Since 1963 the Canadian Chiropractic Examining Board has conducted competency examinations for individuals seeking licensure to practice chiropractic in Canada. To maintain currency with changes in practice, examination content and methodology have been regularly updated since that time. This paper describes the process used by the Canadian Chiropractic Examining Board to restructure the examination to ensure it was current and to align it with the 2018 Federation of Canadian Chiropractic’s Canadian Chiropractic Entry-to-Practice Competency Profile.


A subject-matter-expert committee developed proposed candidate outcomes (indicators) for a new examination, derived from the competency profile. A national survey of practice was undertaken to determine the importance and frequency-of-use of the profile’s enabling competencies. Survey results, together with other practice-based data and further subject-matter-expert input, were used to validate indicators and to create a new structure for the examination.


The new examination is a combination of single-focus and case-based multiple-choice questions, and OSCE (objective, structured, clinical examination) methodology. Content mapping and item weighting were determined by a blueprinting committee and are provided.


Administration of the new examination commenced in early 2024.

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Author notes

Author Contributions Concept development: DC, AM, TT. Design: DC. Supervision: DC. Data collection/processing: SB, DC, AM. Analysis/interpretation: SB, DC, AM, TT. Literature search: DC. Writing: GB, SB, DC, AM, TT. Critical review: GB, SB, DC.

Supplementary data