Beginning in January 2027, the National Board for Respiratory Care (NBRC) will retire the current exam structure and introduce a single, comprehensive examination known as the Respiratory Therapy Examination.
This new format will combine what was previously assessed across two separate exams—the Therapist Multiple-Choice (TMC) and the Clinical Simulation Examination (CSE)—into one streamlined test.
Designed to uphold the high standards of the Certified Respiratory Therapist (CRT) and Registered Respiratory Therapist (RRT) credentials, this change aims to reduce barriers for graduates entering the field while maintaining the integrity and rigor of respiratory care certification.
Why the Change?
In 2027, the NBRC will implement one of the most significant changes in its credentialing process in decades. But this isn’t a sudden shift—it’s part of an ongoing effort to modernize the exam process.
Back in 2015, the Board eliminated the second multiple-choice exam that candidates once had to pass to earn the RRT credential. Now, they’re taking it a step further by removing the Clinical Simulation Exam altogether.
The goal? To make the path to becoming a respiratory therapist more efficient and less intimidating—without sacrificing the quality or integrity of the profession. This single-exam format is designed to reduce testing fatigue, lower entry barriers, and streamline the credentialing experience for students entering the field.
What is the Respiratory Therapy Examination?
The new Respiratory Therapy Examination will officially launch in January 2027 and will serve as the sole pathway for earning either the CRT or RRT credential. This exam replaces the current dual-exam system—no more separate Therapist Multiple-Choice (TMC) and Clinical Simulation Examination (CSE). Instead, candidates will take one exam, and their score will determine which credential they receive.
The test will feature 160 scored multiple-choice questions designed to assess both foundational knowledge and critical clinical decision-making. The exam will be split into two sessions of two hours each, with a 10-minute break in between. However, candidates who complete the first section early can move straight into the second, and the break is optional.
Credentialing will be based on two distinct cut scores:
- Candidates who achieve the lower cut score will be awarded the Certified Respiratory Therapist (CRT) credential.
- Candidates who reach the higher cut score will earn the Registered Respiratory Therapist (RRT) credential.
Note: This format allows for a smoother testing experience while still distinguishing between entry-level and advanced competencies.
How the Exam Will Be Structured
The new Respiratory Therapy Examination will be built to test not just what candidates know but how well they can apply that knowledge in real-world clinical situations.
That’s why the exam will be divided into two major sections:
1. Breadth of Knowledge
This section will assess a candidate’s foundational understanding of respiratory care. It will cover core content areas similar to those found in the current Therapist Multiple-Choice (TMC) Examination. Expect questions based on:
- Pathophysiology
- Equipment and procedures
- Diagnostic testing
- Patient assessment
- Treatment strategies
Note: These questions will evaluate recall, application, and analysis-level thinking, ensuring a comprehensive understanding of the profession.
2. Depth of Clinical Judgment
This section is designed to replace the Clinical Simulation Examination by incorporating questions that test a candidate’s ability to make sound clinical decisions. These multiple-choice questions will reflect real-life scenarios involving:
- Different patient types (e.g., trauma, COPD, cardiac)
- Varied settings (hospital, emergency transport, home care)
- All age groups (neonatal, pediatric, adult)
- Critical clinical activities, including gathering relevant patient data and making appropriate decisions
Note: While the simulation format is gone, the essence of clinical thinking and judgment is still deeply embedded in this section. The goal is to ensure that all credentialed therapists—whether CRT or RRT—can demonstrate safe and effective clinical reasoning.
What This Means for Current and Future Candidates
If you’re currently pursuing your CRT or RRT credential—or planning to start your journey soon—this change may impact how you approach your exam strategy, depending on your timeline.
Here’s what you need to know:
- Before December 31, 2026: Candidates can still follow the current pathway. That means you can take the TMC Exam, and if you pass at the high cut score, you’ll be eligible to take the Clinical Simulation Examination (CSE). If you pass both, you’ll earn the RRT credential.
- Between January 1, 2027 and December 31, 2027: If you’ve already passed the TMC at the high cut score before the end of 2026, you’ll still be able to take the CSE to earn your RRT through the end of 2027.
- After January 1, 2027: The new Respiratory Therapy Examination becomes the only option. You’ll take one comprehensive exam. Your score will determine whether you earn the CRT or RRT credential—no separate simulation exam is required.
This new system may be a welcome change for students who have found the CSE to be stressful or difficult to schedule. It simplifies the process while still ensuring high standards for entry into the profession.
However, the new clinical judgment questions will still require you to think critically and apply your knowledge under pressure—just in a new format.
Maintaining High Standards
One of the biggest questions surrounding the exam changes is whether the new format will make it easier to earn the CRT or RRT credential. The NBRC has made it clear: this is not about lowering the bar. It’s about updating the testing format to reflect modern educational practices without compromising the integrity of the credentials.
In fact, future CRT candidates will now face a higher standard than before. Under the current system, individuals could earn the CRT credential without ever being tested on in-depth clinical judgment, as that portion was reserved for the CSE.
But starting in 2027, everyone will need to demonstrate some level of clinical decision-making ability—even to earn the CRT.
As for the RRT credential, the bar remains high. Candidates must still meet the rigorous performance expectations that have defined the RRT designation since 1961. The only difference is that these skills will now be evaluated through advanced multiple-choice questions rather than the simulation format.
Note: This change reflects the NBRC’s commitment to producing competent, well-rounded respiratory therapists who are ready to handle real-world challenges across all patient types and care settings.
FAQs About the New Respiratory Therapy Examination
What is the Name of the New Exam for Respiratory Therapists?
The new exam is officially called the Respiratory Therapy Examination. It will replace both the current Therapist Multiple-Choice (TMC) Examination and the Clinical Simulation Examination (CSE), combining them into one comprehensive test.
This change, set to take effect in January 2027, is part of the NBRC’s effort to simplify the credentialing process while maintaining high professional standards.
The exam is designed to assess both the broad knowledge base and the critical clinical judgment skills necessary for respiratory therapists, making it the single pathway to earning either the CRT or RRT credential based on performance.
How Many Questions Are on the Respiratory Therapy Examination?
The Respiratory Therapy Examination will consist of 160 scored multiple-choice questions. These questions are carefully designed to evaluate both the candidate’s general knowledge and clinical decision-making skills.
The exam is divided into two sections: one focused on the breadth of respiratory care knowledge and the other on the depth of clinical judgment. The entire exam is administered over a four-hour period, broken into two two-hour sessions.
Note: This format allows for a thorough and balanced assessment of a candidate’s readiness to practice as a Certified or Registered Respiratory Therapist, depending on their overall score.
What Is the Time Limit for the Respiratory Therapy Examination?
The Respiratory Therapy Examination has a total time limit of four hours, which is divided into two separate two-hour sessions. Candidates are given the option to take a 10-minute break between the sessions, although it is not mandatory. If a candidate finishes the first section early, they may proceed to the second section immediately without waiting.
This flexible format is designed to provide a more comfortable testing experience while still maintaining a structured schedule. It allows examinees to manage their time efficiently as they navigate through 160 multiple-choice questions that test both knowledge and clinical judgment.
How Are the CRT and RRT Credentials Awarded to Candidates?
The Respiratory Therapy Examination uses a dual cut score system to determine which credential a candidate earns. Those who achieve the lower cut score will be awarded the Certified Respiratory Therapist (CRT) credential, which demonstrates entry-level competence.
Candidates who reach the higher cut score will earn the Registered Respiratory Therapist (RRT) credential, indicating a more advanced level of knowledge and clinical skill.
This approach eliminates the need for separate exams while still clearly distinguishing between the two levels of professional achievement. It ensures fairness and consistency in how credentials are awarded moving forward.
What If I Pass the TMC Exam at the High Cut Score but Don’t Complete the CSE Before December 31, 2026?
If you pass the Therapist Multiple-Choice (TMC) Exam at the high cut score before December 31, 2026, but do not complete the Clinical Simulation Examination (CSE) by that date, you’ll still have a grace period. The NBRC will continue to offer the CSE through December 31, 2027, giving you an additional year to complete the current pathway to the RRT credential.
Alternatively, if you prefer, you may take the new Respiratory Therapy Examination after January 1, 2027, and earn the RRT credential by scoring at or above the new high cut score. Both paths remain valid during the transition period.
Final Thoughts
The upcoming changes to the NBRC credentialing system mark a major milestone in the evolution of respiratory care education and testing. By replacing the traditional TMC and Clinical Simulation Exam with a single, comprehensive Respiratory Therapy Examination, the NBRC aims to reduce barriers for new graduates while preserving the rigor and credibility of the CRT and RRT credentials.
This new exam format offers a more unified approach to testing knowledge and clinical judgment, ensuring that every respiratory therapist entering the field—whether as a CRT or RRT—has demonstrated essential competencies in both areas. While the format is changing, the expectations remain high.
If you’re a current student or a future candidate, now is the time to stay informed, adjust your study strategy, and prepare for a more integrated exam experience. As 2027 approaches, the NBRC will continue to release updates, so keep an eye on their website and social channels for the latest information.
Change can be challenging, but it also brings opportunity—and this one is designed to support your success as you step into a vital role in healthcare.
Written by:
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.
References
- Registered Respiratory Therapist (RRT). The National Board for Respiratory Care. 2025.