You have 4 hours to complete the NBCOT® Exam. Tension is high, anxiety is creeping in. What can you do to manage your time and pace yourself so you can successfully finish the exam within the allotted time? In this article, I share 7 pacing strategies for exam day, as well as time management strategies that I wish I had known before taking the exam. Be sure to also check out Study Smarter, Not Harder for more test taking strategies and tips.

1. keep an eye on the clock

On your computer screen, you will have a running clock that shows the amount of time remaining as well as a counter that keeps track of how many questions you have left to answer. Be sure to assign a fixed time budget for each question and stay within the allotted time.

Do the math ahead of time and calculate/remember roughly what question number you should be on at 9:00AM, 9:30AM, 11:00AM, etc so you would not get too far off track.


You have 4 hours to finish 3 CST items and 170 Multiple Choice questions. That gives you a target goal of 30-35 minutes for the CST portion and approximately 1 minute per each MC question. Here is a sample pacing strategy:

  • OTR® Online Tutorial (Optional– Does not count against exam time)
  • CST: 30-35 minutes (The CST portion has 3 items so plan to spend ~10-12 min/CST item)
  • Another Optional Tutorial for Multiple Choice Section (Opportunity for a short break!)
  • 70 MC questions: 70 minutes
  • Optional Break: 10-15 minutes (Taking a break DOES count against exam time)
  • 100 MC questions: 100 minutes
  • Review: 20-25 minutes

Familiarize yourself with the computer testing environment by taking an online OTR® Tutorial or COTA® Tutorial. This will give you an idea of what to expect during the actual exam. Remember, tutorials are optional and DOES NOT count against your exam time. The exam clock will resume when you either click the “End” button or when the allotted time for the tutorial runs out. By watching the tutorial ahead of time, you can use this time to take a short mental break instead. 


You have 4 hours to finish 200 Multiple Choice questions. That gives you more or less one minute per question. Here is a sample pacing strategy:

  • COTA® Online Tutorial (Optional– Does not count against exam time)
  • 100 MC questions: 100 minutes
  • Optional Break: 10-15 minutes (Taking a break DOES count against exam time)
  • 100 MC questions: 100 minutes
  • Review: 20-25 minutes

2. Have a plan for questions you cannot answer

Even with great preparation and studying, you will encounter questions that you just can’t seem to answer. Plan ahead for this situation and prevent undue stress by designating one letter that you will use for all the questions you cannot answer. For example, I designated the letter “A” and used that same answer every time I came across a question  I could not answer. These sort of pacing strategies on exam day can help prevent decision fatigue and reduce anxiety. Remember, points are NOT deducted for selecting incorrect answers. That means, even your most random, wild guess will always be better than leaving the questions blank because you may not have time to return to the question again. 


  • Consider selecting YES if you cannot decide between YES or NO. The advantage of choosing YES will be that you will receive feedback, which will give you information about your selection and possibly give you clues to help answer other questions.
  • Once you make a selection on a CST item, you cannot deselect it. Also, once you exit the CST portion of the exam to begin the MC items, you cannot return to the CST section to review or change any answers.

3. do not rush

While it’s important to keep an eye on the clock and move swiftly through the questions you cannot answer, you must also discipline your mind to stay calm so that you can work through each question with focus and clarity. Time management is about pacing yourself while staying calm so that you don’t risk making a critical mistake or overlooking important clues. Treat every question as if it were the last time you’ll be seeing it because you may not get another chance to review your answers. That means, do not skip questions or leave any questions unanswered with hopes that you will get back to it at a later time.

4. identify key words and clues

  • Identify the priority and where you are in the OT Process look for key words such as contraindication, recently diagnosed, at-risk, precaution, most appropriate, best, initial action, first action, next step, immediate.
  • Consider the practice setting (e.g. acute inpatient vs. psychiatric setting); nature of the condition (e.g. acute, progressive, degenerative, etc); frame of reference (e.g. biomechanical vs. rehabilitative); population(e.g. pediatric vs. geriatric).
  • Ensure your answer choice reflects an action that is safe, ethical, occupation-based, client-centered and skilled. 

5. answer the actual question

Identify the sentence that contains the actual question you need to answer. For example, even if you are met with a long question that describes a complex clinical scenario, the actual question you have to answer may be quite simple and straight forward. So be sure to review your final answer to make sure you’ve answered the actual question.

6. Don't change your answers

Once you’ve selected and marked your answer, don’t second-guess yourself and change the answer unless you know for certain you answered incorrectly. However, if you suddenly remember a fact or notice a clue in the question that you hadn’t noticed before, reexamine your answer choices and change the answer accordingly.

7. remain confident

If you’re like many others, you will walk out of the testing center with knots in your stomach and even tears in your eyes. But, remember how far you’ve already come, endured and accomplished to get to this point in your life. You are capable, smart and intelligent, regardless of what a man-made testing result may indicate, because you are more than your education, test taking abilities, status or title. You are worthy yesterday, today and tomorrow, just the same, for your worthiness is not defined by a number, but by your character, passion and unwillingness to give up. 

Success is not final, failure is not fatal. It is the courage to continue that counts.