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From the clinical simulation exam to RTE clinical judgment
If you studied for the Clinical Simulation Exam (CSE), the 2027 Respiratory Therapy Examination will feel different. The branching simulations are gone. Clinical judgment is now tested inside the same multiple-choice exam, in a section the NBRC calls Depth of Clinical Judgment.
Then: the CSE
The CSE has 22 problems (20 scored and 2 pretest), each simulating a clinical setting and patient situation, with four hours to finish.[2] It remains available through December 31, 2027, only for people who passed the TMC at the high cut score before December 31, 2026.[4]
Now: Depth of Clinical Judgment on the RTE
The NBRC says the clinical judgment section is organized around the same elements as the simulation exam: patient types, settings (in hospital and out of hospital), patient ages (neonate, pediatric, adult), and clinical activities (information gathering and decision making). The entire exam is assembled from independent multiple-choice items.[1]
Per the Detailed Content Outline, each clinical judgment item is linked to a patient condition, a clinical judgment type, a setting, and a task from the Breadth of Knowledge section. These items are written only at the application or analysis level, not recall.[3]
The 60 items, by the numbers
| Patient condition | Items per form |
|---|---|
| Adults | 50 |
| Chronic lung disease (intubation and invasive ventilation 5, noninvasive management 6, outpatient management 3, evaluation for a new diagnosis 3) | 17 |
| Trauma | 4 |
| Cardiovascular | 5 |
| Neurological or neuromuscular | 4 |
| Medical (infectious disease 5, ARDS 5, other 5) | 15 |
| Pre- and post-operative care | 5 |
| Children | 10 |
| Pediatric | 4 |
| Neonatal (resuscitation 3, respiratory distress syndrome 3) | 6 |
| Clinical judgment type | Items |
|---|---|
| Information gathering: "choose what to assess or interpret information" | 20 |
| Decision making: "decide what to add, modify, continue, or discontinue" | 40 |
| Setting | Items |
|---|---|
| In a hospital | 46 |
| Outside a hospital | 14 |
Across the whole 160-item exam, 15 to 18 items involve neonatal or pediatric patients. Each clinical judgment item pool includes at least 3 ethics items, though a given form may not include one.[3]
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How to practice for it
This is our advice, based on the outline above.
- Decision making is two-thirds of the section. Practice "what should you do next?" questions more than "what is this?" questions. For every answer, ask: add, change, continue, or stop?
- Information gathering is still a skill. Know which assessment or test answers the question being asked, and how to read the result.
- Chronic lung disease and medical patients are 32 of 60 items. COPD, asthma, infections, and ARDS deserve the most time.
- Don't skip outside-hospital care. 14 items are set outside the hospital: think clinic, home care, rehab, and discharge planning.
- Answer like the textbook, not your unit. Items reflect standard references and national guidelines, not local protocols.
How TidalPrep's cases work
To be clear: the real exam scores independent multiple-choice items. Our "cases" are a study format, not a copy of the exam format. Each TidalPrep case follows one patient through 5 linked multiple-choice items with updates between them. Every item is tagged as information gathering or decision making, in or outside the hospital, and mapped to its outline section, so your results show which kind of judgment you miss. Each choice has a written rationale.
Start free: 50 questions