Interview with James Badge, D.C., President of National Board of Chiropractic Examiners "The primary mission of the National Board of Chiropractic Examiners," according to James Badge, D.C., "is to provide quality standardized testing or assessment of licensure candidates such that an official regulatory body (state or national licensing board) may accept or require our exams to fulfill licensure or registration requirements without further testing. In this regard, we are an independent not-for-profit third party testing service for the chiropractic profession" The NBCE's organizational structure is based upon having one voting delegate from each state's chiropractic examining board. It is governed by an 11-member board of directors: The state delegates elect five geographic district directors; the Federation of Chiropractic Licensing Board's president and vice president are appointed to the NBCE board; and the board elects four at-large directors to make up the eleven. The board is the policy-making body for the organization that has a 33-person staff of professionals and support personnel under the direction of the executive vice president. In this interview with The American Chiropractor, Dr. Badge describes the role the NBCE plays in chiropractic education, the relationship between the NBCE and the Council on Chiropractic Education, and the future of chiropractic education. TAC: Can you tell us what role the NBCE plays in chiropractic education? Badge: Examinations from the NBCE are a reflection of the material taught in our chiropractic colleges; we validate the edu- cation an individual candidate for licen-sure has received. Even though we do not drive the chiropractic college curriculum, national standardized examinations, such as the NBCE's written and practical exams, invariably have some impact on what is being taught. TAC: Do you feel the NBCE effectively fulfills that role? Badge: The National Board has gained international respect for excellence in standardized assessment of candidates' understanding of classroom material and their practical skills. In fact, there is a high correlation between how an individual performs on NBCE exams and his or her grade point averages. We feel we have a very good handle on what is taught through the Delphi studies. By continually surveying chiropractic college instructors via a Delphi study and by involving instructors from all colleges in the test selection process, we ensure that NBCE exams appropriately reflect what is being taught in chiropractic colleges. Delphi studies form the basis for our Parts I and II exams. These processes keep the connection between the exams and what is being taught fully intact. In addition, we conduct a job analysis of chiropractic to determine what chiropractors do in practice. This forms the basis of the test plans for the written clinical competency exam (Part 111) and the national practical exam (Part IV). The Job Analysis of Chiropractic 2005 has just been introduced and is available at www.nbce.org. TAC: What are some of the complaints or problems that you are currently working to address, which relate to providing tests that accurately reflect a student's education on various subjects? Badge: The cost of the exams is always a concern because, like everything else, it inevitably goes up. However, to provide a complete line of standardized examinations, to provide relevant and legally defensible exams, and to ensure complete security in question development and exam administration, we realize that we cannot do our job adequately without incurring increased costs. The National Board is a not-for-profit organization and takes raising exam fees very seriously. For example, when we raised fees in 2002, it was the first increase since 1992. Since then, we have kept our increases at a minimal level. There are other issues of current interest to the National Board. One is the shift on many campuses to outcome-based education versus prescriptive (based on the number of hours required to obtain a degree). This change may have an effect on how the Part I (basic science) exams are developed. Other issues we continue to be interested in are computerization of our written exams. Over the past four years, we have analyzed this thoroughly and continue to study the matter. At this time, it is not feasible, as the costs would be prohibitive for examinees, especially given the fact that we actually "bring" the exams to them by testing on all but one chiropractic college campus in the U.S. and Canada. We have computerized the Special Purposes Examination for Chiropractic (SPEC), a post licensure exam used for reciprocity or disciplinary matters at the request or requirement of the state boards. Since practitioners may not be near a chiropractic college campus, these exams have been made available at multiple computer testing centers throughout the country. This is possible because the number of individuals taking the SPEC is a relatively small population compared to our Parts I, II and III exams. We are also in the process of computerizing a companion exam to the SPEC, which is the Ethics and Boundaries exam. This exam, like the SPEC, is only for practitioners who have been required by their state board to show an understanding of these two important areas. TAC: Do the NBCE and the Council on Chiropractic Education have any relationship? Badge: We are a third party, not-for-profit, independent testing organization not influenced by either the colleges, the CCE or the Association of Chiropractic Colleges. The only relationship we have with the CCE is in that the results of a standardized testing program, such as the NBCE's, is of interest to not only each college, but also to the accreditation body that is evaluating the college's programs. Thus, we are independent of one another, but we cooperate and keep abreast of the actions and activities of the CCE. We examine students and graduates of colleges that are accredited by a body recognized by the U.S. Department of Education, and that are authorized to issue the Doctorate of Chiropractic degree by their state of domicile and that are accepted for licensure in at least one state. Also, with the permission of all colleges that are members of the Association of Chiropractic Colleges, we provide performance information directly to the CCE as one of their measures of a college's perfor- mance. TAC: Does the CCE ever review average board scores as submitted by each school? Badge: The CCE reviews each college's average board scores and performance data as a part of the commission on accreditation evaluation of the school. The data may also be submitted to the CCE by the school. TAC: Do you think prospective students or alumni of each school would benefit from knowing the average board scores of the various schools within the profession? Badge: This subject has been discussed many times and many feel that it may be a good piece of data for a prospective student to have in making their decision on which chiropractic college to attend. AI- though I agree with this, there are other factors to consider. For example, we do not know the emphasis a prospective student may put on a college's average performance on national standardized exams. In the chiropractic profession, possibly more than most, there seems to be a greater reliance on where a parent, close friend or even their family chiropractor went to college rather than reviewing extensive data. Likewise, location plays a great role in the choice of a college. 14C: Would the NBCE have any problem providing The American Chiropractor with the average scores periodically, so that we may publish them on our TAC website, as well as in the magazine? Badge: Yes. 1 answer this emphatically, as providing this data for publication would place the National Board in an awkward position with the colleges. We restrict the colleges from using National Board scores for advertising and/or promotional purposes, unless they are averaged over a full year and do not specifically make claims based on the scores. The National Board maintains an excellent working relationship with all of the colleges and this would be jeopardized if either the colleges or the National Board breached this trust. Publication of this type of data would require a signed agreement from all the colleges and then, to ensure accuracy, etc., the data would be published directly by the NBCE in print or on our website. Once again, I do not see this as a possibility in the foreseeable future. TAC: Do you see any trends developing in chiropractic education and, if so, how will they affect chiropractic overall? Badge: I see a potential shift to outcome-based programs, as cited earlier, and 1 see chiropractic education growing and hopefully maturing internationally, as well. The National Board has formed the International Board of Chiropractic Examiners to address standardized pre-licensure or pre-registration testing for jurisdictions throughout the world, as various countries begin to realize the importance of chiropractic health care. Many schools are opening up worldwide, and we (chiropractic in the United States—its founding country) must be willing to assist in providing standardized assessment of their students. I believe that, to ensure the safety of the public, chiropractic must develop a more uniform identity along with a more unified understanding of our profession and how best to serve the patient public in all countries. TAC: Any final words for our readers? Badge: Yes. While your questions for this interview have been focused primarily on our relationship to chiropractic education and associated matters, I would like to add that the National Board is a bridge between an individual's college career and their becoming a safe and effective licensed practitioner.img James John Budge. B.A.. D.C.. F.A.C.C. F.I.C.C. graduated from Palmer College, and has been a member of the National Board of Chiropractic Examiners since 1986. He has served two terms as Chief of Staff for the chiropractic service at Scottsdale Community Hospital, for a staff of twenty-five doctors of chiropractic, and lectured on hospital protocol throughout the United Stales. He was elected President of the National Board of Examiners in May 2004. NBCE headquarters is located at 901 54 Avenue. Greeley. Colorado 80634. phone number 800-887-4320. James Badge, D.C.
