How to Pass the Clinical Simulation Exam (CSE) Vector

How to Pass the Clinical Simulation Exam (CSE) (2024)

by | Updated: Apr 20, 2024

Passing the Clinical Simulation Exam (CSE) is a requirement for respiratory therapy students to obtain the Registered Respiratory Therapist (RRT) credential.

This rigorous exam tests not only theoretical knowledge but also the depth of clinical judgment and decision-making skills in simulated patient care scenarios.

This explains why the CSE is known as one of the most difficult examinations in the medical field, with a pass rate of approximately 63% for new candidates.

The key to passing the CSE lies in a strategic approach that involves thorough preparation, mastery of cardiopulmonary disorders, and critical thinking skills.

This article is meant to provide aspiring respiratory therapists with effective strategies and practical tips on how to prepare for (and pass) the CSE.

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What is the Clinical Simulation Exam (CSE)?

The Clinical Simulation Examination (CSE) is an essential component of the credentialing process for respiratory therapists in the United States. Administered by the National Board for Respiratory Care (NBRC), the CSE is designed to assess a candidate’s clinical competency and ability to apply knowledge, skills, and judgment in simulated clinical scenarios.

Clinical Simulation Exam Structure

Each CSE problem represents a clinical scenario or patient situation that is designed to simulate real-life scenarios in the clinical practice of respiratory care.

Being eligible to take the CSE means you already passed the TMC Exam with a high-cut score. Therefore, as you know, the TMC Exam covers a wide range of topical content.

The CSE covers the same topical content, but it examines your knowledge in a totally different way by focusing on disease management in individual patient scenarios.

In other words, the CSE is designed to test your patient management skills and ability to evaluate ongoing treatment, recommend changes, and adapt to circumstances and events.

Therefore, to accomplish this, the CSE displays each problem in a unique format compared to the traditional multiple-choice questions that we’re all used to.

CSE Sample Problem

Here is how each problem will appear on the CSE:

CSE Sample Practice Problem
Three windows will appear on the screen at all times during the exam:

  1. Scenario
  2. Options window
  3. Current section

The first window displays the “Scenario” at the top of the screen, along with your beautiful picture that will be displayed in the upper right-hand corner.

Each problem begins with a brief paragraph in this window providing preliminary patient information. The following sections will display information about the patient’s changing situation.

Each Scenario window will also provide you with specific instructions about whether to “CHOOSE ONLY ONE” response in the section or to “SELECT AS MANY” responses as appropriate to gather information.

It is extremely important that you carefully follow these instructions.

The “Options” window is displayed in the lower left portion of the screen. This window contains all options, choices, or possible responses that you can choose from.

You can select an option by clicking the check box next to each option.

The third window is the simulation history window…

The “Current Section” window is displayed in the lower right portion of the screen. This window shows the options chosen in the current section, and the results for each choice are displayed in this window.

It also shows the “Simulation History” from all previous sections, including the options you selected.

When you finish a section, you can hit the “Go To Next Section” button at the bottom left of the screen to move on to the next section.

A pop-up will appear, asking you to confirm if you want to continue to the next section. Be sure to only click the “Yes” button when you are 100% ready to proceed because you can’t go back.

Note: A timer box is shown in the lower right portion of the screen, which displays how much time you have left to finish the exam. If this is distracting, you can hide this box simply by clicking on it.

Clinical Simulation Exam Components

Clinical Simulation Exam Components Illustration
Each CSE problem has three components:

  1. Scenario
  2. Information Gathering
  3. Decision Making

The “Scenario” establishes the setting and general parameters. The “Information Gathering” section provides information about the patient that is normally obtained in chart review or diagnostic testing, such as vital signs, ABG results, etc.

This is the decision point that you will need to recommend what happens next for the patient.

After being given the “Scenario,” you must use the “Information Gathering” section to access the patient and make an analysis and evaluation according to the information provided.

Then, the “Decision Making” process requires you to decide and recommend what happens next for the patient.


The “Scenario” describes the physical setting for you, the respiratory therapist, and the patient. This may include the setting (e.g., hospital, clinic, patient’s home, ICU) and the time of day.

This section also provides important general information about the patient, such as:

  • Age
  • Sex
  • General appearance
  • Presenting condition

This section may also provide information about the patient’s medical history and briefly explain their current illness or circumstances.

While reading the Scenario, the first thing you want to do is interpret if the situation is an emergency. If there is an emergency, remember that you must take immediate action to help the patient.

If you determine that there is no emergency, then you can proceed to gather more information to make a clinical decision.

Information Gathering

The “Information Gathering” section allows you to learn more details about the patient. This section lists 15-20 options to choose from, which could include the patient’s vital signs, ABG results, PFT results, and various lab studies.

You must only select those that are important and relevant for the patient, given what you learned from the “Scenario.”

You must avoid selecting anything that could be dangerous for the patient. Therefore, you must strive to avoid selecting anything that you know is unnecessary or not relevant to the patient at this time.

Try to select only the most relevant and essential information.

Once you click an option to make a selection, it will reveal the results of what you clicked on the screen. For example, if you select that the patient needs an ABG, as soon as you click that option, it will reveal the patient’s ABG results on the screen.

Then, if necessary, you can act immediately. For example, if the ABG results reveal respiratory failure, you should immediately recommend intubation and mechanical ventilation.

During the “Information Gathering” section, you should always be on the lookout for a medical emergency. If you notice signs and symptoms of a medical emergency, you must act promptly to help the patient.

If there is no emergency, you can proceed to gather more information.

Decision Making

After making selections in the “Information Gathering” section, you will be directed to the “Decision Making” section. This is where you’ll make the final decision for the patient, given what you’ve learned during the other steps.

You will typically be asked to choose from 4-5 options and must make the best possible selection for the patient.

After making a selection, it will usually say: “Physician Agrees. Done.” However, in some cases, it could possibly say: “Physician Disagrees. Make another selection.”

If so, please do not panic! This does not necessarily mean that you made the wrong selection.

Some problems are just designed to take you through another step. Therefore, if this happens, you must proceed to choose the best option using the information that you have available.

After making a decision, you will be directed to the next scenario. This alternation between “Information Gathering” and “Decision Making” usually cycles back and forth around 4-5 times for each problem.

Note: You must read the scenario carefully, gather the necessary information, and then make the best possible decision for the patient.

Clinical Simulation Exam Scoring

The Clinical Simulation Exam (CSE) is fully computer-based and has a 4-hour time limit. The exam has a total of 22 problems that are selected from 7 different categories:

  1. Adult Chronic Airway Diseases
  2. Adult Trauma
  3. Adult Cardiovascular
  4. Adult Neurological or Neuromuscular
  5. Adult Medical or Surgical
  6. Pediatric
  7. Neonatal

Note: Two of the problems are pretested scenarios that are individually scored based on the judgment of the NBRC. The remaining 20 problems count toward an individual’s actual score.

Clinical Scenario

Each CSE problem represents a clinical scenario or patient situation that is designed to simulate real-life scenarios in the clinical practice of respiratory care.

One unique characteristic of this exam is that each version is unique. This means that each version will have a different minimum passing score, which is decided by the testing committee.

More than half of the total points that you can earn will come from the selections you make in the ‘Information Gathering’ sections.

To pass the exam, your final score must exceed the minimum passing score for your unique exam. The average passing score is approximately 72%.

That doesn’t sound so bad, right?

The scoring system for the CSE runs from +3 points to -3 points. In other words, you can earn up to 3 points, or you can lose up to 3 points, depending on your selections or lack thereof.

How to Earn Points

There is typically one best available answer to earn a maximum of +3 points. This selection is always necessary for proper patient care, and not selecting it could cause harm to the patient.

You can earn +2 points for choosing the essential selections that benefit the patient. You can earn +1 point for any other helpful selections.

Note: You get 0 points for any selections that are neither helpful nor harmful. In other words, this will not help nor hurt your overall score.

How to Lose Points

You will lose -1 point for selecting anything that is counterproductive. You will lose -2 points for selecting anything that is very counterproductive.

You will lose -3 points for selecting anything that is detrimental or harmful to the patient.

Therefore, you must strive to only make selections that earn you points and avoid those that cause you to lose points.

Note: That’s why it’s essential for you to learn and understand both the topical content and disease management of the pathological conditions that we will cover throughout this course.

How to Pass the Clinical Simulation Exam (CSE)

Student who passed the Clinical Simulation Exam (CSE) Vector
Passing the Clinical Simulation Exam (CSE) isn’t easy, but it’s definitely achievable with the right approach and mindset.

This challenging exam is designed to test not just your knowledge, but your ability to apply that knowledge in complex clinical situations, making thorough preparation and practice essential.

Here are effective strategies and practical tips to enhance your chances of earning a passing score:

  1. Understand the Exam Format
  2. Master the Content
  3. Develop Critical Thinking Skills
  4. Practice Time Management
  5. Utilize Helpful Resources
  6. Study Strategically
  7. Learn from Practice Scenarios
  8. Maintain a Positive Mindset

Understand the Exam Format

Understanding the unique format of the CSE is crucial for success. The CSE differs from traditional exams as it uses simulated clinical scenarios to assess your ability to apply knowledge and make critical decisions in real-life situations.

It comprises three main windows: Scenario, Options, and Current Section, each playing a unique role in presenting the problem and allowing you to interact with the exam.

Familiarizing yourself with this format helps in navigating the exam more efficiently, ensuring that you can focus on applying your knowledge rather than figuring out the mechanics of the test.

Master the Content

Mastering the content covered on the CSE is essential. While the exam focuses on clinical scenarios, the foundational knowledge required spans across a wide range of topics you have learned.

This includes understanding the disease processes, diagnostic methods, treatment options, and patient management strategies.

Deep diving into each category ensures you’re well-prepared. Utilizing resources like textbooks, study guides, and reputable online content can enhance your grasp of the necessary material.

Develop Critical Thinking Skills

Developing critical thinking skills is key to excelling on the CSE. The exam challenges you to not only recall information but to apply it in complex, often changing scenarios.

This involves analyzing the given patient information, making informed decisions, and anticipating outcomes.

To hone these skills, engage in practice scenarios that mimic the exam’s format, critically evaluate case studies, and discuss different approaches with peers or mentors.

Learning to think like a practicing respiratory therapist will enable you to navigate the exam’s decision-making components more effectively.

Practice Time Management

Effective time management is pivotal on the CSE due to its comprehensive format and the need to make timely decisions.

With a 4-hour limit to navigate through 22 problems, it’s important to allocate your time wisely to avoid rushing or spending too much time on one scenario.

Learning to quickly read and interpret scenarios while leaving adequate time for decision-making can significantly improve your performance.

Utilize Helpful Resources

When it comes to passing the CSE, finding the right study tools can make all the difference. That’s where our CSE Boost Course comes into play.

It’s a comprehensive program packed with over 50 video lessons and some pretty awesome bonuses, all aimed at boosting your scores and getting you past the finish line.

We’ve designed it to cut through the noise and zero in on what you really need to know for the exam.

Plus, with a track record that speaks for itself, it’s clear why so many students choose our course when they’re ready to tackle the CSE with confidence.

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Study Strategically

Studying strategically involves more than just covering the material; it’s about focusing on your weaknesses and turning them into strengths.

Which topics were your weak points on the TMC Exam?

Identify those areas and prioritize them in your study plan for the CSE. If, for example, you found patient assessment or mechanical ventilation challenging, dedicate extra time to these topics.

Additionally, set specific, achievable goals for each study session to keep track of your progress.

Remember, the key is not just to study more but to study smarter by actively engaging with the material and applying it in practice scenarios.

This approach will not only prepare you for the CSE but also equip you with valuable skills for your future career as a respiratory therapist.

Learn from Practice Scenarios

Using practice scenarios is an essential strategy to prepare for the CSE. These scenarios mirror the complexity and format of the actual exam, offering a hands-on opportunity to apply your knowledge in simulated clinical situations.

By engaging with practice scenarios, you’re not just studying; you’re practicing the art of critical decision-making under pressure.

Each scenario challenges you to integrate your theoretical knowledge with practical application, helping you identify areas where you may need further review or a different approach.

Visit the NBRC website for a free CSE practice exam to familiarize yourself with the format and type of questions you’ll encounter on the actual exam.

Maintain a Positive Mindset

Keeping a positive mindset is essential when preparing for the CSE. It’s easy to feel overwhelmed by the volume of material and the pressure of the exam.

But remember, your attitude can significantly impact your study efficiency and exam performance.

Focus on your progress, celebrate small victories, and remind yourself of your capability to overcome challenges. Incorporate stress-relief techniques like exercise, meditation, or hobbies into your routine to stay balanced.

Surround yourself with positive support from friends, family, or fellow students who encourage your efforts.

Approach your studies and the exam with optimism and resilience, believing in your ability to succeed.

This positive mindset isn’t just about feeling good; it’s a powerful strategy to enhance learning, boost confidence, and navigate the CSE with a clear, focused mind.

Final Thoughts

Passing the Clinical Simulation Exam (CSE) is a formidable yet achievable goal for any student striving to become a Registered Respiratory Therapist (RRT).

By focusing on understanding the exam’s structure, mastering the relevant content areas, developing your critical thinking and decision-making skills, and utilizing available resources, you can significantly improve your chances of success.

It’s also important to manage your study time efficiently, concentrate on your weak areas, and maintain a positive and resilient mindset throughout your preparation journey.

Remember, the goal of the CSE is to prepare you for the realities of respiratory therapy practice, ensuring you have the skills and judgment necessary to provide high-quality care.

With dedication, persistence, and a strategic approach to your study and preparation, passing the CSE is within your reach, opening the door to a rewarding career as a respiratory therapist.

You’ve got this, and don’t forget, we’re rooting for you every step of the way!

John Landry, BS, RRT

Written by:

John Landry, BS, RRT

John Landry is a registered respiratory therapist from Memphis, TN, and has a bachelor's degree in kinesiology. He enjoys using evidence-based research to help others breathe easier and live a healthier life.