2024candidate guide electronic fetal monitoring c-efm

2024 Candidate Guide:

Electronic Fetal Monitoring

2024 CANDIDATE GUIDE

ELECTRONIC FETAL MONITORING

C-EFM

Congratulations on taking the next step in your career – earning your C-EFM certification!

INFORMATION INCLUDED:

Fees & General Policies 2-5

About the Exam 6

Exam Content 7-9

Study Guide 10-11

Study Resources 12

Sample Questions 13-14

Scoring & Test Report 15-16

Terms of Certification and

Certification Maintenance 17

THIS EXAM’S PURPOSE

The purpose of the NCC Electronic

Fetal Monitoring Subspecialty

Certification is to provide a

competency-based examination

that tests specialty knowledge and

the application of that knowledge

for licensed health care

professionals in the US and

Canada, who utilize the

application of electronic fetal

monitoring and interpretation of

data obtained to provide care to

obstetrical patients in both

inpatient and outpatient settings.

IT IS IMPORTANT TO READ THE

INFORMATION IN THIS GUIDE. IT

EXPLAINS ALL POLICIES TO WHICH

CANDIDATES WILL BE SUBJECT.

ABOUT THIS GUIDE

This guide lists fees and provides information that will help candidates

prepare for the examination. It includes the exam content in outline

form, competency statements and study guide. It also provides sample

exam questions to familiarize the test taker with question format, study

resources and lists some of NCC administrative policies & procedures. It is

recommended that candidates familiarize themselves with the

information in this guide.

NCC examinations are offered in several different test administrations

options. The NCC publication Guide to Testing Methods will explain the

different rules and policies based on how the candidate is taking the

examination. Please download this publication from the NCC website and

review the exam administration options. It will answer any questions

about the NCC examination process.

If there are other questions, please feel free to contact NCC through the

“Contact Us” page at NCCwebsite.org.

NCC’S PHILOSOPHY OF TESTING

Certification is an evaluative process that provides the opportunity for

health care professionals in the obstetric, gynecologic and/or neonatal

specialty to demonstrate publicly what they know and to be recognized

for the special knowledge they possess. The NCC certification carries no

licensing authority. The ability to practice as a health care professional is

regulated by the state, and while certification may be required in some

states for specific health care roles, NCC has no regulatory power to

require states to recognize NCC certification for this purpose. Practice

and educational standards are reflected in the certification process, but

the responsibility for development of such standards rests with the

professional specialty organizations and the educational community. NCC

encourages individual to seek out information about how certification

relates to licensure requirements, program accreditation of the

educational institutions attended, the educational and practice standards

of national specialty organizations, and employment expectations.

NCC core and subspecialty programs are accredited by the National Commission for Certifying Agencies

FEES & GENERAL POLICIES

2024 Candidate Guide:

Electronic Fetal Monitoring

EXAMINATION AND RELATED FEES

EXAMINATION FEES*

Test Center and Live Remote Proctoring (LRP) Computer Exam Fees are

$210 which includes the non-refundable $50 application fee.

*Examination fees are subject to change.

CANCELLATION: 6 HOUR WINDOW

Candidates have six hours from the time the submit an exam application to

cancel the exam. The order can be canceled by logging into the account and

clicking on "Cancel Application" found under the new certification. Only the

candidate can cancel the application and they must meet the 6-hour

window. After the six hours they must withdraw or pay for a change.

CHANGE REQUEST

Candidates who cannot take their currently

scheduled examination, have missed their

testing date or need to take a different

exam - can request a change for a fee of

$125. Details are on the NCC website.

WITHDRAWAL FEE

A Testing Center or LRP testing candidate

who withdraws from testing is subject to a

$105 withdrawal fee. The candidate will

receive $105 of their $210 payment, minus

any outstanding charges. Bulk Purchase

Voucher candidates cannot withdraw.

RETEST FEE

Retest candidates must pay full application and examination fees. There are

no discounts and they must complete a 90-day wait period* before

resubmitting an application for testing. (*see Retest Policy page 4).

Certification exams of the same specialty can only be taken TWICE in a

calendar year for the same candidate. Candidates must submit a new

application and again demonstrate eligibility and licensure.

SUBSTITUTION FEE

Candidate substitutions are not allowed for any reason.

THIRD PARTY PAYMENTS

Applicant fees paid by third parties will be refunded to the third party in

accordance with stated refund policies, in the event the applicant is

determined ineligible or withdraws within the specified time. Vouchers are

nonrefundable.

NO REFUNDS WILL BE

CONSIDERED FOR ANY

CANDIDATE

• who has taken an

examination

• who is not successful in

achieving certification

• who failed to take the exam

at a Test Center or via Live

Remote Proctoring (LRP)

within the 90-day testing

window and did not submit

a change request within

stated time frames

• who failed to schedule an

appointment to test within

the first 30 days of their 90-

day eligibility window and is

unable to schedule their

exam within their eligibility

window.

• who failed to have proper ID

or meet any required rules

• who failed to login to the

test portal or appear at the

test center (no-show) or

who signed in late to the

test portal or arrived late to

the test center

• who failed to take a

scheduled exam for any

reason (illness, quarantine,

accident, death, etc.)

Test Date Change

Test Center and Live Remote

Proctoring (LRP) exam

candidates can change their

scheduled testing date to

another date within their

window once for free.

Candidates must handle this

directly with PSI/AMP.

Refer to the NCC testing

guide for details.

FEES & GENERAL POLICIES

2024 Candidate Guide

: Electronic Fetal Monitoring

PAYMENT INFORMATION

• All applications are subject to a

nonrefundable application fee.

• All fees are nonrefundable

except where otherwise noted.

• Payments can be made by

credit card (Visa, American

Express and MasterCard only).

NCC does not accept debit cards

or split payments (part check and

part credit card).

• Payments can be made by e-

check: bank routing number and

account number required.

• For payments made by third

parties, any refund will be issued

to the third party and not to the

applicant. Vouchers are

nonrefundable.

• All payments must be in US

funds.

• Exam fees can only be

submitted online at the NCC

website. Applications will not be

accepted by mail, phone or fax.

• NCC will accept group

payments for certification exams

from institutions. Details are on

the NCC website under Bulk

Purchases.

OTHER NON-REFUNDABLE PAYMENT RELATED FEES

INCOMPLETE APPLICATION FEE

All incomplete applications are subject to a non-refundable $30

reprocessing fee upon the submission of proper documentation.

Incomplete applications are those submitted with missing information, (e.g.

required licensure information and corroborating uploaded documentation;

containing incomplete or incorrect information; or do not include full fee

payment).

RETURNED CHECKS AND CREDIT CARD CHARGEBACK FEE

A $30 fee will be assessed for any check or e-check returned or a credit card

payment disputed for any reason. Remittance thereafter of all fees and

applications must be in the form requested by NCC.

LICENSE VERIFICATION

If licensure information is requested requiring an additional submission, the

candidate will have two weeks to provide the license with all the correct

information and pay the non-refundable $30 reprocessing fee. If this is not

provided within the two weeks, the application will be marked ineligible.

Ineligible applicants will receive a refund minus the $50.00 non-refundable

application fee. There are no refunds or withdrawals for applications using

a bulk code.

VERIFICATION OF CERTIFICATION

Third party notification of status will NOT be released without authorization

from the certified individual. A $30 fee is required for any third-party

notification or issuance of duplicates of test results reports. Verification

requests can only be submitted after official results with score report have

been uploaded to the candidate’s NCC account.

Verification requests can only be made via the online verification system on

the NCC website. NCC does not issue verifications via the mail or fax.

Certification will be revoked or withheld if a returned check or a

chargeback request on a credit card payment results in loss of

income to NCC and the monies are not recovered in an alternate

payment. Fees received at any time will first be applied to any

unpaid prior certification/special fees.

FEES & GENERAL POLICIES

2024 Candidate Guide:

Electronic Fetal Monitoring

UNSUCCESSFUL CANDIDATES

A candidate who sits for the

examination and does not receive a

passing score is not eligible for any

refund nor for any credit on any

later NCC exam.

NONDISCRIMINATION

It is the policy of NCC that no

individual will be excluded from

the examinations as a result of

age, sex, race, religion, national

origin, ethnicity, disability,

marital status, sexual

orientation, military status or

gender identity.

AMERICANS WITH DISABILITIES

ACT

Special testing accommodations

will be provided pursuant to the

Americans with Disabilities Act.

Any requests for special testing

accommodations must be made

in writing and submitted with the

application. The accommodation

request form can be downloaded

from the NCC website. Upon

receipt of a request for special

accommodations, NCC will

contact the applicant. Such

requests must be signed by a

clinician, physician, or other

qualified specialist with training

and experience appropriate to

diagnose and treat the specified

disability.

GENERAL POLICIES

EXAM CATEGORY CHANGES

Candidates can only request an exam category change by completing a

Change Request Form on the NCC website and submitting with non-

refundable payment of $125. Candidates are only allowed one change

request (e.g. After a change request is submitted no other change request

can be submitted). All change requests must be approved by NCC. There

will be no refund of original or Change Request fees. Eligibility must be re-

established for the new exam category, and additional documentation and

fees may be required. The time to consider eligibility for the new category

will count toward the original assigned 90-day testing window.

Examination category cannot be changed from a subspecialty or RN Core

application to a NNP or WHNP certification. Examinees must take the

exam for which they have been determined eligible. No changes will be

permitted on examination day. If a candidate knowingly or unknowingly

takes an examination other than the one they were found eligible to take,

the examination will not be scored. No refunds will be allowed, and all fee

policies will apply if the candidate reapplies for an examination. See

website for complete details.

RETEST POLICY

Candidates may retake the examination if they do not pass. They must

reapply 90 days after the test was taken, submit all applicable fees and

documentation, and re-establish eligibility according to the appropriate

deadlines. There is no limit to the number of times a candidate may retake

the examination. However, the maximum number of times a candidate

can take the same NCC test in a calendar year is two.

All retest candidates must wait 90 days from the date their exam was

taken before they can submit a new application to retest.

• this date is provided in the candidate's results notification

• this 90-day wait period affects all modes of testing

Any loss of power or internet during an exam in which there was more than

15 minutes of testing with exposure to more than 10% of the exam requires

a retest at a Test Center. Candidates will have to wait 90-days before they

can reschedule and they must follow NCC’s retest policy. A decision on the

timing of a second attempt will be made after NCC reviews the test

exposure. There is no need to complete a new application, but candidates

MUST notify NCC of the internet disconnection issue as soon as computer

access is available.

If a retest application is submitted prior to the 90-day wait period, the

application will be returned as ineligible. The applicant will be subject to

the $50 non-refundable application fee.

FEES & GENERAL POLICIES

2024 Candidate Guide

: Electronic Fetal Monitoring

COURSES AND MATERIALS

NCC does not offer or sponsor

review courses or review

materials for its certification

examinations. Examination

candidates should view any

course of study as being

independent of NCC. Candidates

should carefully examine the

merits of any individual exam

preparation offering before

participating.

TEST DISCLOSURE

NCC does not make test

questions available for review.

Because test questions may be

used for more than one

examination administration,

distributing this information

would compromise the security

of the test questions and would

increase the cost of certification

if the questions had to be

replaced each year.

REVOCATION

Your certification may be

revoked for falsifying any

information submitted to

determine eligibility to take the

certification examination or for

maintaining certification, for

losing your license to practice, or

for failing to pay designated

certification or maintenance

fees.

POLICIES ARE SUBJECT

TO CHANGE

WITHOUT NOTICE.

GENERAL POLICIES (CONTINUED)

INTERNET DISCONNECTIONS

If the candidate has started the exam and is disconnected, please use the

PSI tech lines if testing with LRP or if at a Test Center discuss immediately

with the proctor to attempt to get reconnected and continue testing.

If the candidate is unable to get reconnected after starting the exam, the

timing for a second attempt to take the exam will be based on how much

time and how many questions they were exposed to. If a candidate is

disconnected and cannot be reconnected and has tested for under 15

minutes and were exposed to less than 10% of the exam they may be able

to reschedule within their current eligibility window. Candidates must work

directly with PSI that day to reschedule and if they run into any issues

they must notify NCC within 3 days of testing. If a candidate tests for

longer than 15 minutes and/or saw more than 10% of the questions on the

exam they will have to wait 90 days before they can reschedule, and they

must follow NCC’s retest policy. A decision on the timing of a second

attempt will be made after NCC reviews the test exposure. Please note,

candidates will need to retest at a Test Center. Please notify NCC of the

internet disconnection issue as soon as computer access is available.

APPEALS PROCEDURE

Any request to waive any policy of the NCC Board of Directors relative to

eligibility, administration, examination content issues, or certification

maintenance must be received in writing within 60 days of the dispute. All

requests should be sent to the attention of the NCC President at

nccpresident@nccnet.org. The correspondence should contain a detailed

account as to why the NCC policy should be waived or the candidate’s

status should be changed. Such requests are referred to the NCC Policy

Review Committee of the Board of Directors. All decisions will be provided

in writing. Cases not resolved by the Policy Review Committee will be

referred to the full Board of Directors.

DESIGNATION AUTHORIZATION

Certification is a non-transferable, revocable, limited, non-exclusive license

to use the certification designation “C-EFM®”, subject to compliance with

the policies and procedures, as may be revised from time to time.

Any use or display of NCC certification marks and/or logos without the prior

written permission of the NCC is prohibited. Any candidate or certificant

who manufacturers, modifies, reproduces, distributes or uses a fraudulent

or otherwise unauthorized NCC certificate, NCC designation or other

credential may be subject to disciplinary action, including denial or

revocation of eligibility or certification. Any individual who engages in such

behavior also may be subject to legal action.

ABOUT THE EXAM

2024 Candidate Guide

: Electronic Fetal Monitoring

ABOUT THE EXAM

TIMED EXAMINATION

Two (2) hours are allotted to

complete the examination.

EXAM FORMAT

The Electronic Fetal Monitoring

examination consists of 125 test

questions. 100 are scored and the

remainder are embedded in the

exam as pretest items. The pretest

items do not count toward the

examinee’s final results.

- There is one question format

used for all NCC examinations.

- Each question has a premise

(stem) and three possible

answers, two distractors and

only one correct answer.

- The answer options are

alphabetized by the first word in

each answer option to

randomize the answers.

- Tests are delivered in a different

random order for each

candidate.

- Questions will test both basic

knowledge and application of

knowledge.

- Questions that contain

laboratory data will show results

in conventional units of measure

with international units in

parentheses.

- Drugs are listed in both generic

and trade names where

appropriate.

EXAMINATION CONTENT DEVELOPMENT

The development of NCC certification involves many individuals and

involves a meticulous process of review. There are three major groups

that contribute to the test development process:

ITEM WRITERS:

MDs, RNCs and others identified with special expertise have the

responsibility of drafting test items per designated assignment for review

by the content team and expert reviewers. Item writers are solicited from

the NCC certified population, by recommendations or through the

volunteer portal.

REVIEWERS:

Reviewers are MDs, RNCs or other designated experts who assist the

content teams in review of test items developed by the item writers.

Reviewers are responsible for reviewing items for content relevance and

confirming that references cited for the questions support the items as

written.

CONTENT TEAMS:

Content team members are experienced practitioners and are appointed

on an annual basis by the NCC President. Content teams are solicited from

the NCC certified population, by recommendations or through the

volunteer portal. To see the current membership composition of the

Content Team responsible for the Electronic Fetal Monitoring

examination, please visit the NCC website under the section on NCC

Leadership.

Content team members are MDs, RNCs or other identified experts who:

- develop and update the test outline and competency statements

- review test items developed by item writers

- review item statistics from exam administrations and pretest

examinations

- approve the exam forms to be administered

- review item banks

In addition, NCC uses volunteers for standard setting and content

validation studies/job analysis studies.

EXAMINATION CONTENT

2024 Candidate Guide

: Electronic Fetal Monitoring

Electronic Fetal Monitoring exam

The chart shows the percentage distribution of questions on the Electronic Fetal Monitoring exam

across the major content categories covered on the examination.

The major focus is on Pattern Recognition and Intervention. Lesser emphasis is on Physiology, and Fetal Assessment

Methods with EFM Monitoring Equipment and Professional Issues having the lowest percentage of content covered

on the exam.

Electronic Monitoring

Equipment

11%

Physiology

70%

Pattern Recognition

and Intervention

Fetal Assessment

Methods

Professional Issues

EXAMINATION CONTENT

2024 Candidate Guide:

Electronic Fetal Monitoring

EXAM OUTLINE

This is an outline of topics and

areas which may be included in

the Electronic Fetal Monitoring

examination.

Percentages identified for the

topic areas represent a range of

the number of test questions

assigned to each content area

and therefore might total more

or less than 100 percent. These

ranges do not necessarily reflect

the content of future exams.

10.00 Electronic Monitoring Equipment (5%)

(External and Internal, Artifact, Signal Ambiguity, Failure and Troubleshooting)

11.00 Physiology (11%)

Uteroplacental

Factors affecting Fetal Oxygenation

12.00 Pattern Recognition and Intervention (70%)

Fetal Heart Rate Baseline

Fetal Heart Rate Variability

Abnormal Uterine Activity

Fetal Dysrhythmias

Maternal Complications

Uteroplacental Complications

Fetal Complications

Fetal Heart Rate Accelerations

Fetal Heart Rate Decelerations

Normal Uterine Activity

13.00 Fetal Assessment Methods (9%)

(Auscultation, Fetal Movement and Stimulation, Nonstress Testing,

Biophysical Profile, Cord Blood and Acid Base Balance)

14.00 Professional Issues (5%)

(Legal, Ethics, Patient Safety and Quality Improvement)

EXAMINATION CONTENT

2024 Candidate Guide:

Electronic Fetal Monitoring

ASSOCIATED COMPETENCIES

• Apply knowledge of maternal-fetal assessment methods when selecting electronic fetal monitoring or intermittent

auscultation to evaluate fetal status.

• Interpret data from the electronic fetal monitor to differentiate between actual fetal data and equipment failure.

• Use knowledge of the advantages and disadvantages of electronic fetal monitoring to provide information to the

pregnant patient and her support person(s).

• Apply knowledge of fetal heart rate regulation to the interpretation of electronic fetal monitoring data.

• Identify and interpret the significance of fetal heart rate patterns.

• Interpret data from electronic fetal monitoring to differentiate between normal and abnormal fetal heart rate

patterns.

• Apply knowledge of common pregnancy complications to the development of a comprehensive plan of care based

on electronic fetal monitoring data.

• Apply knowledge of uteroplacental and maternal-fetal physiology as they relate to fetal oxygenation.

• Identify indications for adjunct fetal assessment and incorporate findings into the plan of care.

• Incorporate knowledge of current practice and legal practices into nursing care.

STUDY GUIDE

2024 Candidate Guide

: Electronic Fetal Monitoring

ELECTRONIC MONITORING EQUIPMENT

• Fetal heart rate monitoring

-Internal

-External

• Uterine monitoring

-External

-IUPC

• Equipment failure and troubleshooting

-Artifact Detection

-Signal Ambiguity

PHYSIOLOGY

• Uteroplacental

-Uteroplacental circulation

-Fetal circulation

-Fetal heart regulation

• Factors affecting fetal oxygenation

-Uterine activity

-Maternal factors

-Anesthesia

-Drugs (Therapeutic & Recreational)

-Placental factors

-Umbilical blood flow

-Acid base and cord blood gases

STUDY GUIDE

2024 Candidate Guide:

Electronic Fetal Monitoring

PATTERN RECOGNITION AND INTERVENTION

• Fetal baseline heart rate

-Bradycardia

-Tachycardia

-Variability

-Sinusoidal

• Fetal heart rate variability

-Identification

-Causes

• Abnormal uterine activity

-Decreased blood flow

-Response to hypertonus

-Tachysystole

• Fetal dysrhythmias

-Supraventricular tachycardia

-Congenital heart block

-Ectopic beats

• Maternal Complications

-Preterm Labor

-Hypertension

Gestational hypertension

Preeclampsia-eclampsia

HELLP syndrome

Chronic (essential)

-Postdates Pregnancy

-Diabetes

(Gestational, Type 1, Type 2)

-Multiple gestations

-Infections

-Maternal obesity

• Uteroplacental complications

(previa, abruption)

-Uterine rupture/scar dehiscence

• Fetal complications

-Injury

-Cord compression

-Hypoxemia

-Demise

• Fetal heart rate accelerations

• Fetal heart rate decelerations

-Early

-Variable

-Late

-Prolonged

• Normal uterine activity

-Resting tone

-Contractions

Frequency

Duration

Intensity

FETAL ASSESSMENT METHODS

• Auscultation

• Fetal movement and stimulation

• Nonstress testing

• Cord Blood Acid Base Testing

• Biophysical profile

• Fetal Acoustic Stimulation

PROFESSIONAL ISSUES

• Legal

• Ethics

• Patient safety

• Quality Improvement

STUDY RESOURCES

2024 Candidate Guide

: Electronic Fetal Monitoring

THE NICHD LANGUAGE AND

DEFINITIONS ARE UTILIZED

IN THE EXAM AS NOTED IN

THE 2008, 2010 UPDATES

AND 2019 REAFFIRMATION.

ALL EFM TRACINGS USED IN

THE EXAM ARE SET AT A

SPEED OF 3CM/MIN FOR

PURPOSES OF

INTERPRETATION

The following references are used by content team members and

outside item writers to generate test questions for the EFM

examination. This list is not intended as an all-inclusive list of

references, nor does it imply that items on the current examinations

were necessarily referenced from any of these publications.

• ACOG, Management of intrapartum fetal heart rate tracings,

Practice Bulletin, No. 116, American College of Obstetricians and

Gynecologists, Obstetrics & Gynecology 2010(Reaffirmed 2019);

116:1232–40.

• Cunningham, et al., Williams’ Obstetrics, McGraw Hill, 2022.

• Landon, et al., Gabbe’s Obstetrics: Normal and Problem

Pregnancies, 8th ed., Elsevier, 2021.

• Lyndon, et al., Fetal Heart Monitoring Principles and Practices,

AWHONN, Kendall Hunt, 2021.

• Menihan, et al., Electronic Fetal Monitoring Concepts and

Applications, 3

ed., Wolters Kluwer, 2019.

• Miller, et al., Mosby’s Pocket Guide to Fetal Monitoring: A

Multidisciplinary Approach, 9

ed., Mosby Elsevier, 2022.

• NCC Monograph: Fetal Assessment and Safe Labor Management,

Simpson, Kathleen, NCC, 2021.

• Simpson, et al., AWHONN’s Perinatal Nursing, 5

ed, Wolters

Kluwer, 2021.

• Resnik, et al., Creasy & Resnik’s Maternal-Fetal Medicine Principles

and Practice, Elsevier, 2022.

SAMPLE QUESTIONS

2024 Candidate Guide:

Electronic Fetal Monitoring

ELECTRONIC FETAL MONITORING SAMPLE QUESTIONS

Listed below are five sample questions to acquaint the candidate with the test question format. These questions do

not reflect the scope or the difficulty level of the questions on the actual examination. The reference from which

each question is derived is also cited. However, other references might substantiate a different answer, and the

answer shown here might be substantiated by other references. The rigorous review to which actual test questions

are subject is not applied to these sample questions. The focus that should be attended to in reviewing these items is

format, not content.

1. Following an ultrasound which revealed

decreased amniotic fluid, a patient at term is

admitted in early labor. It should be recognized

that oligohydramnios often results in fetal heart

rate decelerations that are

A. late in onset or occur after the peak of the

contraction

B. synchronous with that of the contraction

C. varied in depth and duration

Answer: C

Simpson, et al., AWHONN’s Perinatal Nursing, 5

ed,

Wolters Kluwer, 2021, pgs. 387-388

2. In comparing early and late decelerations, a

distinguishing factor between the two is

A. onset time to the nadir of the deceleration

B. the number of decelerations that occur

C. timing in relation to contractions

Answer: C

Miller, et al., Pocket Guide to Fetal Monitoring,

Elsevier, 2022, pgs. 124, 125

SAMPLE QUESTIONS

2024 Candidate Guide

: Electronic Fetal Monitoring

3. Based on interpretation the above tracing, this

tracing would classified as

A. Category I

B. Category II

C. Category III

Answer: B

Miller, et al., Pocket Guide to Fetal Monitoring,

Elsevier, 2022, pg. 107

4. The underlying cause of early decelerations is

decreased

A. baroceptor response

B. increased peripheral resistance

C. vagal reflex

Answer: C

Simpson, et al., AWHONN’s Perinatal Nursing, 5

ed,

Wolters Kluwer, 2021, pg. 429

SCORING & TEST REPORT

2024 Candidate Guide:

Electronic Fetal Monitoring

HOW EXAMS ARE SCORED

NCC examinations are criterion-referenced. This means the passing score is

based on a predetermined criterion. This criterion is a statistical ability level

established by the Content Team based on evaluation of criticality of

content and the test questions’ past statistical performance. Questions

used to determine pass/fail have proven statistical history that

demonstrates the question is appropriate for use to measure an

individual’s ability level.

There is no set percentage passing level. An ability level for each candidate

is calculated based on the number of questions they answer correctly

(there is no penalty for wrong answers). Pass/fail is determined based on

this ability level as compared to pass/fail standard which is a

predetermined ability criterion. When different forms of the examination

are used, a process called equating is initiated. This procedure converts all

results to a common scale. So someone who takes a slightly more difficult

form of the exam will need to answer fewer questions correctly than

someone who takes a slightly easier form of the exam.

NCC utilizes the item response theory of psychometrics for the analysis of

its examinations. Item response theory (Rasch analysis) is the study of test

and item scores based on assumptions concerning the mathematical

relationship between abilities and item responses. This is a commonly used

system, and such examinations as the NCLEX and other health related

certification examinations utilize this type of psychometric analysis.

Test reports identify pass/fail status, and they give feedback on the various

content areas of the examination in the form of word descriptors: very

weak, weak, average, strong and very strong. No percentages or standard

scores are given. These descriptors are based on the items within a given

subtest. The overall pass/fail decisions are based on the full test, and the

verbal descriptors are intended to provide suggested feedback on strengths

and weaknesses in various content areas. Since this feedback is based on

relatively few items, general verbal descriptions are given instead of

subtest scores. These word descriptors are for information only, and they

should be interpreted cautiously due to the small number of items included

in each content area.

HAND SCORING YOUR

EXAMINATION

If you believe there might be a

discrepancy in your test

results, you may request a

hand score for a fee of $55.

You must make this request

via the NCC website within 60

days of receiving the pass/fail

report by selecting that option

from your NCC profile at

NCCwebsite.org or go to the

certification tab

https://www.nccwebsite.org/

certification-exams, scroll

down to “Other helpful

information” and click “Exam

hand score request” to submit

your request.

SCORING & TEST REPORT

2024 Candidate Guide:

Electronic Fetal Monitoring

SAMPLE TEST REPORT

Candidates will receive an official test results report from NCC. It will be located in your NCC account. Shown below is

a sample test result report for a candidate who has passed the examination.

ELECTRONIC FETAL MONITORING EXAMINATION

Test Results

NAME DATE:

ADDRESS

Pass/Fail: PASS Maintenance Due Date:

Your credential is designated as: C-EFM® (Certified - Electronic Fetal Monitoring)

EXAM CONTENT REPORT

Overall pass/fail decisions are based on your overall exam performance. A candidate must obtain a score equal to or

higher than the “passing score” to pass the exam. A candidate’s performance on the examination is not compared to

the performance of others taking the examination.

In addition, the test report provides you with feedback on the various content areas of the examination in the form

of word descriptors: Very Weak, Weak, Average, Strong and Very Strong. No percentages or standard scores are

given. These descriptors are based on items within a given subtest and are intended to provide suggested feedback

on strengths and weaknesses in various content areas. Since this feedback is based on relatively few items, general

verbal descriptions are given instead of subtest scores. Word descriptors for scoring are set using these ability levels

and utilize equal intervals of scale above and below the pass point to provide additional feedback. See the Important

Facts and Information on Test Results and Scores page for more detail. These word descriptors are for information

only, and they should be interpreted cautiously due to the small number of items included in each content area.

Content Area (Percentage of Questions on Exam) Your Results:

Physiology (11%) WEAK

Pattern Recognition and Intervention (70%) AVERAGE

EFM Equipment; Fetal Assessment Methods; AVERAGE

Professional Issues (19%)

TERMS OF CERTIFICATION AND CERTIFICATION MAINTENANCE

2024 Candidate Guide:

Electronic Fetal Monitoring

AFTER PASSING THE EXAM

CREDENTIAL

Successfully completing the

Electronic Fetal Monitoring exam

entitles you to use the credential

C-EFM® (Certified – Electronic

Fetal Monitoring).

TERMS OF CERTIFICATION

NCC certification is awarded for a

period of three years.

The effective date for

certification is the date on the

official NCC score report letter

that shows a passed examination.

MAINTENANCE AUDITS

Certificants must maintain the

conference/CE description

and/or objectives, along with the

CE certificate which are required

to be uploaded if chosen for

random audit. Pre-approval of CE

does not exempt a certificant

from random audit.

NO CONTINUING

EDUCATION IS ISSUED FOR

TAKING THE

ELECTRONIC FETAL

MONITORING EXAM.

MAINTAINING CERTIFICATION

- NCC certification must be maintained every three years.

- Certification that is not maintained will expire

- The NCC certification maintenance program allows you to continue your

certification status by obtaining 15 hours of continuing education credit

- For continuing education credit to be used for certification maintenance

it must be earned between the date of your notification of certification

and the date your maintenance is due.

- The maintenance process includes submitting a maintenance application

prior to the maintenance due date with appropriate fees and requested

documentation. All CE must be in Electronic Fetal Monitoring. Using NCC

CE modules does NOT automatically maintain your certification.

Individuals must submit a maintenance application and pay a

maintenance fee in addition to any CE fees.

- Maintenance applications are subject to random audit. If an individual is

chosen for audit, they will be required to upload CE certificates and

course descriptions. These records should be maintained during each

maintenance cycle, until the maintenance application has been approved.

Individuals can upload these documents in their maintenance application

throughout their maintenance cycle. Documents from NCC modules are

already on file with NCC and therefore are not requested or audited.

- The maintenance due date is the last day the certification is active. NCC

Certified professionals do not need to wait until their maintenance

deadline to apply. As long as they have obtained the required contact

hours of continuing education credit - maintenance applications can be

submitted up to 12 months before this date to avoid a lapsed certification

while the maintenance application is in review. Maintenance will be due

in the quarter in which they were notified of their certification (not the

date on which they took the examination). Maintenance due dates can be

found by signing into the certified professional’s NCC account. Sign into

the account using the associated email and password.

The NCC website has more detailed information

For more information about the certification maintenance program, click

the purple "Maintain your Certification" box.