Predictors Of First-Time National Board Passage For Respiratory Therapists

Date of Award


Degree Name

Doctor of Philosophy


Educational Leadership, Research and Technology

First Advisor

Louann Bierlein Palmer, Ed.D.

Second Advisor

Jianping Shen, Ph.D.

Third Advisor

Karen Kain, Ph.D., RRT


National boards, pass rates, respiratory therapy, TMC


Respiratory therapists fulfill a vital role that saves and improves lives. To achieve recognition for their knowledge, unique skills, and dedication to clinical excellence, they must pass a series of national board exams. Achieving credentials from the National Board of Respiratory Care (NBRC) is a challenge, a true testament to the skills and strengths required for excellence in the profession. The problem prompting this study is the number of respiratory graduates who are not passing the Therapist Multiple Choice (TMC) exam on their first attempt. The goal of respiratory programs is to prepare graduates for success on the TMC exam and given declining pass rates, efforts are needed to identify factors that may be contributing to the decline.

The purpose of this quantitative research study was to examine the extent to which selected academic and non-academic variables can predict success or failure on the national boards for graduates who have graduated through a required respiratory therapy associate's degree curriculum in two Midwest states community colleges.

his study employed a non-experimental, ex post facto research design that included 264 graduates from two associate degree respiratory programs from January 2015 through December 2020. A stepwise logistic regression procedure was performed, eliminating the explanatory variables to significantly predict success or failure on the TMC's first-time attempt. Key results included a positive relationship between four academic variables involving students’ grades within four courses (Pre-Program Biology A&P, Pharmacology, Cardiovascular Physiology, and Neonatal and Pediatric Critical Care) and TMC first-time pass success. For every one-point change in the Pre-Program Biology grade, the log odds of pass vs. failure on the TMC increased by 8.42. For every one-point change in the Pharmacology, the log odds of pass vs. failure on the TMC increased by 3.55. For every one-point change in Cardiovascular Physiology grade, the log odds of pass vs. failure on the TMC increased by 7.20. For every one-point change in the Neonatal and Pediatrics grade, the log odds of pass vs. failure on the TMC increased by 6.65. The odds of accurately predicting TMC outcome was 91.9% of the time using the four significant variables.

This research results can be used to enhance respiratory therapy programs' admission policies, remediations, mentoring, and curriculum development. In addition, increasing the number of graduates who complete the TMC on the first attempt and promptly join the respiratory therapist workforce will demonstrate positive social changes by mitigating the respiratory therapist shortage promoting safe patient care. Importantly, it adds to the literature on these complex issues, in which no previous research had been found examined associate degree respiratory therapy programs, and thus it is of significance to that population.

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