Quick answers: NBCE Part IV
What is on the NBCE Part 4 exam?
Part IV is an OSCE with eight stations: seven patient-encounter stations and one technique station. The NBCE's test plan lists testable content areas of musculoskeletal, neurological, cardiovascular/pulmonary, gastrointestinal, endocrine, renal/urological, and malignant conditions. Each encounter is graded on five components, from evaluation and examination to documentation.
How long is NBCE Part 4, and what is the format?
Each of the seven encounters has a 2-minute door-chart review, a 14-minute standardized-patient encounter, and a 6-minute SOAP note. The technique station has a 2-minute chart review and a 14-minute encounter to set up ten adjustments, with no note. Those times add up to about 2 hours 50 minutes before transitions.
Where and when is NBCE Part 4 offered?
Part IV is given at the NBCE Assessment Center in Greeley, Colorado; the first live exam was April 10, 2026. Test dates run Fridays through Sundays, 48 weeks a year. You can reserve a date up to six months ahead, and scheduling closes 17 days before the test date.
Who can take NBCE Part 4?
You need to have passed Part I, be within six months of graduation or already a graduate of an eligible chiropractic college, and obtain your registrar's online authorization. Doctors licensed on or before December 31, 1997 are not required to have passed Part I. You can retake Part IV without re-establishing eligibility.
How is NBCE Part 4 scored, and what is a passing score?
Scores use the NBCE's 125 to 800 scale. The NBCE recommends a passing score of 375, but each state sets and recognizes its own Part IV standard, so check your state board. Scores are generally available online about four weeks after the exam.
How do I study for NBCE Part 4?
Practice what is graded. Run timed 14-minute encounters with a partner, write SOAP notes in six minutes, rehearse ten adjustment setups with the six technique checkpoints, and practice the three case types the NBCE says you will see: treatable, co-management or further testing, and urgent referral. The full plan is below.
Is there an NBCE Part 4 study guide or practice exam?
The NBCE publishes a Part IV test plan, an orientation video, preparation tools, and planning pages, and states that third-party prep materials are not affiliated with or endorsed by the NBCE. ChiroEDU doesn't sell Part IV prep, because it's a hands-on exam; its Part 2 and Part 3 exams cover the related written content.
These answers draw on NBCE pages: Part IV · Part IV Test Plan (Assessment Center) · Planning tools · Scoring. The 2 hours 50 minutes is our arithmetic on the NBCE's published station times. Checked September 30, 2026.
What Part IV is
Part IV is an OSCE (objective structured clinical examination). You move through eight stations and work with standardized patients:
| Station | How many | Time |
|---|---|---|
| Patient encounter (case management) | 7 | 2-minute door-chart review, 14-minute patient encounter, 6-minute SOAP note |
| Technique | 1 | 2-minute chart review, 14-minute encounter to perform 10 adjustment setups (no SOAP note) |
By the NBCE's published timings, that is 7 × 22 minutes plus 16 minutes, or about 2 hours 50 minutes of station time, not counting movement between stations. The NBCE's planning page tells examinees to be ready to spend four to five hours at the test site.
What each station grades
The NBCE's test plan for the Assessment Center names the testable content areas (musculoskeletal, neurological, cardiovascular/pulmonary, gastrointestinal, endocrine, renal/urological, and malignant) and says each session includes cases of three kinds: treatable in a chiropractic office, needing additional testing or co-management, and needing urgent referral or outside the scope of chiropractic care.
| Station type | Graded components |
|---|---|
| Each of the 7 patient encounters | Patient Evaluation (obtaining relevant clinical information) · Patient Examination (accuracy and appropriateness of procedures) · Clinical Decision Making and Case Management (assessing findings and choosing a course of action) · Interpersonal and Communication Skills · Documentation (accurate, concise SOAP note) |
| Technique station | Demonstrating and verbalizing patient position, doctor position, segmental contact point, doctor's contact point, stabilization hand, and line of drive, plus communication and professionalism |
What changed in 2026
Part IV used to rotate between testing sites. The NBCE has consolidated it into its own Assessment Center in Greeley, Colorado. The first live exam there was April 10, 2026. The NBCE says the center offers exam appointments 48 weeks a year, most weeks Friday through Sunday with up to three sessions a day, where the old model ran twice a year. You can book up to six months ahead. Exact dates show up in your MyNBCE portal. Plan travel early; the NBCE also publishes airline and hotel discounts and a shuttle from Denver International Airport.
Eligibility, fees, and scoring
- Eligibility: passed Part I, and currently within six months of graduation or already graduated from an eligible college, with your registrar's online authorization.
- Fee: $1,585.
- Scoring: 125 to 800 scale. The NBCE's recommended passing score is 375, but states can set their own Part IV standard, so check your state board.
- Scheduling: closes 17 days before your test date. Withdrawals and refunds go through the NBCE directly.
- Retakes: you can retake without re-establishing eligibility. If you have already passed Part IV, you can't retake it unless a state board requires it.
How to study for NBCE Part 4
There is no answer key to memorize for an OSCE. The plan below is built from the NBCE's published station times and grading components, plus ordinary practice habits. The NBCE says third-party study materials are not affiliated with, endorsed, or approved by the NBCE, and it publishes its own test plan, orientation video, and planning tools.
- Start with the grading components. Every patient encounter is graded on the same five things. Score yourself and your practice partner on each one after every mock encounter.
- Run timed 14-minute encounters. Practice a focused history, a focused exam, and a brief report of findings inside the clock, with a partner playing the patient.
- Write SOAP notes in six minutes. Seven of the eight stations end with a note written at a computer, so practice getting a clean, concise note down fast. The NBCE publishes a list of accepted SOAP abbreviations.
- Practice the three case types. Rehearse one case you would treat in the office, one that needs more testing or co-management, and one that needs an urgent referral or is outside chiropractic scope. The decision is part of the grade.
- Drill the ten adjustment setups. Rehearse each one, saying aloud the six checkpoints: patient position, doctor position, segmental contact point, doctor's contact point, stabilization hand, and line of drive.
- Cover the content areas. Keep your diagnosis and case-management knowledge current across the musculoskeletal, neurological, cardiovascular/pulmonary, gastrointestinal, endocrine, renal/urological, and malignant areas. This is the same clinical reasoning tested in Part II and Part III.
- Watch the orientation video and plan the trip. The NBCE publishes an orientation and instructional video for Part IV, so watch it before test day and the format won't be new. Book your date early; the NBCE says October through December are the most popular months.
Where ChiroEDU fits
ChiroEDU doesn't sell Part IV prep, because it's a hands-on exam. The written clinical-reasoning content behind the case-management stations is where ChiroEDU's practice exams help, in Part III (clinical vignettes and radiology) and Physiotherapy. ChiroEDU is independent of the NBCE.
Sources: NBCE Part IV · Part IV Test Plan · Part IV Planning Tools · Part IV Deadlines · Part IV Planning · Redesigned Part IV · Scoring · Fee Schedule. Checked September 30, 2026. Verify current details on the NBCE site. ChiroEDU has no affiliation with the NBCE.