What the CBT can ask you about
If you have found yourself learning which committee signs off a service change, which clause of information governance law lets a dataset be shared without consent, or the stages a Bill passes through at Westminster, you are revising something the computer-based test cannot ask you about. It is worth knowing why, because the boundary is published, and it is narrower than a lot of revision material suggests.
The NMC sets out what the test covers in three documents, all of them public. The test specification for the 2021 Test of Competence gives the number of questions in each category and the mix of question difficulty. The adult nursing blueprint maps every one of those categories onto the proficiency statements in the Standards of proficiency for registered nurses, the 2018 document most people know as Future Nurse. The candidate information booklet gives the timings, the marking and the question format. Between them they answer the question precisely: every clinical question in the test sits on a numbered proficiency statement, and the answer has to be something the NMC's own reading list covers.
That reading list is a short one. The Code, the standards of proficiency, national clinical guidance from NICE, the British National Formulary, Resuscitation Council UK, the standard clinical procedure manuals, and public health guidance of the kind the UK Health Security Agency publishes. Five Acts come up because nursing practice turns on them: the Mental Capacity Act, the Mental Health Act, the Equality Act, the Human Rights Act and the Children Act. That is close to the whole of it.
What follows from that is the useful part. A thing can be entirely real, entirely British and still not examinable, because the test is sat by nurses who trained anywhere in the world and have never worked a shift in the NHS. The name of a local safeguarding arrangement, the internal escalation route in one trust, a national operating standard for a service, a branded model of reflection or supervision: all real, none of them something the NMC could expect a candidate in Kerala or Manila to know by name.
The place this bites hardest is the two platforms whose titles sound administrative. Platform 5 is about leading and managing nursing care and working in teams. Platform 7 is about coordinating care. Read the statement headings on their own and they sound like management theory, and several of platform 7's are literally worded around health policy, health economics and political awareness. They are still nursing questions.
| Platform | What the wording sounds like | What a question can actually ask |
|---|---|---|
| 5 | Managing and supervising staff | Who to escalate a deteriorating patient to, and when |
| 5 | Governance and incident frameworks | What to do first after a medicines error, and what to record |
| 7 | Health economics and resource allocation | Choosing the right dressing, or not opening a sterile pack early |
| 7 | Building a business case for funding | What to hand over when a shift is short, and what care cannot be given safely |
| 7 | Political awareness and influencing policy | Raising a concern about unsafe practice, and who to raise it with |
We applied that test to our own question bank this month and it did not come through clean. Two hundred and forty three questions across those two platforms were asking candidates to name things the NMC's sources do not cover, and they have been withdrawn and rewritten. The two questions published on the platform 7 page were among them, which is a fair indication of how little anybody had looked. We will not pretend that makes the rest of the bank verified, because it does not, and nothing here has been checked by the NMC.
So the practical advice. When a question asks you to pick a named thing, ask yourself whether a competent nurse anywhere in the world could be expected to know that name. If the answer is no, it is not a question the test would set, whatever bank you found it in. Revise the Code, the standards, the guidance and the drugs, and read what each category of the test actually covers rather than working from a list of topics somebody assembled from a UK nursing degree.