If you’re preparing for respiratory therapy exams, here’s what you need to know:
- TMC Exam: Focuses on foundational knowledge with 160 multiple-choice questions in 3 hours. Passing gets you the CRT credential, and a higher score qualifies you for the CSE.
- CSE Exam: Tests clinical decision-making through 22 patient scenarios in 4 hours. Passing earns you the RRT credential.
Quick Comparison Table
| Feature | TMC Exam | CSE Exam |
|---|---|---|
| Format | 160 multiple-choice questions | 22 clinical scenarios |
| Duration | 3 hours | 4 hours |
| Focus | Core knowledge and skills | Clinical decision-making |
| Pass Rate | 77.3% CRT, 68.1% advanced | 63% |
| Cost | $190 (new), $150 (repeat) | $200 |
Both exams are essential for respiratory therapy credentials. The TMC tests your knowledge, while the CSE evaluates your ability to apply it in real-life scenarios. Keep reading for tips on preparation, scoring, and test day logistics.
How To Pass The Respiratory Therapy Board Exams (TMC/CSE)
How the Exams Are Structured
The TMC and CSE exams are designed differently to evaluate specific aspects of respiratory therapy skills. Here’s a breakdown of how each exam is structured.
TMC: Multiple-Choice Questions
The TMC exam includes 160 multiple-choice questions, which you need to complete within 3 hours [6]. Out of these, 140 questions are scored, while 20 are unscored pretest items [5]. The test focuses on three main cognitive areas: knowledge recall, information application, and analysis and evaluation. Each question is tied to a scenario or concept that requires precise evaluation for accurate scoring.
CSE: Clinical Scenarios
The Clinical Simulation Examination takes a different approach. It features 22 patient-focused problems to be completed in 4 hours [1]. Of these, 2 are pretest items and do not impact your score [5]. This exam mimics real-life patient care situations, adapting based on your responses. As of March 2024, the project scenario section has been removed, sharpening the focus on clinical decision-making [7].
Format Differences
| Feature | TMC Exam | CSE Exam |
|---|---|---|
| Time Limit | 3 hours | 4 hours |
| Total Questions/Problems | 160 questions | 22 problems |
| Scored Items | 140 | 20 |
| Question Format | Multiple choice | Scenario-based with evolving decisions |
| Primary Focus | Knowledge and skills | Clinical decision-making |
| Response Type | Single best answer | Multiple decision points |
The key difference lies in how each exam evaluates your abilities. The TMC focuses on assessing your respiratory care knowledge and skills through multiple-choice questions [3]. On the other hand, the CSE tests your clinical judgment by presenting evolving patient scenarios that require critical thinking [2]. Together, these exams provide a well-rounded evaluation of both theoretical understanding and practical decision-making.
What Each Exam Tests
TMC: Core Knowledge Areas
The TMC exam evaluates foundational respiratory therapy knowledge. It covers key concepts, equipment use, and patient care procedures. Major topics include mechanical ventilation, pharmacology, pathology, airway management, and pulmonary function testing [3].
It specifically measures your ability to:
- Assess patient conditions and recommend appropriate actions
- Operate and troubleshoot respiratory care equipment
- Start and adjust respiratory care treatments
- Track and evaluate the success of interventions
This ensures you’re prepared for entry-level responsibilities.
CSE: Patient Care Decisions
The Clinical Simulation Examination (CSE) focuses on clinical decision-making. It uses detailed patient scenarios to test your ability to think critically and make informed decisions.
You’ll encounter scenarios that require:
- Reacting to changing clinical conditions
- Making decisions based on patient needs
- Solving problems in complex situations
"The clinical setting and patient situation for each problem are designed to simulate reality and be relevant to the clinical practice of respiratory care." – The National Board for Respiratory Care [1]
For instance, you might need to address respiratory acidosis by adjusting ventilator settings or initiating non-invasive ventilation (NIV) [8].
Subject Area Comparison
Here’s a breakdown of how the two exams differ in focus:
| Assessment Area | TMC Focus | CSE Focus |
|---|---|---|
| Clinical Knowledge | Basic principles and theory | Practical application in patient care |
| Decision Making | Single-step solutions | Multi-step problem solving |
| Patient Assessment | Standard protocols | Adapting to evolving scenarios |
| Equipment Management | Operation and maintenance | Troubleshooting in clinical settings |
| Treatment Planning | Standardized procedures | Tailored care strategies |
| Critical Thinking | Applying knowledge | Managing complex clinical situations |
The TMC confirms your understanding of core respiratory care principles, while the CSE tests your ability to apply this knowledge in real-life clinical contexts [4]. Together, they provide a full assessment of both theoretical knowledge and practical skills needed for professional practice.
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Test Day Details
Registration and ID Rules
To take either exam, you must register through NBRC-approved centers and bring a government-issued photo ID on test day. You can apply online or by paper. The TMC exam costs $190 for first-time applicants and $150 for repeat applicants. The CSE exam has a flat fee of $200 for all candidates. Both tests are available at over 300 assessment centers across the country, operating Monday through Saturday (excluding national holidays).
| Requirement | TMC | CSE |
|---|---|---|
| Application Fee | $190 (new), $150 (repeat) | $200 (all applicants) |
| Testing Centers | 300+ locations nationwide | 300+ locations nationwide |
| Testing Days | Monday–Saturday | Monday–Saturday |
| ID Requirements | Government-issued photo ID | Government-issued photo ID |
| Scheduling Method | Online or paper | Online or paper |
AARC members can receive a one-time $40 discount when applying for their first CSE exam [3]. Be sure to review the exam duration and break rules to manage your time effectively on test day.
Items and Breaks
The timing and break policies differ between the two exams. The TMC exam lasts 3 hours [3] and doesn’t include scheduled breaks, though you can take restroom breaks if needed. The CSE exam is 4 hours long [5] and allows for 5-minute breaks, but the clock keeps running during these breaks [7].
Test Center Setup
Once you’re familiar with registration and break policies, it’s helpful to know what to expect at the test center. While the TMC exam uses multiple-choice questions and the CSE exam focuses on clinical scenarios, the overall testing environment remains consistent for all candidates. Exams are offered year-round at NBRC-approved centers, giving you flexibility in scheduling [3][4].
How to Prepare
Study Tools
Getting ready for the TMC and CSE exams requires different approaches. The TMC exam focuses on multiple-choice questions that test your overall knowledge of respiratory therapy, while the CSE exam evaluates your ability to make clinical decisions through patient scenarios.
| Study Resource | TMC Exam | CSE Exam |
|---|---|---|
| Practice Questions | NBRC-style multiple-choice questions with feedback | Clinical scenario-based simulations |
| Core Focus | Broad understanding of key topics | Patient management and decision-making |
| Study Materials | Textbooks, online tools, and practice exams | Case studies and scenario-based exercises |
| Time Management | Timed practice sessions to mimic the exam format | Full-length simulation practice |
Respiratory Cram provides tailored tools for both exams. You can subscribe for $39/month per exam or choose a combined bundle at $49/month. Their platform offers NBRC-style questions with instant feedback for TMC prep and realistic clinical scenarios for CSE practice.
Study Planning
A well-structured study plan is essential to succeed. For the TMC exam, focus on major topics such as mechanical ventilation and patient assessment.
For the CSE exam, concentrate on:
- Disease management: Learn about common respiratory conditions and their treatments.
- Critical thinking: Practice interpreting patient data to make sound decisions.
- Time management: Work on completing full-length practice scenarios to build endurance.
"The Persing Review believes that the best way to prepare for the NBRC credentialing exams is by practicing exam questions and discussing the materials related to each question." – The Persing Review [9]
These strategies will help you make the most of the tools available.
Using Respiratory Cram
For TMC prep, take advantage of unlimited exam retakes to strengthen your understanding of multiple-choice questions. Use the detailed explanations provided to address any gaps in knowledge.
For the CSE exam, focus on the platform’s realistic simulation scenarios. These exercises help you improve your clinical decision-making skills, analyze patient data effectively, and manage your time during full-length simulations. Detailed feedback on each choice ensures you learn from mistakes and refine your approach.
Getting Your Results
This section explains how scores are calculated and when you can expect your results for both exams.
TMC Score Breakdown
The TMC exam uses a simple scoring method. Each of the 160 multiple-choice questions is worth one point, and you need at least 62% to pass [10]. Your score determines your credential options:
| Score Range | Outcome | Next Steps |
|---|---|---|
| 86–91 | CRT credential | Start working as a Certified Respiratory Therapist |
| 92+ | CRT + CSE eligibility | Qualify to take the CSE for the Registered Respiratory Therapist credential |
| Below 86 | No credential | Retake the exam after the required waiting period |
In 2022, over 77% of applicants passed the TMC exam [10]. Specifically, 77.3% of new candidates earned the CRT credential, and 68.1% qualified for RRT eligibility [3].
CSE Scoring Details
The CSE evaluates your clinical skills using a scoring range of +3 to –3 for each decision. Scores are divided into two main areas:
- Information Gathering (over 50% of total points):
Focuses on how well you collect data. Points are deducted for unnecessary actions or missing critical information. - Decision Making:
Assesses your clinical judgment and treatment decisions. Scoring depends on the complexity of each scenario. The average passing score is 72% [2].
When to Expect Results
For the TMC exam, your score and a detailed report are available immediately after you finish [3]. CSE results are initially provided at the test center upon completion [1], with a full score report emailed within 24 hours [11]. If you don’t receive your CSE results within 24 hours, contact PSI at 833-256-1424 or examschedule@psionline.com [11].
Score reports include a breakdown of your performance across different content areas, helping you pinpoint strengths and areas for improvement. This feedback is an excellent tool for refining your clinical skills and preparation.
Summary
Here’s a quick look at the main differences between the two exams:
| Aspect | TMC Exam | CSE Exam |
|---|---|---|
| Format | 160 multiple-choice questions | 22 clinical scenarios (20 scored) |
| Duration | 3 hours | 4 hours |
| Testing Focus | Core knowledge and proficiency | Clinical decision-making |
| Scoring System | 1 point per question | +3 to -3 points per decision |
| Pass Rates (2022) | 77.3% for CRT level | 63% for new candidates |
| Cost | $190 new / $150 repeat | $200 all candidates |
The TMC exam evaluates your understanding of core concepts through multiple-choice questions, while the CSE focuses on assessing how you make decisions in clinical scenarios. The passing threshold for the CSE is set at 72% [2].
To perform your best on exam day, keep these tips in mind:
- Time Management: Stick to the time limits for each exam.
- Format Familiarity: Practice using exam-specific mock tests.
- Critical Thinking: Hone your ability to make sound clinical decisions.
- Stress Management: Use relaxation techniques and plan to arrive early.
- Physical Preparation: Get enough rest and eat well before the exam.
Adjust your study approach to match the unique demands of each test for better results.
