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Why have a licensure exam?

Why do licensing boards require passing the NPTE for licensure? Why isn’t graduation from a CAPTE-accredited program sufficient?

There are a few points that need to be considered when answering this question:

  • Purpose of exam

    The purpose of the NPTE is different from the purpose of physical therapist (PT) or physical therapist assistant (PTA) programs. The programs’ primary purpose is to educate PTs and PTAs. The educational component provides a broad range of knowledge, education and skills, including a clinical component, so that PTs and PTAs understand the role of physical therapists and physical therapist assistants in providing healthcare to patients. Programs teach skills and knowledge that might not be used by entry-level practitioners, but will be used as individual becomes more experienced.

    The NPTE's specific purpose is to protect the public by testing candidates on the minimum knowledge and education necessary for safe and competent entry-level work; it does not include a clinical component.

  • Pressures and requirements

    Programs can be subject to many different pressures – the pressure to graduate a certain number of students or to maintain a certain passing rate on the NPTE are two that come to mind.

    Development of the NPTE is subject to a different requirement – the Federation must be able to provide evidence to licensing boards that the NPTE is a valid and reliable tool for measuring entry-level competence of PTs and PTAs.

  • Standards

    Even though all programs are accredited by CAPTE, there is variation in programs. This includes coursework and grading standards. The NPTE provides licensing boards with one standard to which everyone is held accountable.

  • Competence

    Completion of a broad educational program and passing a specific exam that measures entry-level competence provides licensing board members with the assurance that they are licensing or certifying competent entry-level practitioners who will be able to grow and mature in their profession.

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Can my students test prior to graduation?

Another way to prepare your students is to communicate with your state licensing board to find out whether it allows students to take the NPTE prior to graduation. Some states allow this option if the school provides the proper paperwork.

  • Temporary licensure

    Some states also allow students to practice during the period between graduation and the state receiving the results of their NPTE; others do not allow unlicensed personnel to practice for any reason. Check with your licensing board to see if this is an option and what the procedures are for obtaining a temporary license.

  • Licensure Reference Guide

    Get a quick overview of each state’s rules and regulations on taking the NPTE prior to graduation and temporary licensure. Always check with your state to ensure you have the latest information.

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Is the NPTE licensure testing program still accredited?

Yes, the Federation’s NPTE program continues to hold Stage One and Stage Two accreditation from the Buros Institute for Assessment Consultation and Outreach (BIACO), a not-for-profit organization that provides independent evaluation of testing programs’ adherence to standards of quality essential for development and administration of fair, valid, and reliable tests.

  • Accreditation process

    The accreditation process includes submission of materials to BIACO auditors describing the NPTE program’s organizational structure, test development and other important details. Stage One accreditation also confirms FSBPT’s adherence to the BIACO Standards for Proprietary Testing Programs, which are based on testing industry standards and guidelines.

  • External review

    The Federation welcomes external review as an essential step in maintaining a high-quality testing program and providing assurance to the public, the Federation’s member licensing boards, and test candidates that the NPTE is a fair, valid, and reliable test.

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Why not use “free” NPTE practice questions found on the Internet?

Students need to be very, very cautious when finding "free" sample questions on the internet or in chat rooms.

  • Theft

    One reason to avoid using, soliciting or disseminating such materials is theft of copyrighted materials. Just because a website offers test questions as a sample doesn't mean that the questions aren't copyrighted. These questions may be test questions stolen from a combination of legitimate test preparation courses, FSBPT's practice exam and assessment tool (PEAT) and the NPTE itself. Each copyright owner has the right to pursue legal action (including monetary damages) for copyright violation. FSBPT has, more than once, pursued legal action against individuals and companies that used copyrighted questions from PEAT or the NPTE.

  • Quality assurance

    Important questions should be asked about the quality of free items found on the internet. Writing effective test questions is extremely time consuming and requires considerable skill. Using poorly written test questions as preparation strategy may be detrimental to students' ultimate success.

The content outline provides detailed information about what content will be on the exam, and in what proportion. In addition, candidates might want to attend a legitimate test preparation course, purchase a copy of PEAT or participate in group study opportunities with classmates or others preparing for the NPTE.

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Why are examinees limited to taking the NPTE three times in a twelve-month period?

Our current test administration policy was implemented in 2005 in response to recommendations from an external commission convened in 2003 to review FSBPT’s test development and administration procedures. The commission recommended that FSBPT limit the total number of attempts to three to address test security and score validity concerns.

  • Control item exposure

    The policy addresses test security by controlling item exposure – controlling the total number of candidates who see the live test questions in a given test administration period. The commission cited item exposure, the availability of the Internet for sharing test experience information and the use of websites for test preparation activities as three factors which, in combination, made restricting the number of attempts a serious security need.

  • Assemble test forms

    FSBPT combined this test administration policy with a specific plan to assemble test forms to drastically reduce the number of times a candidate could see a given item.

By combining the two strategies, FSBPT can increase the assurance that a candidate’s test score is a reasonable representation of his or her underlying knowledge rather than access to live test content prior to the administration. Increasing score validity benefits candidates, jurisdictions and employers.

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NPTE Development

I have heard that the questions on the NPTE take a long time to develop and validate. Since the profession of physical therapy is rapidly changing and is becoming much more evidence based, how do you assure that the questions on the exam are current?

It is critical that a high stakes licensing examination covers current practice. While it is a challenge to maintain this currency, the item writers and exam committees work very hard to assure the exam reflects current practice. Currency is maintained via the following steps:

  1. The exam blueprint or content outline is revised at a minimum of every five years. The exam blueprint determines the content of the exam and assures that the content is relevant to current practice.
  2. Currency is stressed at item-writer workshops; item writers are required to reference questions to recognized authoritative texts that have been published within the past five years.
  3. Items are not used where there may be conflicting references or viewpoints in the literature
  4. An item goes through committee review multiple times and each time, it is reviewed for currency.
  5. The item goes through a final review for currency (among other things) prior to each and every time it is being released as an operational question.

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Linking admissions criteria to performance on NPTE

As a PTA program, we maintain very high admissions criteria for our students. However, with the increased pressure to admit diverse populations as well as the pressure to admit most anyone at the community college level, we are having a hard time justifying this standard. Have there been studies linking admission criteria to performance on the PTA exam?

Most of the studies looking at admission criteria and pass/fail performance on the NPTE have been focused on physical therapist programs. However, several researchers are beginning to look at this topic related to PTA programs. You may want to contact your colleagues to see what efforts are being conducted related to NPTE performance of PTA programs.

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Are NPTE questions getting harder?

I have heard that the NPTE questions have gotten harder over the last couple of years due to better item writer training. Is this true?

Test questions are NOT becoming more difficult. High quality items are more difficult to answer correctly for students who do not know the material. However, individual test questions on the NPTE are not becoming more difficult. The FSBPT monitors item- and form-level difficulty as a standard part of its psychometric procedures. Test forms are assembled to be as similar as possible with respect to content and difficulty.

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Do NPTE items have more than one right answer?

I have been told that the exam is structured in such a way that there are two "right" answers, but that one is a better choice. Is the exam scored using a partial credit model to account for an individual who might select the less favorable of the correct choices? Or is it an all-or-none credit system?

There is only one correct answer for each question. The item writers and exam committees go through great lengths assuring that there is one correct answer and three incorrect answers. Each option must be backed up with a rationale and reference as to why it is either correct or incorrect. Beyond this, statistics are collected on the item that also helps support the one correct answer. There is no “partial credit” for an answer. It is either correct or incorrect.

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Recalled NPTE questions

A question from a student: As an exam candidate who just completed my examination, I recall several questions on the exam where I was not sure of the answer. Is it ok for me to discuss the questions with my instructor?

On the surface, it may seem natural for you to go to a faculty member to discuss specific questions on your licensing examination. You may want to be assured that you answered the item correctly. You may also be motivated to “learn from mistakes” and a discussion of the question could be a productive learning experience. This is particularly true if you find you have failed the exam. You certainly want to pass the next time! However, by doing this you are putting yourself and your instructor in jeopardy.

  • Every item on the exam is copyright protected

    When a candidate takes the exam, the candidate agrees not to share any question or part of a question with anyone else. Good intentions do not nullify this agreement or the copyright protection of the exam. The bottom line is that it is illegal for a candidate to share a test question with an instructor or anyone else.

You might say: “Ok, so it is technically illegal, but what is the harm if I discuss the item with my instructor? I can trust her. She would not share the information. So, no harm no foul.” Basically, it is not for you to decide when you can break the law or when you can’t. The law is the law.

A parallel question from an instructor: Can I talk to my students about the NPTE after they have taken it?

  • Discussing specific items are a violation

    Certainly general comments about the exam are not a violation of copyright law. However, if your students discuss specific items or specific characteristics of the exam with you, they are in violation of the confidentiality terms that they agree to when they take the exam. Included in these terms is not disclosing the content of examination items. Legal action could be taken against candidates who violate these terms including criminal prosecution. Ultimately the student may risk being able to ever obtain a license.

Educators may unwittingly cross the line by asking students questions about the exam or by listening to a student share a question from the exam. It is important that educators defend the integrity of the licensure process by making students and colleagues aware of these critical issues and reporting violations when they occur. You can also report any violations to security@fsbpt.org.

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Enhancing NPTE test items

Currently, the NPTE contains questions that include graphics. Does the Federation have plans to add other testing technologies such as “hot spots” or video?

The Federation has been exploring other testing formats for some time. While we have the technical capabilities of utilizing these formats, we are not planning on adding these types of test questions in the immediate future. These types of questions create a host of additional issues and complexities.

For example, a question that requires the examinee to review to a video clip of a gait pattern and determine the dysfunction may seem like the perfect question for a physical therapy licensing examination. However, before such a question can be used, several issues have to be addressed:

  • How much time needs to be allowed for a question that requires the viewing of a video as compared to a standard multiple-choice question?
  • How many times should the candidate be allowed to re-run the video?
  • Is the video clip clear enough that all candidates are able to see the action-taking place clearly?
  • How does one account for the psychometric differences between the video question and other questions?

We continue to explore whether additional test formats provide us with better information related to the competency of the entry-level physical therapist.

Can you provide the background on the 20 PT NPTE scores that were invalidated in 2007?

The following information was taken from the “News and Events” section.

Forensic Analysis Conducted to Investigate Effect of Trafficking in Recalled Test Items Leads to Invalidation of 20 Candidate Test Scores

On Friday, August 17, 2007, the Board of Directors of the Federation of State Boards of Physical Therapy approved the invalidation of 20 candidates’ National Physical Therapy Exam (“NPTE”) test results. This decision resulted from an extensive forensic analysis of the test performances of all candidates who sat for the NPTE between March 1, 2005 and June 5, 2007.

The forensic analysis, conducted by Caveon, a test security company, was commissioned in response to the unlawful trafficking of NPTE questions by Philippines-based exam prep centers. Through its own private investigation efforts, as well as Philippines government surveillance and raids of two Manila test centers in January 2007, FSBPT has confirmed that the centers have distributed to customers compilations of actual NPTE test questions memorized and shared by prior test takers (“recalled items”). In an effort to assess the potential effects of this practice of using recalled test items, Caveon analyzed approximately 23,512 test performances of all NPTE candidates, regardless of place of education.

Caveon’s analysis conclusively establishes that at least twenty individuals benefited unfairly from advance access to recalled test items. All twenty candidates are Philippines-educated, some but not all of whom are already licensed to practice physical therapy. FSBPT’s assessment and review of the Caveon forensic analysis is continuing, so as to determine whether additional candidate score invalidation is appropriate.

In identifying these twenty candidates, the forensic analysis used three statistical indices to identify aberrant candidate performances. First, performance on compromised test questions (those known to be compromised by distribution at Philippines-based test prep centers) was compared to performance on non-compromised test items. Second, the similarity among candidate response choices was examined, with higher degrees of similarity suggesting the possibility of prior knowledge of test content. Third, the analysis computed the probability that each test taker had attended a course at which recalled items were used. In each case, the percentage of candidates flagged as aberrant was highest for Philippines-educated test takers.

FSBPT limited the universe of “aberrant” test performances under each of the three indices to those test results whose likelihood of occurring by chance was at least 1 in 10,000 (one in ten thousand). The twenty invalidated candidate scores are those that appeared aberrant based on all three statistical indices. The likelihood of aberrant performance on all three statistical indices is extremely unlikely and at least less than 1 in one million.

“As with every decision we’ve made in addressing the troubling use of recalled items, the FSBPT Board did not take this action lightly,” stated E. Dargan Ervin, Jr., FSBPT President. “We made the decision only after careful consideration of the issues and in light of the overwhelming statisical data that calls into question the legitimacy of these scores.”