The TMC Examination is the National Board for Respiratory Care's entry-level multiple-choice test for respiratory therapists. It presents 160 multiple-choice items, of which 140 are scored, in a three-hour sitting. Two cut scores make it unusual: the low cut score earns the CRT credential, and the high cut score adds eligibility for the Clinical Simulation Examination if you meet that exam's own requirements. Timing matters right now. The last TMC applications are accepted December 15, 2026, the last test date is December 31, 2026, and a single Respiratory Therapy Examination replaces the TMC and CSE path from January 2027. This guide maps what the test covers, who qualifies, and how to prepare inside that window.
What the TMC examination covers
The exam draws its 140 scored items from three official domains, with most items written at the application or analysis level rather than simple recall.
The official TMC Detailed Content Outline, effective January 2020 through December 31, 2026, organizes the scored exam into three domains. Patient Data carries 50 items and covers evaluating the patient record, performing clinical assessment, gathering clinical information, evaluating procedure results, and recommending diagnostic procedures. Troubleshooting and Quality Control of Devices, and Infection Control carries 20 items. Initiation and Modification of Interventions is the largest domain at 70 items — exactly half of the scored exam.
Each item is also tagged to a cognitive level: recall, application, or analysis. The NBRC Candidate Handbook explains that recall items ask you only to retrieve or recognize facts, while integration items — those at the application or analysis level — respond to new or changing situations and run longer and more complex.
Every form also carries a guaranteed patient mix: at least four pediatric items and at least three neonatal items, with adult or general patients filling the balance. If you have seen study lists naming separate domains for pathophysiology or pharmacology, note that the official outline folds that content into these three domains — pharmacologic recommendations, for example, sit inside the interventions domain.
- Patient conditions named in the outline include COPD, asthma, heart failure, cystic fibrosis, trauma, sepsis, pulmonary embolism, and neonatal respiratory distress syndrome, among others.
| Domain | Scored items | Sample tasks |
|---|---|---|
| I. Patient Data | 50 | Chart review, bedside assessment, blood gases, imaging, recommending diagnostics |
| II. Troubleshooting and Quality Control of Devices, and Infection Control | 20 | Assembling and troubleshooting equipment, Standard Precautions, quality control on analyzers and ventilators |
| III. Initiation and Modification of Interventions | 70 | Airway management, oxygenation and ventilation, medications, changing the respiratory care plan |
Sources: NBRC TMC Detailed Content Outline effective January 2020 through December 2026 — Domain totals and cognitive-level columns; Registered Respiratory Therapist (RRT) - The National Board for Respiratory Care — TMC scoring, admission requirements, fees, and FAQs; Candidate Handbook — Cognitive levels and examination preparation
Which version applies and the January 2027 change
You are preparing against the TMC outline effective through December 31, 2026 — or, from January 2027, against the new Respiratory Therapy Examination that replaces it.
The NBRC is consolidating its therapist credentials into a single Respiratory Therapy (RT) Examination, available January 4, 2027, with applications opening October 1, 2026. The RT Examination presents 185 multiple-choice items — 160 scored and 25 pretest — over four hours, and costs $360 for new applicants or $300 for repeat applicants.
The RT exam replaces the two-step TMC plus Clinical Simulation route. It keeps two cut scores: the low cut earns the CRT credential, and the high cut earns the RRT credential directly. There is no separate simulation step.
For the TMC itself, applications close on December 15, 2026, and the last day to test is December 31, 2026. The Clinical Simulation Examination remains available through December 31, 2027, but only for candidates who passed the TMC at the high cut score before the end of 2026.
Two carryover rules protect you. Prior TMC or CSE attempts do not count toward the RT Examination's three-attempt limit. And the CRT-to-Registry admission route is eliminated effective December 31, 2026, so confirm which version you qualify for before applying.
Sources: NBRC Resources - The National Board for Respiratory Care — RT Examination FAQs, TMC retirement dates, admission routes; Registered Respiratory Therapist (RRT) - The National Board for Respiratory Care — TMC scoring, admission requirements, fees, and FAQs; NBRC Respiratory Therapy Examination Detailed Content Outline effective January 2027 — Examination format specifications
Eligibility, fees, and retake rules
You must be at least 18 and qualify through a CoARC-supported degree, a time-limited CRT-to-Registry route, or a Canadian CSRT RRT credential.
Most candidates qualify through the primary route: being 18 or older and a graduate with a minimum associate degree from an entry-into-practice respiratory therapy program supported or accredited by the Commission on Accreditation for Respiratory Care (CoARC). The remaining routes are:
Remember the calendar when choosing a route. The CRT-to-Registry routes disappear after December 31, 2026, and foreign respiratory therapy education does not qualify for TMC admission. Candidates in Canada who hold the CSRT RRT credential qualify through a verification letter sent directly from the CSRT along with a paper application.
Fees are $190 for new applicants and $150 for repeat applicants. TMC applications close December 15, 2026. Testing runs Monday through Saturday at more than 300 assessment centers. On retakes, you get three attempts before a 120-day wait applies between further attempts.
Guard your eligibility records. The NBRC keeps them for one year after you apply; if they go inactive, a passing performance on the RRT pathway exams is nullified and you must reapply under the most current requirements.
- A CRT for at least four years, plus 62 semester hours of college credit including anatomy and physiology, chemistry, microbiology, and mathematics; or
- A CRT for at least two years, plus a minimum associate degree from a CoARC-supported or accredited respiratory therapy program; or
- A CRT for at least two years, plus a baccalaureate degree outside respiratory care with the same 62 semester hours and course areas; or
- The Canadian Society of Respiratory Therapists (CSRT) RRT credential.
Sources: Registered Respiratory Therapist (RRT) - The National Board for Respiratory Care — TMC scoring, admission requirements, fees, and FAQs; NBRC Resources - The National Board for Respiratory Care — RT Examination FAQs, TMC retirement dates, admission routes
Cut scores and what they unlock
One exam, two outcomes: the low cut score earns the CRT credential, and the high cut score adds eligibility for the Clinical Simulation Examination — if you also meet CSE requirements.
The high cut score does not by itself put you into the CSE. The NBRC states plainly that every candidate must meet the Clinical Simulation Examination's eligibility requirements regardless of score, so check those requirements before counting on the simulation step.
The CSE itself consists of 22 problems — 20 scored and 2 pretest — taken over four hours, with clinical settings designed to simulate real respiratory care. Under the 2027 transition, it stays open through December 31, 2027 only for candidates who reached the TMC high cut score before the end of 2026.
If you already hold the CRT and score below the low cut, you do not lose your credential. You can retake the TMC as needed without affecting your current CRT status.
Sources: Registered Respiratory Therapist (RRT) - The National Board for Respiratory Care — TMC scoring, admission requirements, fees, and FAQs; NBRC Resources - The National Board for Respiratory Care — RT Examination FAQs, TMC retirement dates, admission routes
How the outline translates into questions
Item counts show where the weight sits, cognitive levels show how questions will feel, and the outline names the calculations you should be able to perform.
The NBRC's own guidance is to use the outline's item counts for study direction: you can judge each domain's relative importance by its question count. That is why the interventions domain deserves the largest share of your review — its 70 items are half the scored exam.
The cognitive-level totals sharpen that point. Of the 140 scored items, only 33 sit at the recall level; 66 are application items and 41 are analysis items. Recall-only study covers barely a quarter of the exam. The Candidate Handbook describes integration items as responses to new or changing situations, typically longer and more complex than short recall items — so practice applying knowledge to changing patients, not just memorizing facts.
The outline also names the calculations themselves. One of them, the P/F ratio, is pure arithmetic, so you can practice it right here.
Practice exercise
Original arithmetic practice for a calculation named in the TMC outline: use the supplied formula P/F = PaO2 ÷ FiO2, with FiO2 expressed as a decimal. Given PaO2 = 60 mmHg and FiO2 = 0.40, calculate P/F. No clinical classification or treatment decision is requested.
Show answer
150.
The P/F ratio divides the arterial oxygen pressure by the fraction of inspired oxygen: 60 ÷ 0.40 = 150. The division itself is the skill this exercise targets. Classifying the result against disease-severity criteria is a separate outline task — classification of disease severity and applying guidelines such as ARDSNet — so treat those thresholds as their own study topic rather than part of this arithmetic.
Sources: NBRC TMC Detailed Content Outline effective January 2020 through December 2026 — Domain totals and cognitive-level columns; Registered Respiratory Therapist (RRT) - The National Board for Respiratory Care — TMC scoring, admission requirements, fees, and FAQs; Candidate Handbook — Cognitive levels and examination preparation
Official preparation tools and study habits
Start with the free TMC practice examination and the Detailed Content Outline; add the paid Self-Assessment Examination if you want committee rationales for every answer.
Three official resources cost little or nothing. The free TMC practice examination runs on the same software as the real test and needs no account. The Detailed Content Outline shows every task the exam can test. The Candidate Handbook explains scoring, test-day rules, and the cognitive levels used in item writing.
For deeper feedback, the TMC Self-Assessment Examination (SAE) is a paid web-based product with the same number of questions as the credentialing exam. The NBRC describes it as the only product that supplies the examination committees' rationale for each best answer, with individualized feedback and 90 days after purchase to complete it.
One optional routine worth considering: after any practice question you miss, find the matching task in the outline and reread only that row. It keeps review anchored to tested content rather than a generic topic list. This is study advice, not an NBRC requirement.
Sources: Registered Respiratory Therapist (RRT) - The National Board for Respiratory Care — TMC scoring, admission requirements, fees, and FAQs; NBRC Resources - The National Board for Respiratory Care — RT Examination FAQs, TMC retirement dates, admission routes; Candidate Handbook — Cognitive levels and examination preparation
Common mistakes to avoid
Most avoidable problems here are administrative or timeline-based: missing the 2026 deadlines, misreading the cut scores, or letting eligibility records lapse.
- Applying after December 15, 2026 — TMC applications will not be accepted after that date, and the last test day is December 31, 2026.
- Treating a high cut score as an automatic CSE seat — CSE eligibility requirements apply no matter what you score.
- Letting application records go inactive — eligibility records lapse after one year, and an inactivated passing performance is nullified.
- Assuming your attempt count carries over — prior TMC and CSE attempts do not count toward the RT Examination's attempt limit.
- Relying on a CRT-to-Registry route late in 2026 — those routes end on December 31, 2026.
- Studying only isolated facts — 107 of the 140 scored items sit at the application or analysis levels, so practice applying knowledge to changing situations.
Sources: NBRC Resources - The National Board for Respiratory Care — RT Examination FAQs, TMC retirement dates, admission routes; Registered Respiratory Therapist (RRT) - The National Board for Respiratory Care — TMC scoring, admission requirements, fees, and FAQs; Candidate Handbook — Cognitive levels and examination preparation
Your next steps
Confirm your route, pick your exam window, and schedule early.
- Confirm your admission route and gather documents — degree transcripts, or CSRT verification if you qualify through Canada.
- Choose the appropriate route: take TMC by December 31, 2026 and, if you reach its high cut score and meet CSE eligibility, complete CSE by December 31, 2027; or take the new RT Examination from January 4, 2027.
- Submit a TMC application by December 15, 2026 and schedule within the remaining testing window.
- Schedule your appointment at an assessment center, with Monday-through-Saturday availability.
- Download the applicable Detailed Content Outline and take the free practice examination.
Sources: Registered Respiratory Therapist (RRT) - The National Board for Respiratory Care — TMC scoring, admission requirements, fees, and FAQs; NBRC Resources - The National Board for Respiratory Care — RT Examination FAQs, TMC retirement dates, admission routes
Sources
Facts checked:
- NBRC TMC Detailed Content Outline effective January 2020 through December 2026
- NBRC Respiratory Therapy Examination Detailed Content Outline effective January 2027
- Registered Respiratory Therapist (RRT) - The National Board for Respiratory Care
- NBRC Resources - The National Board for Respiratory Care
- Candidate Handbook