Success strategies for passing the NBCOT Exam

Ophira Kopitnikoff, OTR/L
Tara Troianello, OTR/L
You will create a username and password. Do not
create a duplicate account, you will be charged a
You will need a valid email address.
Payment is made by either Visa or MasterCard.
Cost of the exam is $480, plus an additional $40
to report your scores to each state you wish to be
licensed in.
You must complete the application in one sitting;
you cannot exit the screen and login and start
where you left off.
Have your Student ID # ready.
You may apply either online, or send in a paper
For paper applications: mail application and
payment to
P.O. Box 64971
Baltimore, MD 21264
• Go to and follow directions for
online application.
• Application is valid for one year from the date of
submission. ATT letters are valid for 90 days.
Applicants must submit:
- Official Final Transcript or Academic Credential
Verification Form (AVCF) This form states that all
academic requirements have been fulfilled
- Fieldwork Verification by the Academic Program
Director (if applicable)
• Upon confirmation of eligibility to examine, the
candidate will receive an Authorization to Test
(ATT) Letter by e-mail or mail within 10-15
business days after all documentation is received
• The ATT Letter will include:
Contact information for Prometric, and details on
how to schedule, reschedule or cancel and exam
Prometric cannot schedule an examination
until the candidate has received the ATT
A list of Prometric Test sites can be found
online at
Candidates with an approved special
accommodation(s) MUST call Prometric to
schedule their examination.
The ATT letter is only valid for 3 months,
after this time period applicants will have to
reapply for another ATT letter
Scoring calendar: Scheduling the exam right
before the scoring date will allow applicants
to receive scores shortly after taking the
“Practice Based Exam”: The exam
tests the ability to make clinical
decisions based on scenarios
– 170 Multiple Choice Test (MCT) Items
– 3 Clinical Simulation Test (CST) Items
Tutorials are given before each
450/600 is needed to pass the
DO NOT leave anything blank.
Points are rewarded for correct
answers and there is no
penalization for incorrect answers
Some of the multiple choice questions stand
alone, and some are grouped into a scenario
that includes an introduction and is followed
by several questions related to the same case.
There are four answer options, with only one
correct answer
Spend about 1 minute on each MCT question
You may “mark” a question and return to it (it
is better to chose an answer even if the
question is “marked” in case you do not have
time to return
A practice situation called “opening scene” is
presented which may include information related
to practice settings, diagnoses, problem areas
and occupational roles.
Following the opening scene, there will be three
to six sections with questions followed by
potential decisions or actions that may be taken.
There is probably more than one correct answer
After an action is selected, a feedback box will
appear which describes consequences of the
action. After the feedback box appears, answers
can not be changed
Each action may be positive, negative, or
neutral. Testers will not be provided with this
information until the selection is made
Information from the feedback box should be
used to make subsequent decisions
Clinical reasoning and critical thinking are
needed in this section
Spend about 10-12 minutes on each CST
The process of Occupational Therapy:
• Referral, screening, evaluation, Intervention, reevaluation, discharge planning, clinical
reasoning, documentation
Professional Standards and Responsibilities:
Human Development and Aging:
– Professional ethics, Ethical jurisdiction of OT, Practitioner
roles, supervisory guidelines, Health care system, Payment
for OT services and reimbursement, federal legislation
– Pediatric development through geriatric. Includes:
Developmental theories, cognitive development, self care
development, evaluation of developmental milestones,
Musculoskeletal System Disorders
Neurological System Disorders
Cardiovascular & Pulmonary Disorders
Gastrointestinal, Endocrine & Immunological Disorders
Psychiatric and Cognitive Disorders
– Hand, UE injuries, Arthritis, joint procedures, Burns, Amputations,
Burns, pain
– CVA, TBI, SCI, CP, Movement Disorders, MS, SI Dysfunction,
Seizure Disorder
– CAD, PVD, COPD, Carcinomas, Pulmonary Edema
– Dysphagia, GERD, Cancer, Hepatitis, AIDS, Diabetes
– Consciousness, Cognitive Disorders, Psychotic Disorders, Mood
Disorders, Substance related disorders, Anxiety Disorders,
Personality Disorders, Eating Disorders, PDD, ADHD
Biomechanical Approaches
Neurological Approaches
Cognitive- Perceptual Approaches
Psychosocial Approaches
Evaluation and Intervention for Performance
Areas in Occupation
Mastery of the Environment
Biomechanical Approaches
Neurological Approaches
Evaluating motor control, limb and postural
control, Modified Ashworth scale (tone)
Cognitive- Perceptual Approaches
ROM, MMT, Endurance, Edema, Dexterity,
Cognition, perception, A-ONE, Rivermead,
LOTCA, Allen Cognitive Level Test
Psychosocial Approaches
MOHO, Occupational Adaptation, Role
Biomechanical Approaches
– Increasing strength, endurance, balance, Scar
management, joint protection principles, splinting
Neurological Approaches
– CIMT, motor learning principles, adaptation, SI
Cognitive- Perceptual Approaches
– Remediation, Transfer of Training Approach,
Compensation, Dynamic Interaction Approach
Psychosocial Approaches
– Managing problem behaviors, Intervention groups,
child abuse, elder abuse
Performance Areas of Occupation
Assessing ADLs, IADLs, Play/ Leisure, Work:
KELS, MEDLS, Routine Task Inventory, Play History
Intervention to increase independence in these
Mastery of the Environment
Home evaluation, wheelchair assessments, Driver
Intervention to increase independence in these
Make a study schedule
Study in groups
– This will help you get used to the format of the test
– If the same types of questions keep coming up on practice
tests, they are important!
– Write down and review the correct answers and their
explanations/ rationales even for the questions you answer
correctly. There is always additional information in the
– Time yourself
The practice tests are generally harder than the actual
test. If you fail a practice test, DO NOT PANIC, use it
as a guide to study topics you are having difficulty
Chose client centered actions
Read the question carefully before selecting a
Read through the questions and try to highlight
the three important pieces of information.
(Usually extra details that are less important are
thrown in).
Eliminate all answers that are unsafe or unethical
– once you do that you are usually left with 2 choices.
Study precautions and contraindications such as when
you can or can not apply heat or when ranging is
Eliminate obviously wrong answers
Do not “read into” questions
Do not think about treatment you saw with
patients in the clinic or in fieldwork to answer
questions. Try and think of “best practice”
Do not spend more than one minute on each
question, if you do not know the answer, pick the
best one and “mark” it. You can come back if you
have time
Only change an answer if you have a good reason
(you missed an essential word)
Avoid two answers that seem similar or are
Once you make a selection you can not
deselect it
Use the feedback provided as constructive
feedback as you progress through the CST
Do not select an option that “may” have a
negative outcome, you will lose points. It is
better to leave it blank
Do not select more than three or four
options. If you are sure about two, only select
those two
The NBCOT is looking for how something affects FUNCTION. The test is not about
memorizing “levels” but about understanding how “levels effect function”. For
– An individual scores a Level 3 on the Allen Cognitive Level test. At
this level a person can begin using his/ her hands to manipulate
objects, has repetitive movements and requires tactile stimulation
• Functional potential: self care activities such as brushing teeth
– An individual with a C6 SCI has elbow extension.
• Functional potential: Independent depression transfers without use of
sliding board
– An individual with a C8 SCI can tie his/her shoes
– An individual recovering from a TBI is assessed to be at Level VII
of the Rancho Level of Cognitive Functioning Scale . At this level
(automatic –appropriate) he can attend to highly familiar tasks in a
distraction free environment but may need cues
• Functional potential: Sequencing through morning ADL routine with a
visual chart
The NBCOT does not expect students to memorize
every single disorder, symptom or MET level, but the
test focuses on practical application.
Do not focus on how to complete a transfer with a
person who has a specific diagnosis. The questions
test general knowledge. For example:
– An OT practitioners is assisting an individual with
Parkinson’s Disorder in transferring from a W/C to mat.
After locking the brakes the first cue would be:
“Stand up”
“Scoot forward to the edge of the wheelchair”
“Unfasten the wheelchair brakes”
“Position the wheelchair so it directly faces the mat”
– Regardless of the diagnosis the answer would be “B”
Be Familiar with
Allen Cognitive levels
TBI: Rancho Levels of Cognitive Functioning
Glascow Coma Scale
Reisburg’s Stages for Dementia
MET Levels
Child Developmental milestones
Recent test questions have included issues relating to:
– Feeding:, transition from g-tube, tonic bite reflex,
– Transitional Employment Programs
– Ergonomic design
– OTR as consultant for establishing and developing community programs
– Well-elderly
– lymphedema management
– Frames of references: such as Ecology of Human Occupation FOR and
Person-Environment-Occupation FOR
How I personally prepared for
the exam…
What I used:
◦ TherapyEd National OT
Certification Exam, Review and
Study Guide by Rita FlemingCastaldy (2009)
◦ Lecture notes
◦ General textbooks (e.g.
Pedretti’s Occupational
Therapy, Willard and Spackman)
My timeline:
 Finished FWII
 2 week break
 Made a 7 week study schedule, with 3-4 classmates
◦ If you prefer studying alone, like me, I would still recommend this as it
forced me to keep to a schedule
◦ We assigned study categories to each week (based off the chapters in the
exam review book)
◦ Each person studied on their own and we meet at the end of the week to
go over any questions and do practice test questions
Took the 3 review book practice tests, with breaks, and then
reviewed the answers and took notes based on Q&As I had
trouble with
Scheduled 4 days for “full scale” practice tests
◦ Took tests in library cubicle without breaks to simulate actual test
◦ “Build up an endurance”
What worked best for me:
 Found I kept to my schedule more after I actually
◦ Register ASAP!
Taking as many practices tests and/or reviewing practice
Q&As was the best way to prepare
Focusing on my weaknesses
◦ Don’t waste time and energy making study guides or looking in
depth into the subject areas you’re comfortable with – what you
know is enough. So take the time to identify your strengths and
◦ E.g. I barely reviewed hand therapy or phys disabilities because
those are my strengths. I made study guides for neuro and
pediatrics and that helped
Reviewed (briefly) ALL my lecture notes and pulled out old
study guides and review sheets - skimmed all lecture
notes and only pulled out what seemed most important
NBCOT Competency Resources (online)
Self Assessment Tools
Study Group Report Form
Volunteer Services Guidelines and Log
Journal and Textbook Reading Guidelines and Log
◦ Good place to find study groups, ask questions, get
support, VENT, share study materials
Review courses (TherapyEd Occupational
Therapy Certification Exam Preparation
course) – pros and cons
“I made lots and lots of flash cards, rehearsed things verbally with roommates in
college I had been studying with since freshman year, and found ways to make it
fun and quiz each other. Also just a suggestion to relax before the test is to do
something fun and relaxing the night before and not freak out studying...if you
don't know it by then you won't know it and it's better to go into the test relaxed
than all stressed out.” – SB
Focus on ‘bigger concepts’
Study groups, flash cards, study guides/sheets
Make a list of your weak topics to focus on
“I started off slow, several months before taking the test. I looked things over for a
half hour to hour a day and started building up. I made a plan and studied every
subject four about 2-3 days then went back and reviewed it.” – AL
Take off the day before
“I wrote down motivators on my study guides like my starting salary or my name
with OTR after it” – KL
Don’t be discouraged by practice tests
Questions are more application based than knowledge based
Fleming- Castaldy, R.P. (2009). National Occupational Therapy
Certification Exam Review & Study Guide. Evanston, IL:
International Educational Resrouces (
Johnson, C, Lorch, A. and DeAngelis, T. The Occupational Therapy
Examination Review Guide, 3nd Edition. FA Davis Publishing
Company, 2006.
The NBCOT Certification Examination Handbook & Application
(2011). Retrieved August 31, 2011, from the National Board for
Certification In Occupational Therapy websit:

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