Welcome from the nbce

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Welcome from the NBCE

  • Dr. Salvatore LaRusso, NBCE Director-at-Large
  • Dr. N. Edwin Weathersby, NBCE Vice President
  • Dr. Donna Craft, NBCE District II Director
  • Today we’ll cover:
    • Acupuncture, introduced in 2003
    • Special Purposes Exam for Chiropractic (SPEC), introduced in 1993
    • Ethics and Boundaries (E&B) introduced in 2004
    • We’ll spend extra time unveiling the redesign of E&B

NBCE Acupuncture Examination Developed to fill a need for an optional acupuncture competency exam

Use of Acupuncture Examination

  • Acupuncture is an optional, written examination
  • Administered twice each year along with NBCE written exams: March and September

Acupuncture Eligibility

  • Examinees must have completed 100 hours of acupuncture instruction
  • Instruction must be taken at or recognized by:
    • One of the colleges whose students are eligible to take the NBCE exams
    • A college or university accredited by an accrediting body recognized by the U.S. Department of Education

Acupuncture Test Plan

Acupuncture Exam as a Tool for State Boards

  • Assesses individuals who wish to use acupuncture as an adjunct to their chiropractic practice
  • May be used by any state that allows chiropractors to practice acupuncture
    • As part of practice
    • As separate certification
  • Focuses on clinical acupuncture, not traditional Chinese medicine

Special Administration in Ohio

  • Example: Ohio board recently changed requirements
    • Added acupuncture to scope of practice
    • Required passage of NBCE Acupuncture Exam
  • In response to request of Ohio board, the NBCE administered Acupuncture Exam to accommodate the large number of applicants
    • 84 examinees in September 2008
    • 28 examinees in March 2009

NBCE Special Purposes Examination for Chiropractic

Use of SPEC

  • SPEC is for licensed or previously licensed doctors of chiropractic only
  • SPEC is given only at the request of state licensing boards

SPEC as a Tool for Licensing Boards

  • Assesses clinical competency in areas reflecting clinical conditions generally encountered in chiropractic practice
  • Addresses various components of clinical competency, including patient evaluation and case management

When to Use SPEC

  • Special cases including
    • Disciplinary action
    • Reciprocity/endorsement
    • Licensure lapse or revocation

NBCE Post-licensure Exams SPEC and E&B

  • Given only at the request of state licensing boards
  • Request must be on state letterhead
  • Computerized: Offered six times a year
    • Every other month beginning in February
    • Cost of $850.00
    • Offered at Pearson Vue Computerized Testing Centers


  • Since its introduction in 1993, SPEC usage increases every year.
  • Computerization has made SPEC more readily and conveniently available.
  • State boards may wish to enact policy or rules/regulations to require SPEC in cases of concern about a doctor’s clinical competency.

NBCE Ethics & Boundaries Examination

State Boards and E&B

  • The E&B test plan is based on survey responses of state chiropractic licensing boards on the importance of knowledge of ethics and boundaries issues to practicing chiropractic in an ethical and legally appropriate manner.
  • Successful completion of the E&B Examination requires that examinees demonstrate an acceptable level of understanding and judgments pertaining to appropriate relationships and interactions.

NBCE Post-licensure Exams SPEC and E&B

  • Given only at the request of state licensing boards
  • Request must be on state letterhead
  • Offered six times a year
    • Every other month beginning in February
    • Cost of $850.00
    • Offered at Pearson Vue Computerized Testing Centers

E&B Format

  • Currently a 100 question multiple-choice exam
    • 50 questions on ethics
    • 50 questions on boundary issues

E&B Topics Include:

    • Doctor/patient relationship
    • Standards of care
    • Discrimination
    • Informed consent
    • Documentation
    • Negligence
    • Confidentiality
    • Fraud
    • Sexual misconduct and sexual harassment


  • A chiropractor receives a letter from a patient claiming that the doctor injured him during his last visit.  The doctor should take what initial step?
  • Pull the patient’s chart and make any changes necessary to clarify what occurred on the visit in question.
  • Notify the staff to send a letter of dismissal to the patient.
  • Inform his malpractice carrier of the incident.
  • Place a phone call to the patient to set up a complimentary visit with the chiropractor’s associate. 


  • A doctor advertises “no-out-of-pocket expenses.”This is considered:
  • Acceptable, as long as all patients receive this benefit.
  • Inappropriate, as it constitutes insurance fraud.
  • Satisfactory, if patients without insurance coverage are given free care.
  • Unacceptable, as it indicates incompetence and negligence on the part of the chiropractor.


  • What best describes a hostile work environment?
  • Regular and repeated welcomed compliments or actions.
  • Occasional and singular actions of reprimand
  • Regular and repeated unwelcomed offensive words or actions
  • Frequent promotions and salary advances

Rationale for Essay Format

  • Difficulty in writing questions for certain areas that weren’t blatantly obvious
  • Need for a more complete demonstration of knowledge of moral principles
  • Use “scenarios” requiring application of moral principles

Development of Essay Concept

  • The examinee will be given a focused scenario with two “Content Areas.”
  • Content areas represent the categories that the examinee’s infraction violated with respect to Ethics and Boundaries.
  • They will write one paragraph in the writing structure designated for each Content Area.

Writing Structure

  • Develop a position statement
  • Discuss key concepts and terms that support your position
  • Discuss probable consequences
  • Propose solutions and/or corrective actions

Essay Question: A chiropractor is intimately involved with a staff member who is also a patient in the office. The employee is not the chiropractor’s spouse.

  • Essay Question: A chiropractor is intimately involved with a staff member who is also a patient in the office. The employee is not the chiropractor’s spouse.
  • Based on this scenario, explain the potential ramifications regarding the dynamics of such relationships.
  • Content Areas:
  • 1) Balance of Power Issues
  • 2) Boundary Issues
  • Writing Structure:
  • 1) Develop a position statement
  • 2) Discuss key concepts and terms that support your position
  • 3) Discuss probable consequences
  • 4) Propose solutions and/or corrective actions
  • Write a full paragraph for EACH listed Content Area according to the required Writing Structure (see above).


  • Response:
    • Accurate
    • Marginal
    • Incorrect
  • Content:
    • Thorough
    • Limited
    • Not evident
  • Explanation:
    • Exceptional
    • Somewhat
    • Not at all

Grading Grid

Grading Scale

  • 5 points = Exceptionally well-explained; thorough yet concise content with correct responses
  • 4 points = Sufficiently explained; somewhat limited content with correct responses
  • 3 points = Somewhat explained; minimal content with correct responses
  • 2 points = Poorly explained; limited content with correct responses
  • 1 point = Not explained; extremely limited content with correct responses
  • 0 points = Required content is not evident; incorrect responses

Answer Key aka “/Deal-Breakers” Essay Question #9 – ALCOHOL/DRUG ABUSE

  • Position statement:
  • The doctor patient relationship can be compromised IF the doctor is impaired during treatments.
  • Key Concepts :
  • The doctor can make poor/wrong decisions because of the loss in proper brain functions that can lead to bad judgment.
  • The patient can be dissatisfied with the doctor’s decision making.
  • The need to maintain the drug effect will alter the mood of the doctor and can cause a bipolar effect.
  • Probable Consequences:
  • Civil, criminal and/or disciplinary actions from their Board.
  • Malpractice and/or unprofessional conduct charges.

Advantages to State Boards

  • A state board may request that the essay portion of the exam be tailored to a particular infraction or violation
  • The form will list content areas such as:
  • Fraud, Documentation, Standard of Care,
  • Dual Relationships, Negligence, Scope,
  • Sexual Misconduct, Sexual Harassment, etc.
  • 50% multiple-choice general knowledge in ethics
  • 50% focused essay, based on state board request

When to Use the E&B Exam

  • Whenever the judgment of a licensee is called into question
  • Whenever there is a blurring of the boundary between the doctor and the patient
  • Whenever the licensee has stepped over the line for fraud, scope of practice issues, professional misconduct, etc.
  • Whenever you question the integrity of the licensee

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