Occupational Therapy

Before the OT Exam

"Before Anything Else, Preparation is Key to Success."

Alexander Bell

The date for the exam has been set and the clock has started ticking. Anxiety creeps in and you feel as though you’re racing against the clock. Your life is on pause, anxiety is through the roof and you have no clue where to begin. I know this feeling. 

Looking back, I realize that a large part of my anxiety came from not knowing what to expect and feeling completely disorganized and overwhelmed. But it doesn’t have to be this way, and I am here to share my experiences and insights so that you can develop an effective study plan that is sure to set you on the path to success. Let’s get started!

Table of Contents

1. Exam Prep Checklist

The first step to feeling confident is understanding the process. Everything you need to know, as well as all the steps you need to take to get certified, is contained on the NBCOT® Get Certified page. Be sure to also read the NBCOT® Certification Exam Hand Book, which contains the most accurate and comprehensive information. From creating your MyNBCOT Account, requesting Testing Accommodations and sending your transcripts to scheduling your exam and receiving your score, the NBCOT® Exam Handbook will provide you with the most up-to-date steps you need to take to become certified.

2. Know What's on the Exam

Once you’ve read the NBCOT® Exam Handbook and set up your MyNBCOT account, you’ll want to familiarize yourself with the contents you’ll be tested on during the exam. You can review the content areas covered on the exam and the percentage of questions in each domain by going to the NBCOT website and reviewing the Exam Outline.


3. Establish a realistic study plan

Establish a realistic study plan and timeline based on your unique needs and learning style. Everyone’s situation is different and it is up to you to reflect on your own life, priorities and unique circumstances to determine a timeline and study plan that work best for you. Creating a realistic and individualized study plan will help you stay on track and remain accountable to your goals.

You may also consider taking the Entry-Level Self-Assessment to help identify your baseline and overall readiness. From there, you can create a personalized study plan based on your strengths and weaknesses.

4. Know the Score Release Dates

Depending on when you take your exam and how close your exam date is to the score release date, you may find out your result in as little as 3 days or as long as 10+ days. As for me, I wasn’t aware of the fact that there were predetermined score release dates at the time of scheduling my first exam, so I ended up having to wait 8 days to find out my result. Even worse, my score was released on the day of my OTD graduation ceremony, just 4 hours before the commencement. Talk about poor planning! You can avoid this situation by planning ahead and looking at the Scoring Calendar.

5. Create a Productive Study Space

To maximize your study sessions, be sure to spend some time creating a study space that is most conducive to productivity and focus. For some, this might be a loud, bustling cafe, while for others, it may be a quiet, empty library. Wherever it may be, make certain that your daily study sessions are done in an environment that facilitates maximum learning and concentration.

For the days when you are doing simulated practice exams, consider finding a dedicated space that mimics the Prometric Testing Center. That’s because on exam day, you won’t have the luxury of answering questions in a cozy cafe or in the comfort of your living room. I encourage you to do 3 simulated practice exams at your local library or in a quiet cubicle prior to taking your exam. This will give you the exercise, familiarity and discipline you need to eventually sit through hours of intense examination.

Consider having multiple study stations.

When I was preparing for the exam, I designated each area of my house for a different type of studying. For example, I used my desk to learn new content; I used the dining table to stand and review all the questions I got wrong; I used the couch to relax and go through the flashcards. This helped to break up the boredom and restlessness I often experienced.

6. Select Your Exam Prep Materials

There are as many different exam prep materials as there are different learning styles. As such, you will get polarizing responses when you seek others’ input on what might be the most effective study tool because what may work for one individual may not work for another. Ultimately, it is up to you to find and select the materials that best meets your unique learning style. In this section, I will highlight some of the materials that I personally used and found helpful during my own journey. You can also check out How Others Passed, which contains many insightful tips, practical strategies and inspiration from others who successfully passed the board exam.


I utilized AOTA’s NBCOT® Exam Prep as my main study tool because of its well-structured and organized content. The 1-year online subscription comes with downloadable PDFs of all the major topics you need to review, along with nearly 1,000 questions online, including actual retired NBCOT® Exam questions. Whether it’s for the OTR® or the COTA® exam, AOTA’s NBCOT® Exam Prep remains one of the most popular and frequently utilized study tools. 


I believe the strength of the Therapy Ed book is in its practice exam questions. Known for containing some of the most difficult questions, the Therapy Ed practice exam questions truly challenged me to hone my critical thinking skills and improve my clinical rationale. In fact, some of my greatest mental breakthroughs came with the Therapy Ed practice exam questions because they forced me to really dissect and deconstruct the question. Similar to the AOTA’s NBCOT® Exam Prep, the Therapy Ed book also contains a review of all the major topics with detailed charts and outlines.

Despite utilizing both the AOTA’s NBCOT® Exam Prep and Therapy Ed, I did not pass on my first attempt. However, I do not attribute that to the quality of the exam prep materials, or lack thereof. Looking back, it’s not just what I used or how long I studied that determined my success; rather, it was the approach I took on my second attempt that made all the difference. To find out what I did differently to pass on my second attempt, check out How I Went From 422 to 488.


After learning that I did not pass on my first attempt, I decided to purchase the Occupational Therapy Examination Review Guide, commonly referred to as “the purple book.” Although this book does not contain a review of all the major topics like the AOTA’s NBCOT® Exam Prep and Therapy Ed, it’ll give you access to ~800+ practice exam questions. I personally loved this book and felt that it was a great way to practice new questions and gain additional knowledge without recycling through the same old questions and rationales that I had already reviewed from my first attempt. This book is frequently used and recommended by candidates preparing for both the OTR® and COTA® exam. 


The NBCOT® Exam Practice Tests will allow you to take a simulated practice exam with questions developed using the same methodology as the exam itself. It is important to note that the NBCOT® practice tests only provides a feedback report with a scaled score, which means you will not be able to see the correct answers or rationales to any of the questions. However, taking the NBCOT® practice tests was beneficial for me because it allowed me to become more familiar with the type of questions that would appear on the actual exam.


Textbooks might be one of the most underutilized resource, but they can provide tremendous insights when you’re struggling to conceptualize any one content area. If you’re finding yourself struggling to understand a certain topic area, don’t be afraid to delve deep into your textbooks!

7. Review OT Miri's Study Notes & Resources

I encourage you to be diligent in seeking and identifying every resource available to you, including YouTube videos, Pinterest and Quizlet, making sure to always cross reference your material to ensure accuracy and relevance. Below, you will find links to all the resources I have created to help you successfully prepare for the NBCOT® Exam.

8. Adhere to Your Learning Style

What environment and study tools help you learn best? Do you need to see it? Hear it? Teach it? Many of us use a combination of learning styles and it’s important to understand how we learn best. If you’re unsure of your learning style, you can take this quick Learning Style Assessment to find out.  


  • Use flashcards, highlighters and colored pens to color code important words. Flashcards are most effective when memorizing simple principles and concepts. 
  • Draw simple images or pictures that illustrate the concepts you’re trying to learn. A good example of this can be seen in my Allen Cognitive Levels (ACL) video, where I come up with simple icons and images to help me remember each level.
  • Put up flashcards all over your house and quiz yourself every time you walk by these flashcards. For example, the wall next to my dining table had flashcards of the feeding milestones and I looked at it every time I was having a meal. I kept flashcards of the toileting milestones in the bathroom. On the wall next to my wardrobe, I had flashcards of the dressing milestones.
  • Draw or write on your own body. This is particularly helpful when learning the upper extremity 
Imagine and visualize things that you are learning. For example, if you’re learning about Ideational Apraxia, imagine Ariel from the Little Mermaid brushing her hair using the fork.


  • When using flashcards to learn new concepts, read them out loud.
  • Take some time to research and compile a playlist of all the audios/YouTube videos.
  • When learning difficult concepts, ask family or friends to read it out loud to you.
  • If you cannot find audios or videos of the content you’re having trouble learning, consider recording yourself and listening to it.


  • Don’t just rely on pre-made online flashcards or Quizlet online- make your own notes.
  • Take long walks or switch positions. Movement may be helpful in learning/retaining new information.
  • Go through the motion and activities yourself to learn the concepts. An example of this can be seen in my Proprioceptive Neuromuscular Facilitation (PNF) Video, where I use movements from my own daily life, such as applying makeup, to understand and break down difficult concepts.

9. Learn Through Occupations

Remember that we are an occupation-based profession. Most of what you need to learn can be seen and experienced in your everyday occupations. Whether you’re cooking, cleaning or running errands, think about the concepts you’re learning and apply them to your everyday routine and occupations.


One day, I looked over at my husband and noticed that there was this tail sticking out in the back of his head. He usually has an excellent sense of style and is particularly meticulous when it comes to styling his hair. But on this day, he failed to style the back of his head and was completely unaware of this tail sticking out. In that moment, the first thought and association was, “Allen Cognitive Level 4!” This scenario reminded me of patients at ACL 4 who are unable to recognize errors unless it’s clearly visible and require visual cues

So I want to challenge you my friends – While you’re preparing for the NBCOT® Exam, put on your OT thinking cap and see the world through the lens of an occupational therapy practitioner. Before you know it, you’ll be feeling, living and thinking like an occupational therapy practitioner and that’s exactly what you’ll need on the actual exam day. Live and breathe OT. Let it be a natural extension of who you are.

10. Pass the NBCOT® Exam

Here are some blog articles I created to share some important pacing strategies and tips for exam day, as well as time management strategies that I wish I had known before taking the exam. 

Finally, remember why you started your journey. Occupational Therapy is a profession worthy of your pursuit, sweat and hard work. Don’t give up on your dream. Passing the NBCOT® Exam will give you the certification, but it’s your own unique journey through this process that will give you the discipline and character to grow and thrive through every transition and phase of your life. So lift your head up, place your hand over your chest, and speak words of affirmation, power and victory over your life. Visualize yourself receiving your certification in the mail and signing your name with the official title. You can and you will pass this exam. Don’t let anyone or anything make you believe otherwise.

"Courage doesn’t always roar. Sometimes courage is the quiet voice at the end of the day saying ‘I will try again tomorrow.'”