How to Pass the NBCOT OTR® on Your First Try

When preparing for important things, like the NBCOT® exam, I’m the type of person that plans to work on projects a little at a time. Although with good intentions, I might skip a day working on the project and then promise myself, I’ll do double the next day. When the next day comes, I run out of time to finish the part I said I would, and things start snowballing. The snowball generally culminates at midnight the night before the project is due and I’ve become a stress monster trying to get it all finished. I went in with a plan, but my plan clearly failed. 

When preparing for the NBCOT® Exam, I immediately thought “no problem, I’ll study a little each evening during fieldwork” with the intent to be ready to take the exam right after graduation. As with many other similar things, this plan didn’t work. Fieldwork is exhausting. Fieldwork has its own huge learning curve. Fieldwork requires all your bandwidth, leaving none left for studying. 

I needed a plan and accountability to execute the plan if I was going to pass the NBCOT® exam on the first try. I knew I did not want to take the exam multiple times. After all, I did have my first OT job lined up, waiting for me to pass the exam and become licensed. 

5 Tips to Help You Pass the NBCOT® Exam

But where to start? It’s an overwhelming exam and it feels like there’s a lot riding on it. This is ultimately the culmination of the many hours spent in lectures, labs, working in groups with your fellow students, putting together projects, and managing clinical rotations. In order to be successful here are a few tips to get started and help you pass the exam on the first attempt: 

1. Take a practice test cold. 

Yes, don’t study. Just sit down and answer the 170 multiple choice questions over a four-hour time period. You don’t know what you don’t know. You also don’t know if you can focus for the duration of the exam (or sit in the same chair for that long).

2. Figure out what you don’t know.

See those wrong answers on the practice test? That’s where to start your studying.

3. Find your resources.

There are a lot of options for resources when studying for the NBCOT® exam. Consider how you learn best and opt for a couple resources to give you enough variability. 

Here are my favorites:

• Flash cards: Self-made flashcards to encourage me to read the material again and write it down (multi-sensory learning!) Flash cards help me memorize the information. Things like anatomy, developmental ages, pediatric reflexes, etc, are easy to learn using the flashcards and rote memorization. 
• Topic reviews: These consolidate your information into easy to read and understand sections. I found the topic reviews in the Therapy Ed National Occupational Therapy Certification Exam Review and Study Guide to be helpful. The topic reviews help place the information from flashcards into context. 
• Practice questions: Yes, you may have the information memorized; however, application of the information is key.  The exam isn’t testing your rote memorization but rather your ability to use the information clinically and functionally. Application is essential to success with this test. 
  • TrueLearn makes a great platform where you can practice your knowledge. Truelearn has over 1300 occupational therapy practice questions available that are all mapped to the NBCOT® exam content. All the questions provide in-depth, detailed explanations regarding why or why not an answer is correct and all questions have a reference. The reference allows you to go look up the information if you need more details.  Many of these questions provide images, tables, or even a Picmonic that helps further explain the content of the question. 
  • Picmonics are quick and effective two-minute videos that help connect difficult to learn facts and add context to the information provided. Using both Truelearn and Picmonic link the information to application in an easy to remember format.

4. Consider your time available.

Be realistic in how much time you’re willing or able to spend. Initially I had thought I would commit 6-8 hours a day over the course of 4 weeks. Although that felt like the right thing to do, the reality was that I couldn’t stay focused for that duration of time. I instantly recognized that I’d be snowballing again if I didn’t set a more reasonable time goal. I ended up breaking my study sessions into 3–4-hour blocks, after all the exam itself allows you four hours maximum to complete. Building test (and sitting) endurance up to 4 hours was helpful. 

5. Create a schedule.

Once you have found your resources, create a schedule with topics to study, when to take practice tests or check progress, when you will schedule the exam, and the date  when you’re taking the exam. 

When creating the schedule, focus your studying on the areas of weakness first. Use your resources wisely and spend extra time reviewing the tough areas. I created a specific schedule to help keep me on track. I would take one topic, prepare my flashcards, work with the topic reviews, take TrueLearn practice questions to ensure the information was sticking. With the more detailed and specific schedule, I had created daily / weekly goals for me to attain while preparing for the final date. 

Each week, every Friday, I’d take a practice test, using either TrueLearn questions or the tests in the Therapy Ed National Occupational Therapy Certification Exam Review and Study Guide. Taking regular tests allowed me to compare my scores from the previous week. I’d look to see if my weak areas were better and then see where I needed to focus efforts for the following week. TrueLearn is helpful in measuring progress as well by providing performance analytics and national benchmarking. 

Part of your schedule should include scheduling the exam. This feels like a big step and should be done a few weeks after you’ve started studying. Committing to the actual date and time of your test is a big deal and announces, “I’m ready!” Hopefully after studying for a few weeks, you’ve identified your patterns- days of the week and time of day where you’re at your best. I know I’m “brainier” in the mornings and generally better at the beginning of the week than at the end. I scheduled my exam at 9am Tuesday morning.

Advice for the Day Before

Go over those things that aren’t sticking well. Especially on the day before the exam, go back and visit the Picmonics to help with the information. Review more questions, but also focus on your health and mental well-being. Eat well, hydrate, get quality rest and connect with your occupations that center you, bring you joy, and offer a distraction. Also don’t forget to pack the things you need for the test. Locate anything you are taking with you and have it ready to go (including your wallet, phone, and those pesky car keys).

Advice for Exam Day

Eat healthy meals, hydrate, and know you’ve done all the work you’ve needed to do. When you sit down to take the exam, take a moment to write (on the board or paper provided at the testing center) anything that’s been hard to learn or remember. It feels good to do a data dump before settling into the exam. You’ll have that data ready for when you need it. 

Key Things to Remember

The NBCOT® exam is ultimately just a test. Its entire purpose is to encourage a baseline standard of practice for all new professionals. The NBCOT® exam presents itself as an overwhelming feat; however, with proper studying and preparation, this exam is very passable on the first attempt. On average 81% of OTRs and 75% of COTAs pass on the NBCOT® on their first try. Use your resources, create a schedule and stick to it, and you too will pass the exam on the first attempt.