May 25, 2022

Your NBCOT OTR® Study Guide with Everything You Need to Know

Written By: Karla Sternberg, OTR, SCLV, CLVT, MOT | Share: | Last Modified: November 14, 2022

The National Board Certification in Occupational Therapy (NBCOT) Exam determines and certifies the competency of entry-level occupational therapists. This exam provides certification standards and validates the essential knowledge required for effective entry-level practice in occupational therapy. The high standardization of this exam strives to protect the public, promote quality client care, and maintain the integrity of the profession. (NBCOT, 2019).

The examination requires a four-step process: eligibility, application, examination, and results.

NBCOT Exam Eligibility

To be eligible for the exam, the applicant must complete an occupational therapy degree that meets entry-level degree requirements from an ACOTE (Accreditation Council for Occupational Therapy Education) accredited occupational therapy program. An official transcript and date of degree completion is required to complete the application submission process and determine exam eligibility. This official transcript verifies that the applicant has completed the required coursework and that the coursework meets the requirements for the NBCOT exam.

How to Apply for the NBCOT OTR

1. Complete the Online Application Form

To apply for the NBCOT exam, the applicant must complete an online application form at nbcot.org. At this website, the applicant creates an online account, using personal information and identifiers. This account will remain the primary access to NBCOT as long as the applicant or therapist remains active with the organization. This online account allows the applicant to request testing accommodations as needed, determine exam eligibility status, follow examination updates, and view testing results.

Character questions are an important component of the application process. The application consists of eight-character questions in which the candidate must answer yes or no to each question. If any question is answered with a yes, the candidate must provide detailed written documentation of the incident. In addition to the character questions, all applicants must successfully complete a background check prior to approval to take the examination.

2. Pay the Application Fees

Payment for the exam is required to process the application. The cost of the NBCOT exam is $515 for electronic applications. Additional fees occur with paper applications or if additional services are requested.

3. Receive the Eligibility Confirmation Notice

Once complete and submitted, the applicant will be notified electronically if deemed eligible to take the exam through the Eligibility Confirmation Notice. This confirmation notice may be sent to a state regulatory board, employer, or directly to the student and requires 2- 3 days to receive. This notice includes the following information:

Confirmation that the applicant’s application and fees have been received and processed
Confirmation that NBCOT has received and accepted the applicant’s official transcript
Confirmation that the candidate is approved to schedule an exam date
The candidate’s exam history

4. Schedule and Take the Exam

Once deemed eligible to take the exam, the applicant will receive the Authorization To Test (ATT) letter. This letter is sent via email, verifying that the applicant has met the criteria for the exam and is ready to complete testing. The ATT letter is active for 90 days; however due to COVID19, the time has been extended to 180 days. The applicant must schedule and take the exam during the time this letter is active.

5. Transfer Your Exam Score

The applicant must determine how the result and score of the exam will be transferred. NBCOT offers an automatic score transfer where the scores of the exam are sent electronically to the state regulatory board. Applicants may accept one free score transfer per application. Applicants may opt to have scores automatically transferred to an employer for an additional fee.

How Long is the NBCOT Exam?

The NBCOT exam is a computer-based exam administered by Prometric Testing Centers available nationwide. The applicant is allowed four hours to complete the exam; however, additional time is required for administrative processes specific to the testing center.

NBCOT Exam Topics

The NBCOT exam consists of four domains which determine the applicant’s knowledge, clinical reasoning, and problem solving required for entry level occupational therapy practice. These domains are as follows:

Evaluation and assessment required to obtain information regarding factors that influence occupational performance. The evaluation and assessment questions comprise 25% of the exam.
Analysis and interpretation required to formulate conclusions regarding client needs and priorities to develop and monitor an intervention plan. The analysis and interpretation questions comprise 23% of the exam.
Intervention management where the applicant is asked to select interventions for managing a client-centered plan. The intervention management questions comprise 37% of the exam.
Competency and practice management questions address the management of professional activities of self and relevant others as guided by evidence, regulatory compliance, and standards of practice to promote quality care. The competency and practice management questions compromise 15% of the exam.

The exam also consists of three clinical simulation test questions. These test questions provide an opening statement and a series of four sections with a list of decision or action statements. The applicant is required to select yes / no for all action statements. For each yes statement, a feedback box appears with additional information regarding the case. This testing format allows for clinical decision making and encourages the applicant to explore clinical reasoning scenarios to enhance entry level practice.

How Many Questions Are on the NBCOT Exam?

The exam consists of 170 multiple-choice questions. These questions provide a statement followed by three or four possible responses. The applicant selects the single BEST response from the options provided.

Passing the NBCOT

Once complete, the exam is scored. A score of at least 450 is required to pass. The exam scores are released on previously scheduled dates. In order to meet a specific scoring date, the exam must be completed at least three days prior to the desired score release date. The results of the exam may viewed following the score release date in the applicant’s NBCOT account. With successful completion of the NBCOT exam, a congratulatory letter, an official NBCOT certification, and a NBCOT wallet card are mailed. If the exam is not successful, a feedback report is provided to the applicant and includes the overall score, feedback on domain performance, and an explanation for interpreting the results.

Successful completion of the NBCOT exam does not provide state licensure; therefore, before practicing, the applicant must complete the specific state requirements for practice. Each state has varying levels of jurisdiction and requirements for occupational therapy practice.

Re-Taking the NBCOT

Applicants who do not pass the exam on the first attempt are allowed to retake the exam following a waiting period. For the second or third attempt, the applicant is required to wait 30 days before reapplication. For each attempt after the third, additional waiting periods are required. When retaking the exam, the applicant must complete the application process in full and is required to pay the same exam fees. The applicant will be required to have an updated ATT prior to scheduling and retaking the exam.

Certification Renewal

Renewing the NBCOT certification occurs every three years once certified. In order to renew, continuing education units are required, verification of abidance to the NBCOT Code of Conduct is documented, renewal application is completed, and renewal fees are paid in full. Renewing and maintaining this certification allows the therapist to utilize the OTR credential. This OTR credential implies that the therapist “satisfies national standards in education, experience, and professional conduct, and demonstrates that they possess the knowledge and skills to be accountable for the delivery of professional services” (National Board Certification in Occupational Therapy, 2020).

NBCOT Test Taking Strategies

Preparing for the exam is essential to reduce stress, promote testing endurance, and ensure that the content information is current. This is a comprehensive examination that tests all of the knowledge gained throughout the entire educational program. Due to the comprehensiveness of this exam, each area must be reviewed, fully understood, and tested using simulation. The use of self- assessment to determine areas of strengths and weaknesses, flashcards, and practice tests are important tools to build confidence in the subject matter as well as develop endurance for a four-hour examination.

Studying and taking the NBCOT Exam is the final step in an occupational therapy student’s career and the first step as an occupational therapy practitioner. The education the applicant has received through lectures, labs, and clinicals has prepared the applicant for this final examination of knowledge, basic skills, and understanding of the profession. Completing this exam is the beginning to a rewarding career.

References:

National Board Certification in Occupational Therapy, Inc. (2020). National Board Certification in Occupational Therapy – Occupational Therapist Registered, Certified Occupational Therapist Assistant Registered; Certification Exam Handbook.

NBCOT. (2019). Get Certified.

NBCOT. (2019). Our mission.