The “Nice to Know” among the “Need to Know” of the TMC and CSE

Picture of a brain

It’s no secret that both the Therapist Multiple Choice (TMC) exam and Clinical Simulations Exam (CSE) are designed to be challenging.

Atop your RT education which no doubt took grit to finish, you now are faced with the seemingly daunting task of passing one of the most important tests of your career… and, your RT career cannot really even begin until you have made it past the infamous National Board for Respiratory Care (NBRC) exam.

Remember, you must have credentials in order to gain professional licensure in most States in the US, so you may as well do it (the test) right the first time.

If you’re reading this article, however, it may be likely you just missed the mark on either the TMC or CSE, but all is well. Have no fear. You will hopefully find some good insights that put you over the edge into confidence and ultimately success on these important exams, regardless of whether you may think they have been written just for your demise.

Remember, the NBRC supplies a detailed matrix for a reason. These matrixes, readily available on their website ( under the “Document Library”, are essentially your study guide for the exam.

If you are not spending a significant amount of time pouring over the exam matrix, you are throwing away the best opportunity to see an outline of the actual board exam.

Also, you can even identify the relative proportion of questions from each section and the cognitive level (aka. level of difficulty) to be tested for each – see example below in which there are 2 recall-level, 1 application-level and no analysis-level questions in the section testing “Perform Quality Control Procedures”

NBRC exam testing matrix
The above image is a direct extraction from the publicly-available NBRC TMC matrix and copyright of the National Board for Respiratory Care.

The NBRC also supplies a free practice TMC and partial CSE on their website. Additionally, you have the option to purchase a mock TMC or CSE exam directly from the NBRC which closely mimics the actual exams.

On the matrix, you’ll notice greyed out blocks. This indicates there is no item tested for that topic. For instance, in the example above, under the section C. “Perform Quality Control Procedures”, from the 1 application level question tested under this subject matter, it would fall under either of the following subject matter: “Blood analyzers”, “Mechanical ventilators” or “Noninvasive monitors”. There are 2 recall-level questions from this same section and no analysis-level questions for this section.

In regards to CSE matrix, there is no specific number questions known, but you will encounter 22 total scenarios, 2 of which are not graded. Each of these scenarios include a subset of questions that build based upon your decisions.

In summary, if you are not meticulously pouring over the provided matrix prior to testing, you are voluntarily ignoring the equivalent of the NBRC’s version of their exam study guide. Also keep in mind that, according to the matrix, there are several sections that contain subject matter to which a significant portion of the exam is devoted.

Not only does the popular opinion of both graduates and RTs alike concur that the CSE exam is most daunting of the 2 main NBRC exams, but the statistics also confirm this to be true. If you have already passed the TMC exam at the higher cut score (92/140: 66%) and are preparing for the CSE, it cannot be stressed enough that practice makes, well almost, perfect. 

About Tim Gilmore, PhD, RRT, RRT-NPS, RRT-ACCS, CPFT, AE-C 1 Article
Dr. Gilmore is an Associate Professor of Cardiopulmonary Science (CPS) and the CPS Program Director at Louisiana State University Health Shreveport. He holds a PhD in Health Science from Nova Southeastern University, a Masters in Health Sciences and BS in Cardiopulmonary Science from LSU Health Shreveport and an AS in Respiratory Therapy from Bossier Parish Community College (BPCC). Dr. Gilmore’s research interests include ICU care, mechanical ventilation, asthma, and patient education. He is a member of the Louisiana Society for Respiratory Care, American Association for Respiratory Care, and National Board for Respiratory Care. He is a Registered Respiratory Therapist with specialty credentials as a Neonatal Pediatric Specialist and Adult Critical Care Specialist, with national certifications as a Pulmonary Functions Technologist and Asthma Educator. He also serves as a peer reviewer for Respiratory Care Journal and an item-writer for the NBRC.