Exams have always been a big part of student life. And even after one finishes graduate school, they don’t necessarily end.
For recent graduates entering professions such as medicine, counseling, law or architecture, exams for professional licensing or certification loom ahead. Their purpose is to provide proof that the graduate has attained a level of competency in helping professions or those in which health and safety are of paramount concern, educators said.
“The fundamental credentialing issue is that the public needs protection,” said Paul Grussing, acting head of the pharmacy administration department at the University of Illinois at Chicago. “It’s a privilege you can remove if someone fails to perform competently.”
Though most schools don’t offer formal classroom assistance to students facing licensing exams, advice from instructors, administrators and graduates is plentiful.
“Most masters programs are rigorous, so a person graduating has really accomplished something,” said Marcia Maurer, associate dean and director of graduate programs in nursing at Loyola University Chicago. Students in her programs are preparing for advanced-practice nursing in specialties such as women’s health, pediatrics, oncology, cardiac rehabilitation, critical care/trauma and psychiatry.
Joyce Stoddard, a nurse at Good Samaritan Hospital in Downers Grove, was the first critical care/trauma nurse practitioner to graduate from Loyola’s advanced-practice nursing program and in the first group nationwide to sit for the national test for acute care nurse practitioner, which she took in Atlanta in December 1995. Certification for specialties in advanced nursing is relatively new. The movement began in the late 1970s.
There was no way to prepare for the test, she said, because no one had taken it before. “I called the credentialing center, and they said it’s a practice-based test, so there was no studying required.”
But while getting her master’s degree, Stoddard worked as a bedside critical care nurse, and that gave her the knowledge base to pass the exam, she said. “You learn the big picture in the master’s program, specifics come up in practice. I see nurses coming out with a bachelor’s and going right for their master’s. For me, depending on what you’re going to specialize in, you need a solid level of experience in your specialty.”
Post-graduate specialty nursing exams are administered by national certifying boards, which often hold review classes and make study materials available. If a nurse doesn’t pass the certification exam, it doesn’t have the same connotation as not passing the post-bachelor’s licensure exam, Maurer notes.
She advises students to “make sure you have a sense of clinical competence in that area you are prepared to perform in.”
For physicians, licensing takes place after passing the three-part U.S. Medical License Examination administered by the National Board of Medical Examiners. Students take the first part of the exam after two years of medical school, the second part after they complete medical school and the third after they have spent nine months in a clinical residency.
Most medical schools don’t put on a review program, said Jack Snarr, associate dean for student programs at Northwestern University Medical School, Chicago. Although outside consultants offer one-day workshops to give students insight on how test questions are constituted and weighted, most medical students don’t seek them out.
“There’s a reason for these exams: to assure that a person really knows the material,” Snarr said.
Students of chiropractic face a similar series of tests, administered by the National Board of Chiropractic Examiners. Tests are given at the half-way and two-thirds points in their five years of chiropractic schooling and at the end, when they must pass a written clinical competency test before they can apply for state licensure.
There are review sessions for part one of the test, put on by outside agents, but they “wouldn’t help anyone who hadn’t been studying all along,” said Dr. Daniel Driscoll, dean of students at National College of Chiropractic in Lombard.
Post-graduate licensure also is required in pharmacy and dentistry. Candidates in pharmacy must successfully complete either the five- or six-year educational program and experiential training before sitting for a licensing exam. The National Association of Boards of Pharmacy administers the exam, which is used in every state except California.
Mary Jo Hunst, associate executive director of the association, calls the exam “practice based, putting things into a scenario,” so questions rely on context more than on theory.
“The entire (pharmacy) curriculum serves as a preparation,” said UIC’s Grussing. He tells students to review the curriculum content.
In dentistry, the American Dental Association provides two written national board exams that students take during their four years of dental school. Graduates then sit for a regional exam administered by the North East Regional Board of Examiners, which covers 15 states. To prepare for this exam, which has a written and a clinical component, Dr. Dale Eisenmann, of UIC’s College of Dentistry, advises students to “do as much clinical dentistry as they possibly can while they are here in the program.”
The school makes review materials available for the written exams, said Eisenmann, associate dean for academic affairs. To prepare students for the clinical portion of the regional exam, instructors sometimes conduct “mock board exams” when students are working on patients, because they will actually perform such work as part of the real exam.
The State of Illinois issues a license to practice dentistry after receiving documentation that the applicant has graduated from an accredited dental school and passed the requisite exams.
Clinical psychologists, professional counselors, social workers and marriage and family therapists are in professions that require post-graduate licensure by the state. The School of Social Work at Loyola offers students a one-day workshop to prepare them for the licensing exam. Mary Schiltz, associate dean, advises them to take the exam soon after graduation, while the course contents are “still fresh in their minds.”
After 3,000 hours of supervised clinical practice, a licensed social worker can sit for another exam to become a licensed clinical social worker.
Social workers and clinical psychologists were the only counseling professionals who were required to be licensed before the Professional Counselor Licensure Act was passed in Illinois in 1994.
To become a licensed professional counselor, a student can sit for the exam after a minimum of 48 hours of study at the graduate level, including about 600 in-the-field hours. After two to three years of work in a licensed clinical setting such as a human services agency, he or she can sit for a second exam to become a licensed clinical professional counselor.
The clincal licenses open the door for career advancement in both professions.
The course work of the schools follows the eight basic topic areas covered in the licensing exams provided by the National Board of Certified Counselors. Dr. Patrick McGrath, associate professor in the counseling program at National-Louis University, Evanston, recommends that students form study teams and begin studying at least three to four months before the scheduled date for the exam.
Tom Pourchot, director of the master’s programs at Illinois School of Professional Psychology, Rolling Meadows Campus, said that the National Board of Certified Counselors and other independent publishers put out excellent study aids, which are advertised in professional journals.
Questions of public health and safety also guide the requirements for licensure of architects, who must complete five years of course work (or two in the master’s program with a bachelor’s degree in another discipline) and pass a multiple-division Architectural Registration Exam before being allowed to use the title, architect. In addition, students must have fulfilled the requirements of the intern development program, which is administered by the National Council of Architectural Review Boards. The program requires nearly three years of practical experience in various training areas.
“When you look at the profession before licensure in 1897, it was an apprenticeship profession,” said Lee Waldrep, assistant dean for student programs in the College of Architecture at the Illinois Institute of Technology, Chicago.
Beginning in February 1997, the licensing exam will be administered by computer instead of paper and pencil, and the review boards will make practice programs available to candidates.
Kevin Hall, an architect with Booth, Hansen & Associates in Chicago, said that the four-day architectural registration exam is “like a rite of passage.” Because of the long internship required, most people who sit for the exam have been out of school for several years. Hall took a three-month refresher course offered at UIC; he also consulted a preparation guide put out by the National Council. “If you know what the test format is before you go in, it helps an incredible amount,” he said.
Hall graduated in 1989 from Washington University, St. Louis. He took part of the exam in June 1994 and completed it in June 1995.
Of all licensing exams, probably the most notorious is the bar exam to practice law. Every state administers its own.
“The feeling among students is that it’s one of those exams (in which) you really find out what your brain capacity is,” said University of Chicago Law School Dean Ellen Cosgrove, who took the New York bar exam five years ago and practiced litigation in that state.
There are national bar review courses students can take from two private companies. They provide lectures, videotapes and study guides at a cost of about $1,400. The courses begin eight weeks prior to the bar exam, which is offered in July and February.
The bar exam, given in two parts on two consecutive days, consists of 200 multiple-choice questions on multistate law that all candidates must take, and essay questions for which students look at the laws of a particular state.
Third-year law students are in the particularly difficult position of studying for their final exams and their bar exams at the same time, Cosgrove noted. Because the bar exam is practical and classes are theoretical, Cosgrove advises students not to choose classes based on what the bar exam covers, but to “take the courses you are most interested in and which will be most useful in your career.”
