuscitation & RDS; 4 pediatric).
- IG vs. DM: ~20 IG / ~40 DM. Setting: ~46 in-hospital / ~14 outside.
- Age coverage across whole exam: ≥15 and ≤18 neonatal/pediatric items; remainder adult/general. Ethics can appear anywhere.
Scoring, Results, and Timeline
- One total score out of 160 determines CRT or RRT—no “pass both parts” rule. Same-day score reports begin Jan 2027.
- Cut-score study (2026) ports today’s CRT/RRT standards to the new scale (preserves rigor/meaning). Practice exams & SAEs update in 2026; secure SAE refreshes every 2 years thereafter.
- Transition: RRT-eligible candidates may still choose the CSE through Dec 2027 or take the new exam. Retake policy continues (NBRC will reassess after year one).
What This Means for Students
Study efficiently for one exam:
- Master the three breadth domains, especially III: Interventions (50 items)—ventilation/oxygenation changes and care-plan modifications are prominent.
- Practice IG vs. DM thinking: “What data do I need next?” → “What change do I make now?” Sim-style reasoning, MCQ format.
- Expect ethics woven into scenarios, closed-loop communication, handoffs, SDoH barriers, and newer therapies (biologics/CFTR modulators/antifibrinolytics).
- Prepare for age mix (15–18 neonatal/pediatric across the exam) and out-of-hospital cases.
Budget & scheduling:
- First attempt total cost down $30 vs. current TMC + CSE; repeat down $50. One appointment; same-day results.
What This Means for Educators/Program Directors
Blueprint alignment
- Audit syllabi/labs to retire low-yield skills (e.g., diagnostic percussion) and emphasize added domains (SDoH, ethical decision-making, closed-loop comms, handoffs, debriefs, biologics/CFTR).
- Build IG→DM drills using MCQ prompts that mirror the new depth portion. Include out-of-hospital and peds/neonatal proportions.
Assessment & reporting
- Expect “multipurpose” items (secondary codes for patient type, setting, IG/DM) affecting program reports. Results will be on a 0–100% scale, not raw counts—coach faculty to avoid over-interpreting item counts; different graduates will see different sub-counts due to secondary coding.
Timeline prep
- 2026: incorporate updated SAEs/practice exams; review cut-score transfer guidance. 2027: prepare advising for students deciding between CSE (last year) and RTE.
Action Checklist
Students
- Map study to I/II/III domains; over-weight Interventions (50 items).
- Drill IG vs. DM decisions with MCQ rationales.
- Add refreshers on biologics, CFTR modulators, antifibrinolytics, and ethics/communication.
Educators
- Update labs/OSCEs: closed-loop, handoffs, debriefings, trauma-informed care, SDoH barriers.
- Convert legacy sim cases into layered MCQs; ensure peds/neonatal and out-of-hospital coverage.
- Brief faculty on multipurpose item reporting and the percentage-scale program reports.
FAQs
When does the new exam start?
January 2027; same-day scoring begins immediately.
Can I still take the CSE?
Yes—through December 2027 if you’re RRT-eligible; otherwise take the RTE.
How is CRT vs. RRT decided now?
By one total score mapped to CRT/RRT cut scores (via the 2026 cut-score study).
Is the new exam harder?
Rigor is preserved by transferring current standards. The format shifts to MCQs for both breadth and depth—expect heavy applied clinical judgment.
What topics were trimmed or added?
Trimmed: diagnostic percussion, performing peak flow (interpret/teach remains), performing hemodynamic monitoring (interpret remains), CPET (perform + interpret), assembling LTOT devices, recommending aerosolized antibiotics.
Added: SDoH, ethics, closed-loop & debriefing, handoffs, trauma-informed/culturally aware care, antifibrinolytics, biologics for asthma, CFTR modulators.
Source: NBRC “Unveiling the New Respiratory Therapy Examination” (Jimmy Young Memorial Lecture, 2025). All facts and figures above come directly from the official slide deck.
