- What "RRT Training" Actually Covers
- The Education Gate: Programs and Eligibility
- Training for Two Separate Examinations
- Training by Domain
- Training for the Clinical Simulation Examination
- Sequencing Your Preparation Around the Domains
- Fees, Testing Centers, and Attempt Rules
- The 2027 Transition and What It Means for Trainees
- After the Credential: Maintenance Training
- Frequently Asked Questions
- RRT training starts with an eligible CoARC-supported respiratory program, not with exam prep alone.
- The TMC (160 questions, three hours) and CSE (22 problems, four hours) are separate appointments.
- The TMC's largest scored allocation is Initiation and Modification of Interventions, at 70 of 140 scored items.
- Live remote proctoring ended December 31, 2024; testing happens at supervised PSI assessment centers.
What "RRT Training" Actually Covers
Search for "RRT training" and you will find a mix of results: program listings, exam-prep courses, hospital orientation pathways, and continuing education. For the Registered Respiratory Therapist credential, issued by the National Board for Respiratory Care (NBRC), training really means three stacked layers:
- Formal education: an entry-into-practice respiratory therapy program that satisfies the NBRC's eligibility rules.
- Examination preparation: targeted work for two separate assessments, the Therapist Multiple-Choice Examination (TMC) and the Clinical Simulation Examination (CSE).
- Credential maintenance: ongoing learning through the five-year Credential Maintenance Program (CMP) once you hold the credential.
This article walks through each layer with an eye on what is specific to the RRT route. If you are still orienting yourself, start with What Is RRT Certification? or the shorter explainer What Does RRT Stand For? and come back.
The Education Gate: Programs and Eligibility
The standard route to the RRT begins with education. Candidates must be at least 18 years old and hold at least an associate degree from an eligible CoARC-supported or accredited entry-into-practice respiratory program. That is the baseline, and it shapes how you should think about training: the credential is not something you can reach through self-study alone on the standard path.
Sequencing inside the pathway
The two exams are linked. The CSE requires CRT status and a qualifying high-cut result on the TMC. In practical terms, your training has to peak twice: once for a broad, knowledge-heavy multiple-choice test, and again for a case-based simulation that tests how you apply that knowledge across a changing patient picture.
Legacy routes for working CRTs
Some practitioners already hold the CRT and reach the RRT through conditional legacy routes. The published options include:
- Four years as a CRT plus 62 specified college hours.
- Two years as a CRT plus a qualifying respiratory associate degree.
- Two years as a CRT plus a non-respiratory bachelor's degree and 62 specified hours.
- A separately listed route for CSRT holders.
Training for Two Separate Examinations
A common mistake is treating the RRT as one big exam. It is not. The current route requires the TMC high cut score followed by a passing CSE. The TMC alone does not award the RRT. These are separate examinations, not one 182-question appointment, and they train different skills.
| Feature | TMC | CSE |
|---|---|---|
| Format | 160 multiple-choice questions | 22 interactive clinical-simulation problems |
| Scored vs. pretest | 140 scored, 20 pretest | 20 scored, 2 pretest |
| Time allowed | Three hours | Four hours |
| Fee | USD 190 new / USD 150 repeat | USD 200 new or repeat |
| What it rewards | Breadth of recall and application | Sequential judgment in evolving cases |
Both exams are closed book. The only calculator allowed is the virtual calculator supplied in the testing software, and break time counts against your examination time. That last point matters for training: practice sitting through the full duration, because pausing is not free.
Training by Domain
The NBRC publishes detailed content outlines for both exams. The TMC outline (effective January 2020 through December 31, 2026) and the CSE outline (effective January 2020 through December 31, 2027) use three headings each. Six is the supplied heading count across the two assessments, not an official combined six-domain RRT examination. The repeated headings are intentional, and no combined domain weights are established. For a deeper breakdown, see our RRT exam domains guide.
Domains 1 and 4: Patient Data
On the TMC this heading carries 50 scored items. On the CSE the same heading governs how you gather and interpret information while a case unfolds.
- Reviewing clinical records, history, and bedside findings.
- Interpreting arterial blood gases, pulmonary function results, and imaging.
- Recognizing hemodynamic and ventilator-derived data patterns.
- Knowing which additional data to request, and which to skip.
Domains 2 and 5: Troubleshooting and Quality Control, and Infection Control
The TMC heading reads "Troubleshooting and Quality Control of Devices, and Infection Control" (20 scored items). The CSE version says "Equipment" rather than "Devices"; that wording difference is intentional in the official headings.
- Diagnosing alarms and ventilator-patient mismatches.
- Verifying equipment function and calibration.
- Applying infection control principles to devices and patient care.
- Recognizing when a problem is the patient, the circuit, or the machine.
Domains 3 and 6: Initiation and Modification of Interventions
This is the heaviest TMC allocation: 70 scored items. On the CSE it is where most of your decisions are made and judged.
- Starting and adjusting oxygen therapy, aerosol delivery, and airway clearance.
- Ventilator initiation, mode and setting changes, and weaning decisions.
- Emergency and critical-care responses.
- Adjusting the plan as a patient improves or deteriorates.
Key Takeaway
Interventions has the largest TMC allocation (70 of 140 scored items), so protect time for it. But do not neglect Patient Data (50 items); it also feeds nearly every CSE decision.
Training for the Clinical Simulation Examination
The CSE is where many candidates feel least prepared, because it cannot be crammed in the same way. Each of the 22 problems can contain multiple sections and choices, and the examination is scored as a single CSE score summed across the whole test. The 2026 Candidate Handbook does not specify separate information-gathering and decision-making pass thresholds, so your preparation should target overall case performance rather than gaming one half of the format.
Know the case mix you will face
The scored CSE cases are assembled from defined groups. These are case-assembly groups, not additional domain lines:
- Adult Chronic Airways Disease: seven
- Adult Medical or Surgical: five
- Adult Cardiovascular: two
- Pediatric: two
- Neonatal: two
- Adult Trauma: one
- Adult Neurological or Neuromuscular: one
Chronic airways disease dominates, which means COPD and asthma presentations deserve repeated, varied practice. But the pediatric and neonatal groups add four scored cases, and those populations require different equipment, settings, and thresholds than adults. Many experienced adult-care clinicians underprepare here.
Sequencing Your Preparation Around the Domains
Generic study advice is easy to find; our RRT study guide goes deeper on methods. Here is one RRT-specific way to order the work, built around the weighting of the TMC and the CSE's dependence on it.
Patient Data foundation
- Blood gas interpretation, pulmonary function patterns, and chest imaging basics.
- Why first: every later domain assumes you can read the data correctly.
Troubleshooting, quality control, infection control
- Alarm and waveform analysis, equipment checks, contamination and isolation principles.
- Smaller allocation, but these items reward precise, fact-based recall.
Initiation and modification of interventions
- Ventilator management, oxygen and aerosol therapy, emergency responses.
- Longest block because it is the largest TMC allocation.
Integration and timed practice
- Full-length, three-hour mixed sets; then case-style walkthroughs for CSE readiness.
You can test your pacing with timed questions on our RRT practice test platform. For a quick-reference companion while you drill, the RRT cheat sheet condenses the facts that most often trip candidates.
Fees, Testing Centers, and Attempt Rules
Training is not just content; it is also logistics. Plan these in advance so they do not derail your timeline.
- Fees: Standard first attempts total USD 390 (TMC USD 190 plus CSE USD 200). Eligible AARC members may receive a one-time USD 40 first-CSE discount through the prescribed application process, bringing the total to USD 350. These figures exclude education, preparation, membership, and licensure. See the full RRT certification cost breakdown.
- Where you test: Supervised PSI assessment centers. Live remote proctoring ended December 31, 2024, so initial at-home delivery is not a current option.
- Attempts: For each examination, three initial attempts are permitted without the subsequent-attempt waiting interval. Later attempts require 120 days between attempts.
- Repeat fees: The TMC drops to USD 150 for repeats; the CSE stays at USD 200.
Numeric cut scores are not something we can state with confidence, so we avoid quoting them; our passing score page explains how the high and low cut results are used.
The 2027 Transition and What It Means for Trainees
This is the most time-sensitive part of RRT training. The NBRC is moving from the two-exam sequence to a single combined assessment, and the dates matter for anyone planning a testing window.
| Item | Current TMC/CSE route | Respiratory Therapy Examination (2027) |
|---|---|---|
| Structure | Two separate exams | One exam: 185 multiple-choice questions (160 scored, 25 pretest) |
| Time | Three hours (TMC) plus four hours (CSE) | Four hours |
| Fees | USD 190/150 (TMC); USD 200 (CSE) | USD 360 new / USD 300 repeat |
| Outcome | High cut on TMC, then passing CSE, awards RRT | Lower/higher cut scores lead directly to CRT/RRT |
| Key dates | TMC applications close December 15, 2026; TMC testing ends December 31, 2026 | Applications opened October 1, 2026; first availability January 4, 2027 |
The CSE remains available through December 31, 2027, but only for the eligible transition cohort. The CRT-to-registry admission policy expires December 31, 2026. One wrinkle: issuer wording about achieving the TMC high cut "prior to December 31, 2026" conflicts with the announced final testing date, so eligibility from a result earned on December 31 requires confirmation from the NBRC itself.
Key Takeaway
Do not blend the 2027 exam outline into your TMC and CSE study plan. They are separate scopes with separate outlines. Choose your route first, then study the matching content outline. Our RRT exam dates page tracks the scheduling windows.
After the Credential: Maintenance Training
Training does not end when you pass. The RRT is maintained through the five-year Credential Maintenance Program, with a published exemption for credentials earned before July 1, 2002. Three routes are available:
- Assessment-based CE: zero, 15, or 30 Category I credits depending on your performance.
- Examination route: passing the highest relevant examination during the final year of the maintenance cycle.
- Additional credential: earning another qualifying NBRC credential.
CMP payment is USD 25 per payment year before 2027 and USD 30 beginning in 2027. The brochure shows mixed old and new fee versions, but the live issuer FAQ confirms the 2027 effective date. If you are weighing the long-term value of keeping the credential current, see whether the RRT is worth it, plus the RRT salary guide and RRT jobs overview for what the credential tends to open up in practice.
Frequently Asked Questions
Education and preparation can be flexible, but the examinations themselves are not delivered at home. Live remote proctoring ended December 31, 2024, so initial examinations are taken at supervised PSI assessment centers.
No. The current route requires the TMC high cut score followed by a passing CSE. The TMC alone does not award the RRT. The CSE also requires CRT status and a qualifying high-cut TMC result.
Initiation and Modification of Interventions carries the largest TMC allocation at 70 of 140 scored items, so it deserves the longest block. Patient Data (50 items) is a close second in practical importance, since it underpins nearly every decision.
For each examination, three initial attempts are permitted without the subsequent-attempt waiting interval. Later attempts require 120 days between attempts.
That depends on your eligibility and timing. The Respiratory Therapy Examination begins January 4, 2027, while TMC testing ends December 31, 2026. Check the NBRC's transition resources, and for background see What Is RRT? before committing to a route.