A History of the Physical Therapy Examination

By Eileen Bach, PT and John Wadsworth, PT
Forum, Volume 16, Number 1

PRE-HISTORY

We are pleased to inform you that the beginning of the national physical therapy exam is way, way before our time. So we bring you a perspective of the past two-plus decades and welcome, in advance, feedback and details from any “old-timers” in the audience. This is a background painted in the broadest strokes on a national level; we are sure that on the jurisdictional level, there are many more interesting historical perspectives on the exam.

THE REGISTRY EXAM TO THE NATIONAL PHYSICAL THERAPY EXAM (NPTE)

Before 1950, physical therapists took a registry examination for licensure, which was eventually replaced with the exam now known as the National Physical Therapy Examination (NPTE). The NPTE, developed by committees of the American Physical Therapy Association (APTA) in conjunction with Professional Examination Service (PES), was administered at the state level by paper and pencil on three possible examination dates per calendar year. By the 1970s, the PT exam was 300 questions in three parts and administered in all 50 states, District of Columbia, Puerto Rico, and Virgin Islands. Each part was timed and in a separate packet; in addition, scoring was based on a normative model so there were virtually many different passing scores for each administration of the examination. The exam was often called the “PES” exam.

TRANSITIONING FROM APTA TO FSBPT

In the late 1980s, the tiny organization known as the Federation began negotiating with the American Physical Therapy Association to purchase the exam. While there is loads of background here, not to mention a few great stories that the Federation’s founding members can share, the end result was a huge change for the examination program.

During this transition period, the APTA completed the work of the 1986-88 analysis of the practice (the last analysis being over a decade old), chose a new testing company, Assessment Systems Incorporated (ASI), and moved the examination program base from New York to Philadelphia. The new exam blueprint first administered in 1990 now had 200 questions in one part for PT and 150 questions for PTA with timeframes adjusted for fewer questions. There were still only three testing dates annually and the model for scoring remained normative so the variations across the nation on passing scores continued.

We were both members of the APTA Committee on Licensure Examinations of CLE in the mid to late 1980s. We learned a tremendous amount while working on the exam program. Thinking about correct answers and items becomes a way of life and the exam committees spend a great deal of time working in consensus and occasionally, in veto (see more about that in later articles!). It is a tremendous compliment to both the FSBPT and APTA that the transition moved forward so smoothly. While the exam committee’s names and acronyms changed, the exam work continued without missing a beat.

THE EXAM BELONGS TO FSBPT

Once the Federation took over the examination officially in 1991, things really got hopping!

• A new test company was chosen when the 3-year contract with ASI ended, and a familiar name, PES, was back in the mix.
• A new organizational examination structure was implemented which strengthened the validity and reliability of the exam developed for the PT and PTA.
• A new broad analysis of practice for both exams was started in 1995 and completed in 1996. It may be abnormal to mark the passage of time by job analysis but we’re excited to be involved in our third one. The results of the job analysis produced a blueprint that was available as a linear computer based test as well as a paper and pencil test.
• Paper-and-pencil testing had become increasingly at risk for examination security breaches. The goal was a complete transition to Computer Based Testing (CBT). The move to CBT was only possible with a correlative move to criteria referenced scoring, which allowed the setting of one standard passing score, or “cut” score. CBT was made possible by working intensely with PES and a new partner Prometric (formerly Sylvan), the host of computer testing centers.
• This dramatic change to CBT greatly enhanced our exam consumers’ satisfaction on two main areas – one, the exam on computer was now available six days a week at over 200 plus locations (and you could take the exam in any location regardless of where you applied for licensure) and two, a passing score in one jurisdiction was a passing score absolutely everywhere.

ASSUMING MORE DIRECT RESPONSIBILITY

Over the past several years, the Federation has assumed more direct responsibility for some key components of the NPTE and implemented significant efficiencies and workflows. Score transfers, whether a score from last year or from 30 years ago, are now processed in less than 2 days on average. In the past few months, application processing and score reporting have moved to the Federation. Despite some roller coaster twists and turns at the start-up, applications and scores are being reported in a fast, efficient manner in a matter of less than 3 days per application and scores are going out five days a week instead of once per week.

MOVING TO A NEW SCORING METHOD

2000 has been an extremely busy year for NPTE activities as well. Historically, the summer time was the long dreaded period of new exam forms starting existence and a delayed score reporting of several weeks or longer until the exam forms could be finalized. A new scoring method, Item Response Theory (IRT), was implemented a few months ago that eliminated the summer delays. The IRT process was made accessible by the psychometric expertise at PES and by the redoubled item development of the exam committees.

VOLUNTEERS ARE AT THE CORE OF THE PROCESS

The wonderful intricate process of developing the NPTE is based on the devoted efforts of a great group of volunteers. They write, reference, edit review, and enhance items to help create a quality examination. They collate, conference, create, collaborate and credential the items, the exam and the pre-test items. They make volunteerism an art form and we are all indebted to their efforts. All the efforts and innovations continue to move the construction, administration, and scoring of the NPTE forward.