NBCE Part III study guide
NBCE Part III · Work through your exam, one topic at a time.
NBCE Part III - the Clinical Competency Examination - is the third step in the National Board of Chiropractic Examiners' four-part sequence, generally taken in the later clinical phase of chiropractic training or shortly before licensure. Where Parts I and II lean on basic and clinical science recall, Part III asks you to act like a clinician: gather a history, select examination procedures, interpret imaging and laboratory findings, build a defensible diagnosis, justify a management plan, and recognize when referral or co-management is the right answer. The NBCE Part III study guide has 8 sections and about 1,978 words.
01Patient History and Interviewing
Begin open-ended: "What brings you in today?" Record the chief complaint in the patient's own words, then funnel toward specifics. Organize the history of present illness with OPQRST (onset, provocation/palliation, quality, region/radiation, severity, timing) plus functional impact.
289 words, about 1 min02Physical Examination Procedures
Proceed from general to specific: vital signs (blood pressure, pulse, respirations, temperature, height/weight, BMI), posture and gait observation, active then passive range of motion, palpation (temperature, tone, tenderness, trigger points), segmental motion palpation, orthopedic and neurologic testing (dermatomes, myotomes, deep tendon reflexes, upper motor neuron signs), and functional tasks. Compare sides and record numbers-degrees, grades, distances-not adjectives.
264 words, about 1 min03Diagnostic Imaging and Laboratory/Diagnostic Studies
Plain films are reasonable when red flags for fracture, instability, infection, or malignancy exist, or after significant trauma; they are not routine for uncomplicated acute low back pain. MRI is indicated for progressive neurologic deficit, suspected cauda equina syndrome, suspected infection or tumor, and persistent radicular symptoms that fail conservative care.
248 words, about 1 min04Diagnosis and Clinical Impression
A useful diagnosis names the tissue, the mechanism, and the functional consequence-for example, "cervicogenic headache with C2–3 segmental dysfunction and work-limiting loss of cervical rotation." Exclude visceral and systemic mimics before settling: cardiac ischemia can refer to mid-back or jaw, gallbladder to the right scapula, renal disease to the flank, and an abdominal aortic aneurysm to the back in an older smoker. Consider neural tension, vascular, rheumatic, and metabolic patterns.
228 words, about 1 min05Chiropractic Adjustive Technique and Therapeutic Management
Choose technique for the patient, not the practitioner's habit: age, body habitus, bone quality, region, acuity, prior response, and preference. Thrust manipulation and mobilization both have support for musculoskeletal pain; the audible cavitation is not a measure of success.
230 words, about 1 min06Case Management, Referral, and Co-management
Case management is the discipline of deciding who treats what, when, and where. Refer for diagnostic uncertainty, red flags, findings outside your scope, studies you cannot order, and failure to respond to a reasonable trial.
223 words, about 1 min07Ethics, Jurisprudence, and Risk Management
Informed consent is a conversation, not a signature: diagnosis, proposed care, material risks, alternatives including no treatment, and an invitation for questions. The standard of care is what a reasonably prudent practitioner of similar training would do in similar circumstances.
242 words, about 1 min08Documentation and Record Keeping
Initial notes establish the baseline: history, quantified exam findings, diagnosis, functional goals, plan, and consent. Daily notes record subjective change, objective findings, treatment delivered, and the patient's response.
254 words, about 1 min