What does the NPTE Passing Score Reflect?

Setting a passing score involves the process by which a performance standard is established. The passing score typically reflects the test score corresponding to a desired level of performance and is used for making decisions about what level of performance is high enough for a given purpose. The passing scores established for the national physical therapy licensure examinations (NPTE) reflect the level of performance required to provide minimally safe and competent physical therapy services by physical therapists and physical therapist assistants.

Individuals scoring at or above the passing score have met the performance standard and are eligible for licensure, and individuals scoring below the passing score have failed to meet the performance standard and are not yet eligible for licensure. The term “passing score” is used interchangeably with the terms cut score and performance standard.

Passing Scores are Policy Decisions

There really is no “true” passing score that can perfectly differentiate candidates who are competent to practice physical therapy in a safe and effective manner from those who cannot. The passing score is the product of a deliberative process of the experience and the judgments of people who are qualified to make those judgments. Setting a passing score is a policy decision related to the mission of the organization, in this case, to ensure that the public is protected from practitioners who are not competent. That policy decision must keep in mind that one must make certain the bar is not so high that it prohibits individuals who do have the necessary knowledge and skills from being able to enter the profession. Public protection must weigh the trade off between ensuring there are enough practitioners to meet the needs of the public while also ensuring those practitioners are safe and effective.

Ensuring the Score is Defensible

Establishing a performance standard is critical because of its impact on individuals, and numerous steps must be taken to ensure that the score is defensible. The Standards for Educational Psychological Testing contains criteria for establishing defensible passing scores, which have been endorsed by many organizations as the standard for practice both in terms of defensibility and best practices in our field. Included among the criteria are the qualifications of individuals participating in the setting of performance standards, the procedures by which performance standards are set, and the efforts made to validate the results of the standard setting process on an ongoing basis. All of these criteria combined are intended to ensure that the process is documented and defensible.

Establishing a passing score, including standards for passing the NPTE, involves six steps.

1. Deciding on a method that is appropriate for the test.
2. Selecting qualified participants (individuals in the profession considered well qualified in their practice).
3. Training participants on the standard-setting method.
4. Providing feedback about participants’ judgments in carrying out the method.
5. Determining an appropriate passing score taking into consideration the panel’s recommendations.
6. Gathering validity evidence that is intended to bear on the question, “Do the candidates who are awarded the license or the credential seem to be the kinds of people who actually possess the kinds of characteristics important for practice?”

Choosing a Method

FSBPT uses criterion-referenced methods to set and review the passing standards. Criterion-referenced methods require participants to answer the question “What does a candidate have to know and be able to do to perform entry-level physical therapy safely and competently?” In years past, FSBPT has used a “modified Angoff” method to set the standard. In 2023, FSBPT used a modified Bookmark method to review the passing standard. Both of these methods are professionally accepted and well-researched. FSBPT uses an external facilitator to ensure these processes are carried out with a high degree of fidelity.

Selecting Participants

The next step is to select qualified participants who are representative of the profession. Participants are selected to be representative of the profession in terms of practice setting, specialty, geographic location, race and gender. Participants also are required to be knowledgeable about how the NPTE is developed.

Training Participants

The standard setting process involves multiple rounds of training, group discussion, and feedback. Elements of the training typically include the following.

• Having the participants take a shortened version of the NPTE to remind them of the difficulty of taking a comprehensive examination.
• Familiarizing participants with the NPTE Content Outlines, especially those elements that have changed from the previous content outlines.
• Several rounds of discussions of the hypothetical concept of the “Just Qualified Candidate” (JQC), or the candidate who is just barely able to practice safely and effectively. In other words, the JQC is someone who just passes the NPTE (gets a 600). This discussion includes specific examples of works activities that minimally competent candidates would and would not be able to perform.
• Training in the judgment task required of the standard setting method, including a novel task with a clear answer and a practice round with NPTE items.

Rating Task

For previous standard setting meetings, participants estimated the percentage of the hypothetical Just Qualified Candidates who would (rather than should) answer each question correctly. This method was very difficult for participants and tended to result in extremely high passing standards in the first round of the process. In 2023, the move to the Bookmark method to provide more relevant information up front and simplify the rating task. In the Bookmark method, participants review and virtual “Ordered Item Booklet” (OIB), wherein each question in an NPTE examination form is ordered from easiest to most difficult. Participants go through the booklet to determine the last question they think the JQC would be expected to answer correctly. That point is where they place their “bookmark” and is statistically interpolated to derive the passing score for the exam. We also provided participants with the bookmark page representing the current standard as well as bookmark pages that would correspond to the lowest passing percentage and highest passing percentage observed over the last ten years. This method provides information about the relative difficulty of the exam questions, the current passing standard, and the impact of different standards up front, and in a way that is easier for them to use than the Agoff technique.

Feedback and Subsequent Ratings

After the initial round of ratings is completed, we present the range of bookmark placements and facilitate a discussion of the reasons why participants placed their bookmarks where they did, referring back to the description of the JQC to reconsider their ratings. We also present the impact of the ratings on the proportion of first-time CAPTE=educated candidates who would pass the NPTE. This process usually goes through three rounds, and we gather participant feedback to the process to clarify any areas of confusion or misunderstanding.

Recommendation, Adoption, and Implementation

At the completion of the standard setting panel meeting, we gather feedback from the participants to describe what aspects of the practice analysis and resultant description of the JQC were influential in making any adjustments to the NPTE passing standard. Our facilitator prepares a report for the FSBPT Board of Directors, and the Board considers the recommendation and adopts a passing standard for the NPTE. That passing standard is then used to define minimum passing scores (in terms of number of correct answers) on each subsequent NPTE form using an equating process. Using this process, every NPTE form is of equivalent difficulty.

Reviewing the Passing Standard

Each time we publish a new set of content outlines for the NPTE, we review the passing standard. Additionally, if there are major changes to the profession in between content outlines, the FSBPT Board can empanel a task force to review the passing standard. The passing standard must always be consistent with the minimal competence required to practice physical therapy in a safe and effective manner..