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Exam Development & Scoring

The development of a credentialing exam such as the BOC exam is a complex process involving many subject matter experts. Understanding the process can lead to improved performance on the exam.


  • The purpose of the BOC exam is to assess candidates' knowledge in the five domains of athletic training as defined by the current BOC Role Delineation/Practice Analysis:
    • Injury/Illness Prevention and Wellness Protection
    • Clinical Evaluation and Diagnosis
    • Immediate and Emergency Care
    • Treatment and Rehabilitation
    • Organizational and Professional Health and Well-being
  • The questions are written, validated and reviewed by a panel of content experts in coordination with psychometricians. Each question is referenced to at least two textbooks that can be found in the BOC Exam References.
  • Questions for the certification exam are prepared by a committee made up of BOC Certified Athletic Trainers (ATs). Each question is validated by a panel of independent judges in item writing groups, referenced to current resources from the literature on or related to athletic training and repeatedly edited by ATs for clarity and content. Questions satisfy the exam specifications of the current BOC Role Delineation/Practice Analysis.
  • Questions are developed to assess the candidate's knowledge on subject matter from the five domains of athletic training. Each question is also subjected to editing for grammar and technical adequacy by experts from the BOC's testing agency. Thus, content experts write the questions and validate their appropriateness for the exam, and experts in testing review the questions to ensure that the questions perform as intended.
  • The BOC certification exam contains a combination of 175 scored and unscored (experimental) items including:
    • Stand-alone multiple-choice questions
    • Stand-alone alternative items (drag-and-drop, text based simulation, multi-select, hot spot, etc.)
    • Focused testlets
      • A 5-item focused testlet consists of a scenario followed by 5 key/critical questions related to that scenario
      • Each focused testlet may include multiple-choice questions and/or any of the previously described alternative item types
  • Candidates will not know which questions are experimental.
  • Following login, candidates are presented with an entry screen in to the exam. Candidates can select to view a demo or enter the exam. When candidates have completed the exam, they will submit it for scoring.
  • Candidates have the ability to move forward or back throughout the entire exam.
  • Candidates have a total of 4 hours to complete the exam.


Passing Point
  • The passing point used for the BOC certification exam is a criterion-referenced approach called the Angoff Modified Technique. This technique is currently considered by testing professionals to be one of the most defensible criterion referenced methods available for setting passing points. It relies on the pooled judgments of content experts. For example, in this approach, a group of BOC Certified Athletic Trainers (judges) is asked to judge each item on the exam. The criterion used to judge each item is, "What is the probability that a minimally acceptable candidate will answer this item correctly?" This question prompts the judges to consider a group of minimally acceptable candidates and what proportion of that group will answer each item correctly.
  • The average of the proportions, or probabilities, is multiplied by the total number of questions on the exam. The result then represents the "minimally acceptable" score. The final passing point for the exam is based on this pooled judgment and the calculation of the standard error of the mean. Item analysis for each question and reliability indexes are also calculated for each section of the exam. Each new exam version is equated to the initial or anchor version to ensure that candidates are not rewarded or penalized for taking different versions of the exam.
  • Exams are scored by Castle Worldwide, a professional testing service that specializes in certification and licensure exams.
  • Each form of the exam includes experimental items that do not count in scoring. Candidates are scored only on those items that have been aligned to the exam specifications of the current BOC Role Delineation/Practice Analysis and validated for scoring. The exact point value for each question is determined as a function of the weight assigned to its content category as well as the number of questions in that content category. In addition, individual items cannot earn a negative point value. Items that ask for multiple correct answers (i.e., multi-select and drag-and-drop items) are eligible for partial credit. Scores will be reported on a scale from 200 to 800, and the minimum passing score for the exam is 500.
  • Pass/Fail results are posted on the BOC website within 2-4 weeks from the last day of the exam window. Candidates are notified via email that Pass/Fail results have been posted. Candidates may log in to their BOC Central™ profile to access their Pass/Fail results. Exam scores are not posted in BOC Central™.
  • Candidates who were successful on the BOC exam will see a status of "Certified" or "Eligible for Certification" in BOC Central™. If a candidate's status is "Eligible for Certification," use of the ATC® credential is strictly prohibited until a candidate's file is complete and the BOC has granted certification.
  • Candidates who were unsuccessful on the BOC exam will see a status of "Eligible for Exam" in BOC Central™. The BOC recommends candidates register for the next exam window as soon as possible. Do not wait until exam scores have been received in the mail to register for the next exam window.
  • Exam results are mailed to candidates via USPS mail within 2-4 weeks from the last day of the exam window.
  • The exam score is confidential and will not be disclosed unless the BOC receives a written request to do so from a candidate or is directed to do so by subpoena or court order. A candidate wanting scores released to another entity must indicate in writing which particular scores may be disclosed and identify specifically the person or organization to which the scores should be revealed. No candidate scores will be given by telephone, fax or electronic means for any reason.


Review of Exams and Appeal of Questions
  • For security reasons, exam material is not available for review. Candidates who have comments about an exam question should mail their comments to: Board of Certification, Attn: Exam Processing, 1415 Harney St Ste 200, Omaha NE 68102-2250. When item writing committees meet to revise the exam, they will have available to them information provided by candidates. The BOC, however, will not respond to comments individually.