Activate Your Practice Podcast
The Activate Your Practice Podcast is hosted by the Chairman & Founder of Activator Methods, Dr. Arlan Fuhr. This podcast will cover a variety of subjects. Dr. Fuhr will interview guests from different backgrounds and professions, as well as talk about his 50+ years in chiropractic care.
Activate Your Practice Podcast
Just The Facts on the Chiropractic Exams: Flexibility, Centralization, and Community Investment
Discover the transformative changes in chiropractic pre-licensure exams with Dr. Norman Ouzts, CEO of the National Board of Chiropractic Examiners (NBCE). Join us as Dr. Ouzts unveils how computer-based testing has been expanded to offer students greater flexibility, allowing exams to be taken over nine months of the year. Additionally, we discuss the innovative shift of Part 4 exams to a year-round schedule in Greeley, Colorado, creating a fully immersive patient experience. The conversation also highlights the critical role of stakeholders in navigating these changes and ensuring a seamless transition.
We also uncover the strategic move to centralize exam testing as a means of cost management and sustainability, with plans for a new testing center in Greeley set for 2026. This centralization is designed to stabilize exam fees and enhance grading consistency with full-time examiners. Dr. Ouzts shares how the NBCE is reinvesting in the chiropractic community through scholarship support and the invaluable practice analysis data available for legislators and professional associations. Prepare for insights from the upcoming 2025 practice analysis survey, as we explore the NBCE’s forward-thinking approach to adapting within the evolving landscape of chiropractic education.
Hi, I'm Dr Arlen Foer, the chairman and founder of Activator Methods International. Welcome to the podcast Activate your Practice. Today I'm honored to have the CEO of the National Board of Chiropractic Examiners, norman Oates, and we're going to talk about some of the changes that NBCE has been making in the last year, so people know what's going on and so they can not hear some of the things that are not true. We want to put out the facts, as Norm said. So welcome, dr Oates, we're happy to have you on board.
Speaker 1:Thank you. Thank you, so glad to be here. Thanks for taking your time.
Speaker 2:Thank you, thank you so glad to be here. Thanks for taking your time. Well, you're headquartered in Greeley, Colorado, and you held a variety of roles with the National Board and now you're the CEO, and I'm not sure that's a good position or a bad, because you seem to have to take all the heat.
Speaker 1:but how many employees do you have there in Greeley? So in Greeley we had just a little over 40 employees, and then there's another about 1,250 field staff employees that are around the country for administering the exams.
Speaker 2:I've seen articles in the press recently regarding some big changes to the pre-licensure exams. Can you share what prompted NBCE to make these changes?
Speaker 1:Sure, you know, we recognize that the profession is changing, we recognize that the educational landscape is changing. So we listened to our stakeholders the students, the colleges and the state licensing boards and, as a result of that effort, there was about three things that really were highlighted that we wanted to address, and one was a really overwhelming desire from the students wanting more opportunities to test. We recognized that we needed to really find some ways to hold down our costs, better manage our costs, particularly on the exam delivery, and then, finally, to really ensure that our exams align with modern educational practices.
Speaker 2:Well, stakeholders, you know they can input. It's essential. But it can also be diverse and conflicting. How did you balance these? You know different perspectives.
Speaker 1:Well, yeah, you know, everybody I guess has their own perspective right. Well, yeah, you know, everybody I guess has their own perspective right. But we really we spent years listening to our stakeholders. We were very, very intentional in involving them in this process along the way, listening to their concerns. Along the way, listening to their concerns, really trying to understand how the proposed changes would affect them, both positively and negatively, and then trying to find a common ground, and I think what came from that is a series of updates that meets their needs and allows us to continue to improve the quality of our products.
Speaker 2:Now is it mostly the Part 4 that you're changing the most.
Speaker 1:No, we just most recently rolled out some very significant changes with our computer-based testing, which is those of us more seasoned doctors would recognize as our written products. That would be parts one, two, three and PHT. As a result of the feedback from the students and trying to find a solution to offer them more exam opportunities just in August of this past year, we've expanded the offering of all of our computer-based testing products. Prior to August we offered part one in January, part two in February, part three in March and then we would rotate through the year. So it was three times a year they could take each of the tests. We're now rolling it out to where we're going to offer all of the computer-based tests nine months out of the year.
Speaker 1:The reason why it's only nine months is right now we still do part four in May and November and we don't offer an exam in December. As we roll out some of the changes related to part four, which we'll talk about here in a little bit, we really hope to be able to expand the computer based testing and offer all of the written products monthly so that the students have every opportunity to take that test, not when we say that they can take it, but when they feel most comfortable taking it, when they feel most prepared to take the test. Not when we say that they can take it, but when they feel most comfortable taking it, when they feel most prepared to take the test. Because, you know, at the end of the day, we really want to set the students up, to make it convenient for them and set them up for success.
Speaker 2:What challenges have you faced in implementing the changes, the changes for computer-based testing? Well, no, for all of the new stuff, like Part 4, where they come to Greeley Colorado. I think that's what I'm hearing the most.
Speaker 1:Yes, we'll back up and we'll talk a little bit about the Part 4 changes. We are in the process of moving the Part 4 exam to a year-round testing calendar there in Greeley Colorado and we're also changing the format of the test from being a single-point exam station to a full patient experience. So instead of going into the room and being given a list of things to do, which you would then perform on that standardized patient, and then you go to another room and answer a series of questions as it relates to that patient encounter, this will be moving to a candidate-led station which will better measure a candidate's clinical decision-making. So they would walk into a room, there'll be a standardized patient there and they will take that standardized patient through the whole patient experience. They'll do the history, the physical exam, they will come up with a working diagnosis and a treatment plan and then there will be another station dedicated to chiropractic adjusting.
Speaker 2:What challenges have you faced in implementing the changes?
Speaker 1:Well, you know, as you can imagine, change is hard. You know, change is oftentimes met with resistance, and what we've really tried to do is to involve the stakeholders in this process along the way, to let them be part of the conversation and to, you know, have some candid conversations with them and find out what their likes and dislikes are and what their pain points may be, for example, you know we recognize that having the students come to Colorado does create some concern for the travel costs related to coming there, to Colorado.
Speaker 1:I can tell you that the board did not take this decision lightly. We spent a significant amount of time reviewing lots of different models, lots of different possibilities, including staying on the college campuses, which is where we currently administer tests, and at the end of the day, it really came down to sustainability, fairness and long term benefit.
Speaker 2:Well, it seems to me like each campus would have different people and so it had a variable. Am I correct?
Speaker 1:Yes, yes, as I said before, it was delivered across 14 locations and required about 1,250 field staff on any given exam weekend to administer that test. That has to be expensive.
Speaker 2:It's very expensive. How do you do it in Colorado? Do you have people that are full-time, then testers?
Speaker 1:So what we're hoping to be able to do and what we feel confident that we're going to be able to do and the primary motivation behind centralizing is just that to be able to better manage our cost.
Speaker 1:You know the current exam model is just not financially sustainable, as you can imagine.
Speaker 1:Trying to maintain that across 14 different locations it's just getting more and more expensive and it's also getting more and more expensive and it's also getting more and more difficult from a staffing standpoint as well. So by being able to move it there to a centralized location, we can leverage our current resources, we can leverage our current staff and their expertise and ability to implement this exam and we can also better control those costs long term. You know one thing we know for sure is the current model, although we're very excited, the board has worked hard, staff has worked hard to really hold costs down and we've been able to not raise exam fees for six out of the last seven years in spite of record inflation. But we know that's not sustainable. Exam increases on a fairly regular basis and what we're really hoping to be able to do and feel confident that we're going to be able to do uh is is is control those costs and stabilize those exam fees so that students will not have to absorb, uh, those types of increases going forward when?
Speaker 2:do you anticipate opening the new center? And really, going forward?
Speaker 1:When do you anticipate opening the new center in Greeley? So our plan is to open it in the first of 2026. However, you know we are just now on the end phases of the design phase for the building and, as you can imagine I know you've been in the process before of building a nice building. I've gone and had an opportunity to see the Four Science Center there at Logan. It's a spectacular, beautiful building and, as you can know, there's, as you know there's a tremendous amount of preparation that goes involved in the design portion of it before you ever get to construction.
Speaker 1:So we're finishing that up now where we're on track to begin to begin construction February I mean March or early April and we're hoping that we'll be able to to have it open and ready to do some field testing first part of 2026, with the first exam being administered in March of 2026. Now, because we're going to be delayed a little bit into the year, we will still offer in May of 2026 the on-campus testing. We have to do that in order to be able to get everybody tested in 2026 that needs to be tested for licensure. So we'll begin the on-campus test. I mean we will begin the centralized testing. Our plan is March, but we will also still have that May 2026 exam on college campuses, and that will be the last one.
Speaker 2:How does the medical profession test their people?
Speaker 1:The medical profession. It depends if you're talking about. You know when you say medical profession, you know if you're talking just specifically about MDs. But you know you have.
Speaker 1:MDs, dos podiatrists, optometrists, just do the MDs. The MDs they historically did a regional testing, a very similar OSCE type test with standardized patients, osce type tests with standardized patients. After COVID they did do away with their OSCE testing, their version of Part 4. I don't want to speak for them, I can't speak for them, but I think the primary reason is their instrument is used differently than ours. Their version of the Part 4 exam was used for entrance into the residency program. So you know they took the test, they used that for entrance into the residency program where they then went into.
Speaker 1:You know, in essence, an everyday OSCE, but they were working on real patients, so it was a very a continuation of their education, so to speak. Where in the chiropractic profession, this is a true licensure exam and once you pass our licensing exam you then have the ability to get licensed in any 50 states and you can go to work the very next week and start treating patients. Optometrists still use a centralized testing location. I think the podiatrists use a centralized testing location and the osteopaths are in the process of going back and doing some of the OSCE exam for the colleges.
Speaker 2:So this centralized thing is not new.
Speaker 1:No, it's not new at all. Actually, what we were doing is very unique, or what we're currently doing is very unique.
Speaker 2:Shouldn't this standardize things too, I mean?
Speaker 1:Oh, yes, I mean you can imagine the standardization when you're looking at just one location versus 14 locations and we go. An extreme amount of effort and training goes into ensuring the standardization to the extent that we can. But there's no way we can make it. You know, the same, exact same experience across every location, particularly when you know the college campuses are arranged different, the clinics look different, the equipment is different. You know, all those things play a role in the standardization.
Speaker 1:With the, with the centralized testing, we will have full time patients, opposed to the part-time standardized patients that we have now. So there'll be a constant training process for them. We will have full-time examiners where now again we have part-time examiners and they have to go through a regular calibration process in order to maintain that standardization process, in order to maintain that standardization. But with the centralized location, we'll have a full team of examiners. That is their job, that is what they do, and we'll be able to run regular inter-rater reliability studies to make sure that the examination, that the grading, is being consistent across all examiners and everybody will be spot checked. So we will be grading the graders, so to speak, on a very regular basis to ensure that it is fair and equitable across exams and across days.
Speaker 2:Now we've talked all about how you examine students. Let's talk about what you do for students, because until I did this interview I had no idea you were doing this. I see here you're giving a lot of scholarships. Can you give us just a quick rundown on those?
Speaker 1:Yeah, you know our board feels that it's important to invest back in the students. You know we recognize that the students are the future of this profession. One example is the. We believe that the future researchers of the profession are in school now. You know they're the people that we're going to count on in the future to of the profession are in school now. You know they're the people that we're going to count on in the future to be the researchers to move this profession forward.
Speaker 1:And as a result of that, the board recently appropriated the last couple of years $50,000 student scholarships to send two student representatives from every DCP program in the country to the Association of Chiropractic Colleges Research Agenda Conference or the ACC RAC.
Speaker 1:It's a very unique opportunity for them to be there, to get exposed to that, to network and, you know, hope to get the bug and really stimulate that next wave of researchers. It's been exciting to watch. You know I go there and I see them, I meet with those students and then we get a lot of really you know nice emails and letters back from them about what a valuable experience it was and how they're interested now in learning more about research. What a valuable experience it was and how they're interested now in learning more about research. We give to all the student, national student groups. We have a ten thousand dollar award that we offer for an essay competition that we do and we do. I think it's a thousand dollars we give to every DCP program for a scholarship that they can offer at their discretion. So you know, we really try to do our part to give back to the students.
Speaker 2:Also, you're developing new exams. Can you tell me a little bit about it? The one is that chiropractic education readiness assessment, cirsa or CIRA, yeah.
Speaker 1:Yes, it's the CERA. It stands for chiropractic education readiness assessment and it's an exam that you know we all of our new exams that we develop we really the goal of it is to meet the need of the profession, is to meet the need of the profession and this is an exam that came from a collaboration with the colleges. We had 18 of the USDCP programs participate in the development of this exam. It's a two-part exam. It's got both cognitive and non-cognitive items on the test. So the cognitive items measure their competency in basic sciences and then the non-cognitive portion measures self-awareness, grit and emotional intelligence and it's designed to assess that candidate's readiness for the rigor of the DCP program.
Speaker 2:Now that activators taught in 38 different colleges, I always ask you the question when is there going to be some activator questions on the national board? And you say, well, they don't all require, but we have it in the core curriculum now, probably over half. So is that a possibility now that some questions might be submitted?
Speaker 1:So I'm going to give you the very general answer, right, because this is, you know, I've got a team of people that are involved in the whole process, but I'll give you the. And there's a lot behind what goes in the test and how things get on to the test, right, and it's different whether it's part one and two or whether it's part three and four, right? So I'm gonna probably take it down a little bit of a rabbit hole, but it is interesting, I think people ask a lot of times where the questions come from. So part one and two, the questions come from a Delphi study.
Speaker 1:So we have a very objective process that we go through, where we study what is being taught in the college curricula. It's a back and forth interactive process with the colleges and that's what determines what's going to be on the test. As far as the written exams, part three and four is highly anchored to the practice analysis which we do every five years, so it should reflect what's actually being taught in the profession. So that, all being said, particularly on part four and to address your question completely, you know it needs to make sure that every single student has access to the information and every single student has the same opportunity to be successful on that particular aspect of the test, right? So you know, as Activator gets more and more into the college curricula, across all the colleges, to where every single school, regardless of where you went to school, you have access to the information and have the same chance of being successful, then that's a conversation we can have for sure.
Speaker 2:Last question you know you used to put out a survey. I love the survey, you know, because it talked about what techniques were being used and it talked about who did this and who did that. Is that being resurrected?
Speaker 1:We are in the process right now. We just sent the survey out end of the year last year. The 2025 practice analysis is being finalized. Practice analysis is being finalized. As a matter of fact, I just spoke with Dr Himmelfarb, who is our director of psychometrics and research and is the chief author on that. It is scheduled to go in two weeks to the printer to be put together. We're not going to have a print version of it, but we say the printer and it should be released early March. So yes, you will have it shortly.
Speaker 2:Well, I really appreciate that and I've heard a lot of people in the profession say what happened to that survey and I said I'll ask Dr Oates today because I'm interviewing him and so I'm happy to see that it's back, because it gave a lot of real good demographic information and talked about what people were using and so forth. So it was valuable.
Speaker 1:Yes, so it's an extremely valuable instrument. It is used, you know, by by legislatures, is used by state licensing boards. Exactly it is used by associations. A lot of people use it. There's a tremendous amount of data in there and we actually have them all archived on our website. If you go to wwwnbceorg, you will be able to find the archive list of all the practice analysis. They're all word searchable, so it makes it really easy for you to find what you're looking for. And again, we'll have the 2025 one there real shortly.
Speaker 2:Well, it sounds like change. You know, nobody likes change and it's always difficult to do change, but it sounds like you're on top of it. And so, Dr Norman Oates, the CEO of NBCE, we're really happy that you could come on today so we can get the word out to the profession. Thank you so much for having me. You're very welcome.
