Objective: The objectives of this study were to (1) identify factors predictive of performance on the National Board of Chiropractic Examiners Part IV exam and (2) investigate correlations between the scores obtained in the Part I, Part II, Physiotherapy, and Part III exams and the Part IV examination. Methods: A random sample of 1341 records was drawn from National Board of Chiropractic Examiners data to investigate the relationships between the scores obtained on the National Board of Chiropractic Examiners exams. A hierarchical multiple regression analysis related the performance on Part IV to examinee's gender, Part IV repeater status, and scores obtained on the Part I, Part II, Physiotherapy, and Part III exams. Results: The analyses revealed statistical relations among all National Board of Chiropractic Examiners exams. The correlations between Part IV and Part I ranged from r = .31 to r = .4; between Part IV and Part II from r = .34 to r = .45. The correlation between Part IV and Physiotherapy was r = .44; between Part IV and Part III was r = .46. The strongest predictors of the Part IV score were found to be examinees' scores in Diagnostic Imaging, β̂ = .19, p < .001; Chiropractic Practice, β̂ = .17, p < .001; Physiotherapy, β̂ = .15, p < .001; and the Part III exam β̂ = .19, p < .001. Conclusions: Performance on the National Board of Chiropractic Examiners Part IV examination is related to the performance in all other National Board of Chiropractic Examiners exams.

Objective: The National Board of Chiropractic Examiners (NBCE) uses a robust system for data analysis. The aim of this work is to introduce the reader to the process of score production and the quantitative methods used by the psychometrician and data analysts of the NBCE. Methods: The NBCE employs data validation, diagnostic analyses, and item response theory–based modeling of responses to estimate test takers' abilities and item-related parameters. For this article, the authors generated 1303 synthetic item responses to 20 multiple-choice items with 4 response options to each item. These data were used to illustrate and explain the processes of data validation, diagnostic item analysis, and item calibration based on item response theory. Results: The diagnostic item analysis is presented for items 1 and 5 of the data set. The 3-parameter logistic item response theory model was used for calibration. Numerical and graphical results are presented and discussed. Conclusion: Demands for data-driven decision making and evidence-based effectiveness create a need for objective measures to be used in educational program reviews and evaluations. Standardized test scores are often included in that array of objective measures. With this article, we offer transparency of score production used for NBCE testing.

The objective of this paper is to describe changes made to chiropractic national board examinations in the United States, including methodologies in test scoring, and to discuss future directions in test development and administration being considered by the National Board of Chiropractic Examiners (NBCE). Additionally, this paper serves as an introduction to the articles written by the NBCE staff and published in this issue of the journal. Statistical perspective on the properties of a test are presented, and reasons for the NBCE moving to item response theory for test scoring are described. NBCE consideration of on-demand testing and changes implemented in the Part IV practical examination are also discussed.

The chiropractic clinical competency examination uses groups of items that are integrated by a common case vignette. The nature of the vignette items violates the assumption of local independence for items nested within a vignette. This study examines via simulation a new algorithmic approach for addressing the local independence violation problem using a two-level alternating directions testlet model. Parameter values for item difficulty, discrimination, test-taker ability, and test-taker secondary abilities associated with a particular testlet are generated and parameter recovery through Markov Chain Monte Carlo Bayesian methods and generalized maximum likelihood estimation methods are compared. To aid with the complex computational efforts, the novel so-called TensorFlow platform is used. Both estimation methods provided satisfactory parameter recovery, although the Bayesian methods were found to be somewhat superior in recovering item discrimination parameters. The practical significance of the results are discussed in relation to obtaining accurate estimates of item, test, ability parameters, and measurement reliability information.

Objective The main objective of this study was to evaluate the validity of grade point average (GPA) for predicting the National Board of Chiropractic Examiners (NBCE) Part I exam scores using chiropractic GPA. Methods Data were collected during the January 2019 computer-based testing administration of the NBCE's Part I exam. The sample size was n = 2278 of test takers from 18 domestic and 4 international chiropractic educational institutions. Six regression models were developed and tested to predict the Part I domain scores from chiropractic GPA while controlling for self-reported demographic variables. Residuals from the models were disaggregated by pre–chiropractic GPA. Results Chiropractic GPA revealed a positive, statistically significant correlation with sex. The chiropractic GPA was found to be a significant predictor of the Part I domain scores. A different perspective was obtained when residuals (observed minus predicted) were collected and split by the pre–chiropractic GPA. Very good students tended to be underpredicted, while other students were overpredicted. Conclusion This study builds on the cascading evidence from educational literature by providing additional results suggesting that undergraduate (prechiropractic) GPA as well as the GPA obtained in doctor of chiropractic programs are related to the future performance on the NBCE Part I exam. The results provide a first glance at the connection between the standardized test scores, which are often used for instructors' and institutional evaluation and the GPA obtained in a doctor of chiropractic program.