About NPLEX

The NPLEX (Naturopathic Physicians Licensing Examinations) is the examination graduates of one of the approved naturopathic medical colleges must pass to be eligible for licensure in any of the 16 states or 5 provinces that license/register naturopathic physicians. NABNE is responsible for qualifying applicants to take the NPLEX, administering the NPLEX to examinees, and preparing and sending exam results and transcripts to licensing/regulatory authorities.

ORGANIZATIONAL HISTORY OF NPLEX AND NABNE

Prior to 1986, each state and province that regulated the naturopathic profession prepared its own set of board licensing examinations. These examinations were prepared by naturopathic physicians who had no training in item writing and no expertise in test development. Furthermore, the content of each examination was left solely to the discretion of the exam preparers and did not necessarily test the knowledge required for safe naturopathic practice.

During its 1986 sunset review of the naturopathic licensing law, the Hawaii legislature indicated there should be a national examination, one that followed professional standards for testing. To respond to Hawaii's mandate and to address the needs of the growing number of jurisdictions that regulate the naturopathic profession, a group of volunteers established NPLEX. Although it was incorporated as an "examining board", the NPLEX Board was in fact responsible only for preparing and scoring the NPLEX examinations. Each jurisdiction determined eligibility to take the NPLEX and was responsible for administering the examinations, in effect, serving the role of examining board.

At the time, five states and three provinces had laws regulating the naturopathic profession, and two naturopathic medical programs in the U.S. were recognized by the Council on Naturopathic Medical Education (CNME). The original nine-member NPLEX Board had representatives from Arizona, Connecticut, Hawaii, Washington, British Columbia, Manitoba, John Bastyr College (JBC) in Washington, National College of Naturopathic Medicine (NCNM) in Oregon, and the American Association of Naturopathic Physicians (AANP).

From 1986 to 1990, NPLEX contracted with a series of national testing companies. The first of these - ACSI of the National Assessment Institute - conducted the original job (practice) analysis. The practice analysis is a survey sent to naturopathic physicians nationwide to determine the scope of current naturopathic medical practice. The nine blueprints derived from the original practice analysis are exam specifications that ensure that the areas being tested on the NPLEX examinations accurately cover the topics an entry level naturopathic physician can expect to encounter in practice. The examinations based on these blueprints form the core clinical science series now required by every state and province that regulates the practice of naturopathic medicine. The core examinations cover diagnosis (Physical & Clinical Diagnosis and Lab Diagnosis & Diagnostic Imaging), emergency response (Emergency Medicine & Public Health), and treatment (Botanical Medicine, Pharmacology, Physical Medicine, Clinical Nutrition, and Psychology). Three additional treatment examinations (Homeopathy, Minor Surgery, and Acupuncture) are also available for use by jurisdictions that have laws that specify these subjects in the scope of practice.

In its first three years, the NPLEX Board contracted with three different organizations to provide exam development and scoring services: ACSI, Columbia Assessment Services, and the Washington State Department of Health Testing Unit. From the beginning, all clinical items have been written by volunteers (naturopathic physicians who have, since 1994, been trained in the principles of writing multiple-choice items). The Board members served as exam chairs for the original seven core clinical and two clinical add-on examinations, reviewing and rewriting new items. The testing organizations put together the examinations, distributed them to the states, coordinated cutscoring sessions, and then scored the answer sheets. Each organization terminated its contract with NPLEX after a year because the number of examinees was so small in those first years that none could deliver the services in a cost effective manner.

Because there was no prospect of profiting from developing the examinations, the NPLEX Board could not find a fourth testing service willing to bid for the contract. The Board then hired a testing/executive director, took the exam production in-house, and began producing five basic science examinations in addition to the nine clinical examinations.

As the number of jurisdictions that regulated the naturopathic profession grew, the Board expanded. In 1993, when the Ontario College of Naturopathic Medicine became the Canadian College of Naturopathic Medicine (CCNM), NPLEX added representatives from CCNM, Ontario, and the Canadian Naturopathic Association (CNA). With only the eight jurisdictional representatives serving as exam chairs for 14 examinations (non-jurisdictional representatives were not allowed, at that time, to be exam chairs), most Board members were responsible for more than one examination, and all were (as volunteers) being overworked. Subsequently, NPLEX divided responsibility for the 14 examinations among all the Board members.

All Board members were appointed by the constituency they represented, and when Board positions opened up (either because a new jurisdiction passed a licensing law or because someone resigned from the Board), the constituency appointed a new representative. However, three issues arose:

First, NPLEX needed good exam chairs: people who knew how to write and review items, people who understood the psychometric principles of test development, and people who were committed to spending a significant number of hours in NPLEX activities. The problem was that when Board members resigned, the constituencies (i.e., the states, the provinces, the schools, etc.) appointed replacements who were not necessarily qualified to help NPLEX with its mission of producing excellent examinations.

The second issue was that each jurisdiction determined who was eligible to take the NPLEX. The criteria for eligibility differed from jurisdiction to jurisdiction and at least one jurisdiction approved an applicant who did not have the education and training to prepare him to be a safe practitioner. But because NPLEX did not determine who was eligible to take the examinations, it was forced - contractually - to allow the applicant to take the examinations. The NPLEX Board believed it was necessary to have strict national standards for eligibility to take the examinations.

Third, as the regulatory authorities were administering the examinations, NPLEX had no control over the security of the exam booklets once they were sent from the NPLEX office. Several security breeches occurred, each of which required that NPLEX remove a significant number of items from its item pool.

To address these issues, the NPLEX Board held a strategic planning meeting in July, 1998. The Board identified three aspects to the Board Examination Process:

  • The preparation of high quality examinations;
  • The articulation of a national policy regarding who should be eligible to take those examinations; and
  • The secure, fair, and standardized administration of the examinations.

At the strategic planning session, the Board decided that NPLEX was, first and foremost, an exam preparation organization. As such, the Board did not need to be representative of the constituencies, (i.e., having each constituency appoint a member), rather, it needed to be able to choose its own members, basing selection on ability and willingness to be a good exam chair. The responsibilities for setting policy and administering the examinations could more effectively be carried out by a separate body. It was at this level, that of a national examining board, that input from the various constituencies was vital. NPLEX committed to establishing an organization representative of the constituencies in the naturopathic profession, one that would set exam policies, approve applicants to take the NPLEX, and administer the examinations.

In 1999, NPLEX contacted all concerned constituencies for input into the development of an international - U.S./Canadian - examining board. Over the next year, the North American Board of Naturopathic Examiners (NABNE) was established. The five-member NABNE Board of Directors oversees the operation of the organization. The 25-member Advisory Council, comprised of representatives of all concerned constituencies, advises the Board regarding eligibility and exam administration policies. The original draft of NABNE exam policies was derived from the policies of all naturopathic regulatory authorities. In November 1999, the first NABNE Advisory Council meeting was held to discuss these policies and to make recommendations to the NABNE Board. In general, NABNE adopted the most stringent policies that had been established by any jurisdiction. For example, one jurisdiction required that if an examinee did not pass all the examinations in a series (Part I or Part II) within three attempts, s/he would be required to retake all the examinations in that series. Another jurisdiction required that if an examinee did not pass a majority of the examinations in a series (3 of 5 Part I - Basic Science Examinations or 5 of 8 Part II - Core Clinical Science Examinations), s/he would have to retake the entire series. NABNE adopted both of these policies even though each was the policy of only one jurisdiction. As another example, Hawaii does not currently require passage of the five Part I - Basic Science Examinations for licensure. However, in order to take the Part II - Clinical Science Examinations required by the Hawaii Board, NABNE requires that candidates must first have passed the Part I - Basic Science Series.

The first NABNE administration of the Part I - Basic Science Examinations was in January 2000, and the first NABNE administration of the Part II - Clinical Science Examinations was in August 2000.

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ABOUT NPLEX

NPLEX was formed in 1986 with the purpose of providing a national, standardized board examination to be used by all the states and provinces that have laws that regulate the naturopathic profession. Since that time, NPLEX has prepared Part II - Clinical Science Examinations that identify those individuals who have the knowledge and the skills necessary to be licensed as naturopathic physicians; these Part II examinations may be taken by candidates who have graduated from an approved naturopathic medical college. In 1990, NPLEX began to produce five Part I - Basic Science Examinations that may be taken by students who attend an approved naturopathic medical college to ensure that they have the knowledge foundation needed to enter the clinical phase of their training.

The NPLEX Part II - Clinical Science Examinations are based on blueprints (exam specifications) that are the outcome of a practice (job) analysis of the profession. The practice analysis surveyed naturopathic physicians in North America to identify the conditions encountered and the treatments provided in naturopathic medical practices. NPLEX conducted the original practice analysis in 1986, repeated the process in 1996, and is in the process of repeating the process again. NPLEX provides the resulting blueprints to the naturopathic medical schools for use in curriculum development, and to examinees for use in studying for the examinations.

Initially, NPLEX was governed by Board members who also served as exam chairs. In 2003, the structure changed to a five-member Board of Directors, responsible for oversight of the organization, and a 17-member Council of Exam Chairs (NCEC), responsible for oversight of the exam development process. Each member of the NCEC is responsible for a single examination. Since its inception, NPLEX has followed APA/AERA/NBME standards for exam development and scoring. To this end, NPLEX has:

  • Undertaken psychometric evaluation of all aspects of exam development;
  • Based the clinical examinations on a blueprint created from the results of a job analysis;
  • Trained more than 100 naturopathic physicians and basic science faculty in item writing techniques;
  • Used the expertise of a number of NDs, serving on four committees to review items individually and the examinations as a whole in order to ensure relevance and quality;
  • Trained raters and used standard criterion-referenced methods (Angoff) to set the passing scores on all examinations;
  • Conducted studies to assess criterion-related and construct validity;
  • Updated the original job analysis and revised blueprints in accordance with results;
  • Developed and implemented a compensatory model of passing standards in order to make better decisions regarding who has passed the examinations.

The existence of a valid national licensing examination is of vital importance when a group is seeking to pass a regulatory law. NPLEX follows the same standards as the National Board of Medical Examiners (for the USMLE), the National Board of Chiropractic Examiners, the National Board of Osteopathic Medical Examiners, and other healthcare professions. While continually working to improve the examinations, NPLEX is confident that the examinations serve the purpose of identifying those candidates who are ready to practice safely.

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DESCRIPTION OF THE NPLEX EXAMINATIONS

The five examinations (sections) in the Part I - Basic Science Series are designed to test the scientific skills and knowledge necessary for completion of clinical training. NABNE recommends that students take the Part I - Basic Science Series as soon as they complete basic (biomedical) science coursework, as this will give them sufficient time to take and pass the Part I - Basic Science Series before they apply to take the Part II - Clinical Science Examinations. NABNE requires that students pass the Part I - Basic Science Series before they may apply to take the NPLEX Part II - Clinical Science Examinations.

The NPLEX Part II - Core Clinical Science Examination is an integrated case-based examination that covers the following topics: physical, clinical, & lab diagnosis, and diagnostic imaging, botanical medicine, clinical nutrition, physical medicine, homeopathy, psychology, emergency medicine, and pharmacology. This examination is designed to test the skills and knowledge that an entry-level naturopathic physician must have in order to practice safely. Every jurisdiction that licenses naturopathic physicians requires that candidates pass the NPLEX Part II - Core Clinical Science Examination.

Two NPLEX Part II - Clinical Elective Examinations, Minor Surgery and Acupuncture, are optional, as they are not required for eligibility to become licensed as a naturopathic physician in all jurisdictions.

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THE NPLEX EXAMINATION PROCESS

DEVELOPING THE EXAMINATIONS

Exam items are written and referenced by NDs and other qualified professionals in the United States and Canada. Items are screened, reviewed, and rewritten as necessary by local exam committee members that include practicing NDs. New items are added to a computer item bank for each exam administration.

A Central Exam Committee reviews the assembled items, substitutes items where appropriate, and finalizes the content. Before being used, every item is reviewed by at least six NDs for accuracy, relevance, and appropriateness. The examinations are then sent to selected physicians for final proofreading. After corrections are made, exam booklets are produced and are sent to the test sites for administration.

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ESTABLISHING THE PASSING SCORE

Because NPLEX Examinations are criterion-referenced, each examination has a passing score that is independent of the passing scores of previous examinations. The Angoff method (a nationally accepted testing standard) is used to establish this score. Naturopathic physicians rate the difficulty of each exam item by answering the question, "What percentage of minimally competent examinees should be able to answer this item correctly?" These ratings are averaged to get a cut score for an exam item. Then the cut scores for every item in an examination are averaged to determine the cut score for each exam area. In addition, all cut scores are averaged to get an overall competency cut score. All cut scores are set before any answer sheets are scored. Examinations that are judged to be difficult will have lower cut scores than easy examinations (i.e., for a difficult examination, the examinee will be required to correctly answer fewer questions in order to pass).


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SCORING THE EXAMINATIONS

Due to the extensive post-test analysis process, it takes approximately six weeks to complete the scoring process. Exam answer sheets are scanned by an optical mark reader using the latest technology. Reports and statistics are calculated without reference to any individual’s scores. Summary reports provide item analyses and exam summary information for the post-test analysis (PTA).

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POST-TEST ANALYSIS

The purpose of the post-test analysis (PTA) is to review exam items that do not appear on the item analysis to perform as expected. The Exam Chair reviews the items that have been identified by statistical analysis as being potentially problematic. Standard reference texts are used to verify that the keyed answer is correct and that there is only one correct answer. Items are reviewed for clarity. The Exam Chair submits his or her recommendations to the PTA Committee, which makes the final decision regarding the disposition of the item. Credit may be given for more than one answer, or the item may be deemed valid and appropriate in which case no key changes are made. After a decision has been made about every item in question, changes are made to the scoring key and all examinations are re-scored. This process is done to ensure that the items on which the examinee's results are based are appropriate and fair.


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SUGGESTIONS FOR TAKING AN NPLEX MULTIPLE-CHOICE EXAMINATION

The NPLEX Part I - Basic Science Series is designed to test knowledge of anatomy, biochemistry & genetics, microbiology & immunology, pathology, and physiology. If the student takes these examinations at the end of the second year of naturopathic college, the information will be current and he or she will have the best chance of passing all five examinations (sections) in one attempt.

The NPLEX Part II - Core Clinical Science Examination is designed to test knowledge of: physical, clinical, laboratory diagnosis, diagnostic imaging, botanical medicine, clinical nutrition, physical medicine, homeopathy, psychology, emergency medicine & medical procedures, and pharmacology. The Part II - Core Clinical Examination is a case-based, integrated examination. A detailed patient case is presented and a series of questions are asked about that case.

The first step in preparing to take the examinations is to look at the exam specifications (blueprints) for the examinations. All exam items are multiple-choice with one correct answer and three distractors; however, the way the questions are asked may take any of several forms. The NPLEX Blueprint & Preparation Guide (Part I or Part II), which provides sample exam items that illustrate item formats, is the only guide that contains the correct information you will need to study to take the examinations. NPLEX does not endorse any other study guides.

The NPLEX Part I or Part II Blueprint & Preparation Guide can be obtained from the bookstore at an approved naturopathic college or can be purchased by sending a written request, accompanied by a money order in the amount of US$10 made payable to NPLEX to:

NPLEX - Study Guides (Part I or Part II)
Suite 119, #321
9220 S.W. Barbur Blvd.
Portland, Oregon 97219-5434

When preparing to take the NPLEX, there is no quick substitute for years of study. Cramming the night before the examination will usually not improve exam results; it is more important that you relax and get a good night's sleep. You should visit the test site prior to the day of examination to find out where to park and where the exam administration will be held. On the day of the examination(s), you should dress comfortably, arrive at the test site with plenty of time to spare, and expect to have some anxiety. Mild anxiety can actually add to mental alertness.

To avoid common errors associated with filling out the NPLEX exam answer sheet, you should keep these guidelines in mind:

  • Use only the #2 pencil provided.
  • Complete all sections that ask for your personal identification information and fill in the corresponding bubbles completely. If you neglect to fill in your name, the last five digits of your Social Security/Social Insurance Number, the correct exam number, etc., you may not be given credit for your answers.
  • Fill in the bubbles darkly and completely. If a mark is too light or fills only part of the bubble, the optical mark reader may score that item as unanswered, and you may not be given credit for your intended answer.
  • Erase all stray marks or smudges on your answer sheet.
  • Make sure that you have marked your answer for each item in the correct bubble on the correct line of your answer sheet. For example, if you mistakenly mark your answer for item #4 in a bubble on the line designated for item #5, all your remaining answers will be marked on the incorrect line.

You may write on the exam booklets, but all answers must be marked on your answer sheet. When time is called, you must surrender all exam materials to a proctor. You will not be given extra time to transfer answers from your exam booklet to your answer sheet. You will not receive credit for answers that you have indicated only on your exam booklet. These booklets are shredded immediately upon their return to NABNE.

When you encounter an item for which you do not know the answer with absolute certainty, you should try to eliminate some of the responses. If after eliminating one or two of the responses, the correct answer is still not apparent, you should make a best guess from among the remaining choices. Some of the items will be very challenging. You are not expected to answer every item correctly. Usually 60-70% of the items must be answered correctly in order for an examinee to achieve a passing score.

Some exam items are more time-consuming than others, and while you should have no trouble completing the entire examination in the time allotted, spending too much time on one item may make you feel pressured to speed through the rest. If you do skip an item, remember to skip a line on the answer sheet. Because the penalty for an unanswered item is the same as that for an incorrect response, it is wise to mark your best guess on a difficult item and return to it later if time allows.

For practice in taking multiple-choice examinations, you may want to review some of the commercially prepared review guides. However, one difference between these practice tests and the NPLEX is that NPLEX items have only four response choices with one correct answer; there are no complex multiple-choice items like those encountered in some other review guides, such as those for the USMLE.

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WHAT HAPPENS AFTER THE EXAM ADMINISTRATION

NPLEX has an extensive process of reviewing items on the examinations both before and after they have been administered. The following is an explanation of the process that occurs after the exam administration to insure that the examinee's score is based only on items that are valid.

  1. Answer Sheets are Returned to NPLEX.
    After the last examination has been given, the exam administrator returns the answer sheets to NPLEX.
  2. Answer Sheets are Scanned.
    Once the answer sheets arrive at NPLEX, they are scanned via an optical scanner. If the scanner cannot read any information on the answer sheet (personal information or answers) the scanning operator is alerted, the answer sheet is checked, and corrections are made. Even though examinees' names appear on the answer sheets, all scoring and analysis is done without reference to individuals or schools.
  3. Examinations are Computer-Scored.
    The computer calculates statistics for individual exam items and for each examination. Items are evaluated individually on the basis of three criteria: the percentage of examinees who chose the correct response, how well the item discriminated between examinees with high scores and those with low scores, and the spread of responses (i.e., the percentage of examinees who chose each response). Items that few examinees answered correctly, items that were poor "discriminators", and items for which equal numbers of examinees chose three or four responses are flagged for review.
  4. Statistics are sent to the Exam Chair for Review.
    For all flagged items, the exam chair uses standard reference sources to verify that the keyed answer is correct, that there IS a correct answer, and that none of the other response alternatives are correct.
  5. Examinations are reviewed in a Post-Test Analysis (PTA).
    After the exam chair has completed his or her evaluation, the flagged items are reviewed by a post-test analysis committee. The exam chair makes a recommendation as to the disposition of the item, and the PTA committee reviews the items for appropriateness and makes a final decision regarding the disposition of each. If an item is deemed ambiguous, credit may be given for more than one answer. Through this process examinees may be given credit for some items that did not appear to be valid. Consequently, examinees are not penalized for poorly constructed items. After the post-test analysis, changes are made to the answer key and the examinations are re-scored.
  6. Passing Standards (Cutscores) are Set.
    Cutscore committees review individual items to determine the number of items the examinee must answer correctly to pass. NDs determine how difficult each item is by rating it as to the percentage of minimally competent examinees who should be able to answer the items correctly. A very difficult item has a low cutscore (i.e., fewer examinees are expected to answer the item correctly) and an easy item has a high cutscore (i.e., most examinees are expected to answer the item correctly). The ratings of the difficulty of all exam items are averaged to determine the cutscore for each individual examination. Difficult examinations have low cutscores.
  7. Cutscores are Analyzed and Modified if Necessary.
    Each cutscore is subjected to analysis based on a formula that takes into account eight different aspects of the exam statistics (exam characteristics, rater characteristics, and cohort characteristics) in relation to the cutscore. Cutscores may be lowered if this analysis suggests that the original cutscore was set too high. Cutscores are NEVER raised, they can only be lowered. If a cutscore is lowered, more people will pass the examination. 

  8. Score Reports are Produced.

    • Part I - Basic Science score reports indicate the number of items the examinee answered correctly, the number of correct answers required to pass, and a scaled score (which allows comparability between scores on exams with different numbers of items, or for examinations with different cut scores). The report also provides a pass/fail designation for each individual examination.
    • Part II - Core Clinical Science score reports will include two categories:
      • Category 1 (General Exam Area) shows the examinee's overall passing status and his or her passing status for each of three general exam areas.  It includes a visual scale that illustrates where the examinee scored in each of the three general exam areas relative to the cut score.
        • Comprehensive Mastery indicates, with  either a "P" (Pass) or "F" (Fail) designation, whether or not an examinee has passed the NPLEX Part II - Core Clinical Science Examination by virtue of having achieved a minimum converted score of 75 in each of three general exam areas relative to the cutscore.
          • Diagnosis (which reflects the examinee's score on the exam items that relate to physical, clinical, & lab diagnosis, and diagnostic imaging).
          • Naturopathic Modalities (which reflects the examinee's score on the exam items that relate to botanical medicine, nutrition, physical medicine, homeopathy, and psychology).
          • Other Interventions (which reflects the examinee's score on the exam items that relate to emergency medicine and pharmacology).
      • Category 2 (Specific Exam Area) includes a visual scale that illustrates the examinee's performance in each of nine specific exam areas (physical & clinical diagnosis, lab diagnosis & diagnostic imaging, botanical medicine, nutrition, physical medicine, homeopathy, psychology, emergency medicine, and pharmacology).
    • Part II - Clinical Elective score reports indicate the number of items answered correctly, the number of correct answers required to pass, and a scaled score (which allows comparability between scores on exams with different numbers of items, or for exams with different cut scores). The report also provides a pass/fail designation for each individual examination.
  9. Exam Results are Sent to Licensing/Regulatory Authorities. Approximately six weeks after the exam administration, NPLEX gives the score reports to NABNE. NABNE sends Part I - Basic Science exam results to the examinees, and sends Part II - Clinical Science exam results to the examinee and to the single licensing/regulatory the examinee indicated his or her Part II - Clinical Science Exam Application.

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FEES FOR NPLEX MATERIALS AND SERVICES

  • Part I - Basic Science Blueprints & Preparation Guide  US$10 each
  • Part II - Clinical Science Blueprints & Preparation Guide   US$10 each
  • Request for Manual Scoring:
    • Part I - Basic Science Examination  US$20 per examination
    • Part II - Core Clinical Science Examination  US$50
    • Part II - Clinical Elective Examination  US$20 per examination

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ORDERING THE NPLEX BLUEPRINT & PREPARATION GUIDE

NPLEX Blueprint & Preparation Guides can be obtained from the bookstore at an approved naturopathic college, or can be purchased by sending a written request, accompanied by a money order in the amount of US$10 made payable to NPLEX to:

NPLEX - Study Guides (Part I or Part II)
Suite 119, #321
9220 S.W. Barbur Blvd.
Portland, Oregon 97219-5434

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REQUESTS FOR MANUAL SCORING

Because every answer sheet used for an NPLEX Examination is scanned by a state-of-the art optical mark reader, the possibility of a computer scoring error is negligible. However, after receipt of exam results, the examinee can request that NPLEX verify that the answers marked on the answer sheet(s) match the answers recorded by the scanner. A written request for response verification must be made within six (6) weeks of receipt of exam results.

A written request for a manual scoring of an examination must be made to NPLEX no later than April 30th (for examinations taken in February) and no later than October 31st (for examinations taken in August). The request must include your name, mailing address and contact information, the name of each NPLEX Examination you would like to have verified, and a money order made payable to NPLEX in the amount of US$50 for the Part II - Core Clinical Science Examination, and US$20 for each Part I - Basic Science Examination or Part II - Clinical Elective Examination. Send your written request to:

NPLEX - Manual Scoring
Suite 119, #321
9220 S.W. Barbur Blvd.
Portland, Oregon 97219-5434

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FREQUENTLY ASKED QUESTIONS

What are the mandate and terms of reference for NPLEX?

The NPLEX purpose is to provide excellent board examinations that are fair and valid, and will provide good indicators of a candidate's readiness to be a safe practitioner. NPLEX follows ALL testing standards set forth in the Standards for Educational and Psychological Testing (compiled by the American Educational Research Association, the American Psychological Association, and the National Council on Measurement in Education). These are the standards endorsed by the Council on Licensure, Enforcement, and Regulation (CLEAR - a North American organization, of which NABNE/NPLEX is a member).

At the current time, all of the 16 states and 5 provinces that regulate the naturopathic profession recognize NPLEX as the examination that will ensure that physicians who are licensed meet minimal competency standards. NABNE and NPLEX have been endorsed as the standard for the profession by the Council on Naturopathic Medical Education (CNME), the American Association of Naturopathic Physicians (AANP), and the six naturopathic medical colleges recognized by the CNME.

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How are the NPLEX Board of Directors and Exam Chairs selected?

The five-member Board of Directors is responsible for the operations of the organization and is elected from the 16-member NPLEX Council of Exam Chairs (NCEC). The 16 members of the NCEC, in conjunction with the NPLEX Director of Exam Development, are responsible for the exam development process. When a position on the NPLEX Council of Exam Chairs (NCEC) is open, NPLEX first considers people who have served as volunteers on one of the committees (Local Exam Committee, Central Exam Committee, Cutscore Committee) to see if anyone meets the qualifications for the position (i.e., appropriate degree in a basic science field, or notable knowledge in the content area of the specific examination). If no one is identified, NPLEX widens its search and takes suggestions from current NCEC members. NPLEX has very little turnover and so the Board has never had to look further than the current NPLEX volunteer base, or recommendations from NCEC members. However, if in the future an exam chairmanship was open for which there were no nominations from these two resources, NPLEX would advertise the (volunteer) opening with the AANP and CNA.

Once a person has been nominated for the position, s/he is asked to serve as chair for the next examination. If the nominee completes this task in a timely and competent manner, s/he is interviewed by the NPLEX nominating committee. Three or four references are contacted. If the nominee meets the criteria, s/he is invited to attend the next NPLEX meeting where s/he meets all the NCEC members and both the NCEC and nominee determine if it is a good fit. The NCEC then votes whether or not to approve the person. NCEC members are evaluated every few years to ensure continuing performance as an exam chair.

NPLEX has very little turnover in its organization, and 9 of the members on the current Board were either original Board members or were appointed by some constituency. The others have been chosen based primarily on their expertise in the exam area and their willingness to volunteer the significant number of hours required. In its selection process, the Council does, however, also look at a number of other factors:

  • If the exam chair is an ND, naturopathic medical college attended (there are currently three graduates of CCNM, five from Bastyr, four from NCNM, and two from SCNM)
  • Licensing jurisdiction (there are currently three members from Arizona, one from British Columbia, one from Colorado, one from Connecticut, one from Hawaii, three from Ontario, and four from Washington)
  • Sex (there are currently eight men and seven women, with one exam chair position open)

How does NPLEX ensure that the examinations are fair and valid?

Since 1990, NPLEX has focused on developing procedures to ensure that national testing standards are followed. NPLEX follows AERA/APA/NCME standards for test development and administration. Extensive analyses of exam performance and passing scores have led to refinement of systems. NPLEX has completed two criterion-related validity studies of the Clinical Science and Clinical Elective Examinations, and has twice redone the original job analysis.

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