TidalPrep › Guides › CSE strategy: how the clinical simulation exam works

CSE strategy: how the clinical simulation exam works

The Clinical Simulation Exam is ending, but not yet. If you passed the TMC at the high cut by December 31, 2026, you can still take the CSE through December 31, 2027.^[2] Here is how the CSE works and how to approach it.

CSE facts

• 22 problems: 20 scored plus 2 pretest problems, in 4 hours.^[1]
• Each problem has Information Gathering sections and Decision Making sections. Points are summed across the whole exam into one score compared with the cut score.^[1]
• "SELECT AS MANY as you consider indicated" sections: choose every option you think is appropriate, then move on. You cannot return to add choices.^[1]
• "CHOOSE ONLY ONE unless directed to make another selection" sections: pick the single best option; the software shows the result or asks for another choice.^[1]
• A virtual calculator is built in.^[1] In 2025, 63.6% of new CSE candidates and 53.0% of repeat candidates passed.^[3]
• Your alternative: take the RTE from January 4, 2027, and earn the RRT at its high cut.^[2]

Strategy

This part is our advice, not NBRC policy.

1. Information Gathering: choose what changes your next decision. Pick the assessments and tests that are indicated for this patient right now. Shotgunning every option can cost points, and skipping essential data can too.
2. Decision Making: treat the patient in front of you. Ask what is most urgent (airway, breathing, oxygenation) before long-term planning.
3. Read the scenario update after each choice. Patient status changes are clues about whether you are on the right path.
4. Don't fight a bad branch. If a choice was wrong, the next section often gives you the chance to recover. Reset and pick the best action now.
5. Pace yourself: 4 hours for 22 problems is about 11 minutes each. Use the on-screen clock.^[1]
6. Learn the software first. The NBRC offers a free practice exam.^[4]

Related

• From the CSE to RTE clinical judgment
• 2027 RTE FAQ
• NBRC exam day checklist

Sources

1. NBRC Candidate Handbook, rev. 09.08.26 (PDF)
2. NBRC: CRT and RRT, RT Examination page and FAQs
3. NBRC: 2025 Exams in Review (PDF)
4. NBRC: Free practice exams

Exam facts on this page come from nbrc.org and were last checked on October 30, 2026. The NBRC can change its policies at any time, so confirm details on nbrc.org before you apply or test. Written and reviewed by a practicing RRT for TidalPrep.