The NBRC 2027 exam change for RT programs

The NBRC 2027 exam change replaces two credentialing examinations with one. From January 1, 2027, graduates of CoARC-accredited respiratory therapy programs sit a single Respiratory Therapy Examination that awards the CRT or the RRT depending on the score. For program directors the change reaches further than the exam itself: it moves clinical judgment into a multiple-choice format, closes the CRT-to-Registry route, and arrives in the same month as new CoARC accreditation standards. This article sets out what changes, the dates that govern the transition, and what a program can do in the months before it.

What the Respiratory Therapy Examination replaces

Under the current structure, credentialing takes two steps. A graduate sits the TMC, which awards the CRT at its lower cut score and opens eligibility for the CSE at its higher one. The CSE, a set of clinical simulation problems, then awards the RRT. From January 2027 both steps collapse into one sitting.

The NBRC has said it is keeping credentialing standards where they are, neither raising nor lowering difficulty. Its stated aim is to "further minimize barriers to graduates as they enter the profession while maintaining the standards of excellence". It also notes that under the old structure a candidate who stopped at the CRT could bypass a deep assessment of clinical judgment. The single examination closes that path: every candidate now meets the judgment section.

How the clinical judgment section is organized

The depth section keeps the four elements the NBRC used to build the CSE:

• Patient types: chronic airways disease, trauma, and cardiac.
• Settings: in-hospital and out-of-hospital.
• Patient ages: neonate, pediatric, and adult.
• Clinical activities: information gathering and decision making.

What changes is the format. Candidates will meet these elements as multiple-choice items rather than as simulation problems. The breadth section follows the same content domains and cognitive levels as the current TMC, so most of a program's TMC preparation carries over unchanged.

The practical consequence sits in the second year of a program. Practice built around the CSE's problem format will need to become case-based multiple-choice practice, in which a student gathers information about a patient and then commits to a decision. It also needs to reach all four elements, including the neonatal and out-of-hospital patients that a given rotation schedule may not supply in volume.

The transition calendar: three dates

• December 31, 2026. The last day to pass the TMC at the high cut score and keep the CSE route open. The CRT-to-Registry admission policy also ends: from 2027, a candidate without the RRT needs at least an associate degree from a CoARC-accredited entry-into-practice program to sit the new examination.
• January 1, 2027. The Respiratory Therapy Examination launches, and CoARC's 2027 Accreditation Standards for Entry into Respiratory Care Professional Practice take effect.
• December 31, 2027. The final day to sit the CSE, open only to candidates who passed the TMC at the high cut score by the end of 2026. They may take the new examination instead at any point after January 1, 2027.

Because the new examination replaces the TMC from January 2027, a class graduating in 2027 will sit the Respiratory Therapy Examination. The choice between routes falls to students who can pass the TMC at the high cut score before the end of 2026, and advising should put that choice to them explicitly rather than leave it to the application portal. Student handbooks that describe credentialing as a TMC-then-CSE sequence will also need revising before the 2027 class reaches its final term.

What happens to CoARC outcome measures

CoARC's published outcome thresholds still define credentialing success against the TMC high cut score: 60 percent of graduates, measured as a three-year average. Retention carries a 70 percent threshold, also averaged over three years. A program below either threshold must develop a plan of action for improvement under Standard 3.09. RRT credentialing success is reported on the annual report, but CoARC takes no accreditation action on it.

The thresholds page does not yet say how a three-year average will treat cohorts that sat the TMC alongside cohorts that sat the new examination. CoARC has posted FAQs on its 2027 Standards and scheduled live question-and-answer sessions in September 2026. A program close to a threshold should put that question to CoARC directly rather than infer the answer, and keep the reply on file for its self-study.

A checklist for program directors

• Identify students who could pass the TMC at the high cut score before December 31, 2026, and advise them on the choice between the CSE and the new examination.
• Tell current CRTs without an associate degree that the CRT-to-Registry route closes on December 31, 2026.
• Map second-year cases against the four clinical judgment elements and note the gaps, especially neonatal and out-of-hospital patients.
• Replace CSE-format practice with case-based multiple-choice practice that asks students to gather information and then decide.
• Keep breadth preparation aligned to the TMC content domains, which carry over.
• Ask CoARC how credentialing success will be calculated across the transition, and record the answer.

Where simulation fits

The 2027 change raises a curriculum question more than a testing one: how students get enough varied, case-based practice in clinical judgment before they sit the examination. Rotations give depth with real patients, but a program cannot schedule a neonatal emergency or an out-of-hospital transport on demand, and faculty time for one-to-one case rehearsal is finite.

SimMedAi, our AI clinical simulation platform for allied health programs, includes respiratory therapy among the roles it covers. A program planning for 2027 can scope a pilot around one cohort and one term at the pilot process. The free licensure map at the licensure map shows how respiratory therapy is regulated across the jurisdictions a program's graduates may practise in.