How to Pass the NBCOT® Exam on Your Second Attempt

Why the NBCOT® Exam Can Be Tough to Pass

Passing the NBCOT exam is a huge accomplishment for every OT student – and for many, one of the hardest. With first-time pass rates sitting around 68% to 77%, it’s not uncommon for new grads to come up just a few points short and have to regroup for a retake.

That’s exactly what happened to Leah Bicknell, OTD, OTR/L. She didn’t pass on her first try, but she used that experience to reset, rebuild her confidence, and come back stronger to ultimately pass the NBCOT on her second attempt.

In a recent TrueLearn webinar, Leah shared what changed the second time around: how she adjusted her mindset, refined her study habits, and used tools like TrueLearn’s NBCOT SmartBank and Picmonic to improve her performance. 

This post highlights Leah’s biggest takeaways and practical advice for OT students who are preparing for – or retaking – the NBCOT.

Lessons Learned From the First NBCOT Exam Attempt

Leah’s first NBCOT attempt taught her what not to do and why self-reflection is the foundation of a successful retake.

What she learned after her first attempt:

• Passive review doesn’t build recall: Leah realized that rereading notes wasn’t enough; it didn’t lead to long-term retention. Instead, she shifted to active recall: testing herself, practicing retrieval, and using question banks to strengthen memory. This change helped her move from recognition to true understanding, a skill essential for exam success. 
• Don’t skip timed practice: “I barely did any timed full length exams, so when I walked into the real thing, I was not prepared for how mentally exhausting the exam would be. By the time I hit question 20, I was in survival mode.” Timed practice helped her fix that. Simulating real exam conditions improved her focus, pacing, and stamina – all key factors in handling the four-hour NBCOT.
• Avoid analysis paralysis: Second-guessing every option can derail pacing and focus. Leah began using structured reasoning frameworks like S.C.O.P.E. (safe, client-centered, occupation-based, where in the OT process, evidence-based) to guide her thinking and move through questions more efficiently.

In the end, reflection made the difference. She was able to identify what wasn’t working so she could focus her time and energy on what actually does.

Study Strategies That Work on the Second Attempt

The second time around, Leah completely revamped her study plan. Instead of more hours, she focused on smarter methods that prioritized active recall, question endurance, and mindset management.

Key strategies Leah used:

• Simulating real testing conditions: Every week, Leah committed to a full-length, timed exam with no pauses. By the time she sat down for the real exam, her brain and body already knew what four hours of focused performance felt like. It completely transformed how she performed.
  
• Mastering the ‘why’ behind every answer: Don’t just review every missed question. Rather, study why every rationale is correct. This is where true learning happens: in understanding the reasoning, not just memorizing the result.
  
• Turning weaknesses into strategy: “If I missed psychosocial or pediatric questions, that’s what I focused on the next day.” Patterns are data. When you notice a trend in your performance around certain categories, that’s where you should pivot your preparations. Every mistake should be a roadmap for what to master next.
  
• Prioritizing mental health: Studying for the NBCOT is a marathon, not a sprint. What matters most isn’t how many hours you study, but how effectively you’re able to recover. The day before your exam, go ahead and close the books. You’ve put in the work, now trust it. Use that time instead to rest your mind, move your body, and recharge. At this point, it doesn’t make sense to cram more facts, Your goal is to walk into that exam feeling calm, focused, and ready to perform your best

NBCOT Practice Questions and High-Yield Content Areas

During the webinar, Leah worked through TrueLearn’s NBCOT SmartBank questions. And she didn’t just simply answer them, she provided a reasoning behind selecting her answers. She emphasized three important things while covering the questions:

• Always highlight keywords and identify the client’s setting, stage, and needs.
• Use the S.C.O.P.E acronym to reason through answers
  • S for Safe: Choose the option that protects the client first. If a response could cause harm or risk, eliminate it immediately.
  • C for Client-centered: Consider the client’s goals, values, and priorities. The right answer should support what matters most to them, not just what’s efficient or convenient.
  • O for Occupation-based: Select the intervention or approach that keeps the focus on meaningful occupations and daily function, just just body mechanics or isolated skills.
  • P for Process-focused: Think about where you are in the OT process (evaluation, intervention, outcomes). The best answer depends on the correct phase of care.
  • E for Evidence-based: When in doubt, lean on what’s supported by current research and best practice – not outdated habits or personal preference.
• Focus on what’s most right rather than what’s technically correct. There’s a difference, and once you can separate the two, choosing the right answer becomes a little easier.

The NBCOT often tests clinical reasoning, not memorization. Leah summarizes it well: “it’s about knowing the why, not just knowing facts.”

Part of Leah’s strategy the second time around was practicing with targeted question banks. She focused on realistic NBCOT-style questions, reviewed detailed rationales, and used topic filters to zero in on her weaker areas. That’s the same kind of focused approach offered in TrueLearn’s NBCOT SmartBank.

Using OT Exam Study Resources Effectively

Part of Leah’s strategy (and success) was to curate a few powerful resources and know how to use them together. Utilizing every single tool and resource just didn’t make much sense. For her, thoroughly understanding the ones she selected seemed to be the better decision.

Here’s what Leah included in her toolkit:

• TrueLearn SmartBank: Leah practiced with TrueLearn’s NBCOT SmartBank to get used to the types of questions she’d see on test day. The detailed rationales helped her spot patterns, strengthened her reasoning, and built the stamina she needed for a long exam.
  
• Picmonic: For the topics that just wouldn’t stick, Picmonic made them easier to remember. The quick, visual mnemonics turned complex ideas into short stories she could recall when it counted.
  
• TherapyEd: Leah used TherapyEd when she wanted a more in-depth review. The full-length exams gave her a realistic feel for timing and helped her test how well she really knew the material.
  
• AOTA PDFs & YouTube: She also liked using AOTA PDFs for quick refreshers and pairing them with YouTube videos to hear the same concepts explained in new ways. That mix kept studying interesting and made tough material feel more approachable.

Together, these resources work together to build a complete, efficient study system.

Mindset: The Hidden Key to Passing on a Retake 

Leah’s story is also one of resilience. After her first attempt, she took time to rest, reflect, and reset before restarting. “That moment doesn’t define you, it refines you.”

Her advice for retakers:

• Take a break before diving back in. Give yourself mental space.
  
• Simulate, don’t cram. Train like it’s the real exam.
  
• Celebrate progress, not perfection. Every practice test is data, not judgment.

Final Thoughts: Build Confidence Through Consistency

Leah’s experience is a reminder that sometimes we need to shift our minds and approach. It’s important to stay consistent, use the right strategies, and trust the process you chose. Ample practice (the correct kind of practice, of course) and confidence has increased benefits over striving for perfection and cramming until the last minute. 

 Whether this is your first NBCOT exam prep, or you’re planning a retake, give yourself the space to learn, adjust, and grow.

Watch the Full Webinar

How to Pass the NBCOT Exam on Your Second Attempt – with Leah Bicknell, OTD, OTR/L

Get Started with TrueLearn

Don’t leave your NBCOT retake to chance. Learn from proven strategies and practice smarter with TrueLearn’s NBCOT SmartBank –  the question resource designed to help you pass with confidence.

Start Your NBCOT Prep Today