4 National Board of Chiropractic Examiners (NBCE) directors resign after conflicts of interest related to lawsuit

Four directors have resigned from the National Board of Chiropractic Examiners (NBCE), following “a determination by the Board that Robert Daschner, DC (FCLB Appointed Director), Carol Winkler, DC (FCLB Appointed Director), and Karlos Boghosian, DC (At-Large Director and President) had conflicts of interests related to a lawsuit filed May 16, 2022 in the United States District Court, District of Colorado by Dr. Keita Vanterpool against the Federation of Chiropractic Licensing Boards (FCLB), Dr. Winkler and Dr. Boghosian (Case 1:22-cv-01208),” according to an email released by the NBCE.

The four directors resigning were:

Kimberly Driggers, JD, At Large Director
Michael Fedorczyk, DC, District II Director
John McGinnis, DC, District V Director
Jason Young, DC, At Large Director

“Although the board was unanimous in determining that conflicts of interests exist, the implications of these conflicts was disputed among the directors and, ultimately, divisive,” wrote Norman Ouzts, DC and CEO of NBCE.

Ouzts went on to write:

“This letter addresses NBCE operations while we navigate the next steps regarding the board. We are working openly and tirelessly to dispel inaccurate information about the situation, especially in recent inflammatory media coverage.

Developing, administrating, scoring, and reporting results on standardized tests equivalent to the NBCE’s Parts I, II, III, IV and PHT (Physiotherapy) are not trivial tasks. They may be performed only by qualified examiners, fully committed to protecting the public and in accordance with the Standard for Educational and Psychological Testing. The NBCE has served as the gold standard for chiropractic competence assessment since 1963.

Licensing boards that govern the practice of the various healing arts recognize a need for valid, reliable and fair examinations that assure a minimum level of competence. The NBCE was formed as a not-for-profit entity that develops and administers such examinations in order to advance public safety. NBCE does so with a purpose of establishing and maintaining uniform standards of excellence in the chiropractic profession and in chiropractic education primarily, but not exclusively, by preparing and administering examinations to qualified applicants; by providing test, measurement and assessment services in areas of demonstrated need; and by advancing the chiropractic profession in the interests of the National Board and chiropractic testing.

The NBCE governing documents impose corporate responsibilities that include compliance with laws; appropriate resource allocation; transparency; information accountability; continuity of operations; service quality; and meeting stakeholder needs. NBCE testing services assist regulatory bodies in carrying out their statutory mandates to regulate with a shared objective of helping to ensure high standards in the chiropractic profession. To that end, the NBCE meets and exceeds standards for organizations performing high stakes competency testing. This includes:

Validity

The NBCE considers validity the most important attribute of test quality. Our testing programs provide evidence to show that each test is capable of meeting the intended purposes in terms of content and difficulty. To ensure validity, the NBCE clearly describes the content (knowledge, skills, or practical skills) to be measured, the purpose of each test, the inferences to be made from test scores about test takers, and the intended interpretation of results. Our test validation procedures include regular test committee meetings during which representative groups of subject matter experts review each item on test form. The NBCE makes validity information available to stakeholders and the public through regular communications, reports, and publications in peer-reviewed scientific journals. The NBCE conducts research and documents the conceptual, empirical, and theoretical evidence that all tests meet their intended purpose and support the intended interpretations of the scores for intended populations. Validity of our exams is consistently reevaluated.

Reliability

Reliability refers to test score consistency across test forms and test administrations. The NBCE ensures that every specific score obtained in one administration has the same meaning as the same score obtained in a different administration. We ensure longitudinal reliability of scores. The NBCE assures that any reported scores, including category scores communicated on college reports or other documents provided to state licensing boards are reliable to support intended interpretations. We assess reliability using statistical and qualitative methods that are appropriate for the test and the intended uses of the results. The NBCE documents results of reliability studies in our annual report, peer-reviewed conference presentations, white papers, and publications in peer-reviewed scientific journals. In the Part IV examination, where scoring includes the judgment of raters, NBCE provides evidence of consistency across raters and across tasks. Further, we ensure reliability of cut scores, document, and provide information about the consistency of measurement near the cut scores and/or the consistency of decisions based on cut scores. The NBCE documents its reliability analyses to allow knowledgeable people to evaluate the results and replicate analyses.

Fairness

The NBCE designs, develops, administers, and scores tests that are fair across all definable populations. We strive to eliminate effects of construct-irrelevant characteristics of test takers on test scores. For new or significantly revised tests, the NBCE addresses fairness in the design, development, administration, scoring, and use. Standards of fairness are based on the Standards for Educational and Psychological Testing and are aligned or exceed the standards of other health care testing boards and leading companies in the testing industry. The NBCE includes fairness discussions during test committee meetings, standard setting workshops, and meetings with stakeholders. The NBCE provides reasonable accommodations and modifications for people with disabilities, in accordance with applicable law.

Test Design and Development

NBCE test developers start with detailed specifications of test content, test difficulty, and intended populations of test takers. The NBCE uses quantitative and qualitative information about test items to verify quality, which include test content map, test difficulty map, records of item performance, and item and test difficulty curves. Each test program has a specific equating design, which are complex statistical procedures allowing for cross-sectional and longitudinal comparison of test forms and test scores. The NBCE obtains and provides evidence of the qualifications of the NBCE staff and external subject-matter experts involved in developing or reviewing tests. The NBCE takes fairness into account early in the process of test development by writing items that minimize construct-irrelevant variance in scores. The NBCE obtains internal and external reviews of test specifications, items, assembled tests, and test-related materials. The NBCE pretests items by placing them as “field test” items on operational test forms, documenting the sampling process, statistical analyses performed, content evaluations, and results of item-related model fit for models and statistical procedures that evaluate the items and tests. The NBCE evaluates the performance of tests after the first operational administration at which sample sizes are sufficient. The NBCE routinely reviews test specifications, operational item pools, tests, and ancillary materials to verify continued appropriateness and compliance with current applicable guidelines such as laws, chiropractic college curricula and current practice of the profession.

Test Administration

The NBCE ensures that test administration procedures are equivalent across test sites and provide security. The NBCE develops procedures for test administration that are comparable in settings, time, and test-taker experience. The NBCE processes assure standardized test administration whether the exam is taken at a testing center or a chiropractic college. The NBCE informs test takers of what they can expect in the registration processes, during test administration, and following test administration, to improve the entire testing process and eliminate unnecessary stress. Test scores are released four weeks after test administration. The NBCE has demonstrated adaptability, successfully administering testing during the COVID-19 pandemic by mobilizing resources and responding in real-time to evolving situations throughout the country.

Test Scoring

The NBCE psychometric standards are rigorous and among the best in the world. The NBCE employs two psychometric specialists with doctoral level training in statistics, and a data analyst with 20 years of experience. The scoring process at NBCE starts with careful evaluation of incoming data quality. When 100% quality of data is established, raw scoring is performed. Time stamps provided by administration software allows evaluation of valid attempt and construct clicking patterns for each examinee. These patterns are later used for test security evaluation or forensic analyses. In the next step, analyses is conducted based on Classical Test Theory constructing response distributions for each test item. Psychometric staff evaluate each item in terms of expected performance and flag items for review. A post-exam review is conducted with content experts. Item-Response Theory models are used to fit test data and calibrate the items. Equating, scaling, and board score production are the final steps in the scoring process. Each step in test scoring is accompanied by review and quality assurance procedures. Every scoring step is conducted by a PhD level psychometrician and reviewed by a different PhD level psychometrician. The line of research at NBCE continuously improves psychometric and statistical methodology used for test development and scoring. NBCE stays tuned to innovations and development in the field of educational measurement, quickly implementing applicable discoveries. The NBCE’s psychometric research aims to develop, improve, and apply statistical and psychometric methods and capabilities with research objectives aligned with NBCE’s mission. In program documentation, the NBCE describes the norm groups and the norming studies to allow knowledgeable people to evaluate and replicate the norming studies. The NBCE documents the cut score studies and standard setting workshops in sufficient detail to allow knowledgeable people to evaluate and replicate the studies.

Reporting Results

The NBCE communicates testing results after each administration. In particular, each chiropractic college receives a detailed report about student performance and comparison to national averages. Additionally, the NBCE provides information to help score users and the public avoid misinterpretation of scores or other test results for individuals or groups, warning of any likely misinterpretations of the reporting scale. The NBCE publishes exam success rates for the past four years on its website, and provides chiropractic colleges with NBCE-related compliance information required by accrediting bodies. We provide score-related information to the licensing boards in each state. Finally, the NBCE provides score recipients with an appropriate frame of reference for evaluating the performance presented by test takers’ scores or other test results.

NBCE staff is a dedicated collection of professionals who work tirelessly and quietly, day in and day out, to serve students and the public, doing the work that advances the NBCE mission of ensuring professional competency through excellence in testing.

Mudslinging is easy; the work of the NBCE is not. While it would be impossible to correct here all of the errors in recent media, it is important that Stakeholders know the NBCE continues to do its work with diligence and excellence.

We look forward to open dialogue with the Delegates and other stakeholders to navigate the challenges we face consistent with the mission, vision and values of the National Board of Chiropractic Examiners.”



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