One of the most common questions I receive is, “What did you do differently to pass the NBCOT® exam on your second attempt?” In this article, I will list and compare the timeline, resources and strategies I used to prepare for both my first and second attempt and show you how I went from 422 to 488. Keep in mind that everyone’s learning style is different. What has worked for me may not work for you. But, there are some important lessons I learned along the way and these insights go beyond the type of resources I used or the amount of hours I devoted to studying. Ultimately, what helped me pass the NBCOT® exam was the approach I took to truly conceptualize the content and apply my knowledge clinically. I had to learn to think critically, apply clinically and analyze methodically. If you want to know the specific strategies I employed to improve my critical thinking skills and clinical rationale, be sure to also check out my OT Exam Study Tips – Study Smarter Not Harder. 



2 months | 3-4 hours per day (on average) | 5-6 days per week

Note: The numbers above reflect an average over a 2 month period. Some days, I studied for 10 hours straight without a break, while other days I did not study at all. This inconsistency and lack of structure greatly contributed to my feeling overwhelmed and burnt out.


  • AOTA’s NBCOT® Exam Prep
  • Therapy Ed

My primary and main source for studying was the AOTA’s NBCOT® Exam Prep. I printed out and read through all the PDFs that came with the AOTA’s NBCOT® Exam Prep. I also utilized the Therapy Ed book as a supplement whenever I needed more in-depth knowledge.


My study sessions were disorganized, inconsistent and inefficient. On average, I spent around 2-3 hours reading the PDFs, followed by another hour going through the practice exam questions from either the AOTA’s NBCOT® Exam Prep or the Therapy Ed book. Looking back to this time, I realize that my strategy was flawed in many ways:

  • I spent too much time trying to memorize every little detail instead of conceptualizing the content broadly and applying it clinically. Consequently, I did not develop the critical thinking skills necessary to analyze and apply my knowledge. 
  • I didn’t take the time to identify my knowledge gaps, which also meant that I didn’t have a strategy to target my weak areas.
  • I did not do a timed practice exams that require me to sit through a full 4-hour simulated exam. Instead, I did shorter practice exams choosing however many questions I felt like doing that day. Critical mistake. Without going through simulated practice exams that are timed, it is impossible to know how you would perform on the actual exam day. In order to build Effective Time Management and Pacing Strategies, it is of paramount importance to do simulated practice exams. 

The NBCOT® Exam is about so much more than just knowing the facts. It’s also about clinical application. Learning the facts and building your knowledge is just a fraction of what you must do to pass the exam. The rest depends on your ability to think critically and clinically, while applying effective test taking strategies.


This is a photo taken 30 minutes before my first attempt in front of the prometric center in Los Angeles. Although I’m smiling in this photo, I was an utter mess. I had woken up that morning with a deep sense of anxiety and was barely able to eat anything due to feeling so nervous. I rushed out of the house with a cup of coffee in my hand,  paranoid that I would either hit traffic or get lost. Why didn’t I think to visit the prometric center before the actual exam day??

When I got to the testing center, the woman at the front desk stopped me to check the manual to see if my “pajamas” were acceptable in the testing center. Immediate Panic! If I had read the NBCOT® Certification Exam Handbook ahead of time, I would have known the dress code and would have avoided the unnecessary stress during the check in process. By the time I was seated to take the exam, I was already exhausted. Adding to my stress was the fact that I had not taken the Online Tutorial, which would have given me a sense of what to expect ahead of time. So instead of saving my mental energy for the actual exam or taking this time to take a mini mental break, I was frantically going through the online tutorial, trying to learn all the features and options of a computer-based exam. 2 hours into the exam, my brain was foggy and I was barely able to focus. I wasn’t pacing myself at all nor did I have a strategy for dealing with questions I could not answer. Consequently, I ran out of time and ended up rushing and guessing through the last 50 questions. 8 days later, on the day of my OTD commencement ceremony, I received a failing score of 422.


  • Create a structured daily plan and stick to it.
  • Identify the knowledge gaps and target those areas accordingly.
  • Don’t memorize it – conceptualize it.
  • Do LOTS of practice exam questions.
  • Review and understand the rationales for both the correct and incorrect response.
  • Take at least 3 simulated, timed practice exams.
  • Be sure to watch the multiple choice Online Tutorial ahead of time.



2 months | 3-4 hours per day (on average) | 5-6 days per week

As you can see, I didn’t necessarily spend more time studying. But, I did maximize my study sessions to be more focused, consistent and productive by committing myself to strict study sessions free of distractions. I turned off my cell phone, resisted the temptation to check Facebook and told all my family and friends that I would be on “Do Not Disturb” mode during my designated study time. I was determined to prioritize my study sessions and fiercely protected my study time and space.


  • AOTA’s NBCOT® Exam Prep
  • Therapy Ed
  • Pedretti’s Occupational Therapy Textbook
  • Occupational Therapy Textbook for Children by Case-Smith
  • Occupational Therapy Examination Review Guide (“the Purple Book”)
  • NBCOT® Practice Test


Although I had built a strong  foundational knowledge base from studying the AOTA’s NBCOT® Exam Prep and Therapy Ed, I still felt inadequate in my ability to think critically and apply clinically. To bridge this gap, I turned to my favorite textbook: The Pedretti’s Occupational Therapy textbook. But I certainly did not read the textbook cover to cover. In order to prioritize my study sessions based on my areas of weaknesses, I first began by identifying my knowledge gaps and making a list of everything I needed to review.

Once I had a list of all the topics I needed to target, I allocated approximately an hour per study session for content review. These content review sessions were dictated not only by the identified weak areas, but by the practice exam questions that I had previously gotten wrong. I used all the resources I had, including the AOTA’s PDFs, the corresponding sections in the Therapy Ed book and the textbooks to cross reference the materials and solidify my understanding. I know that sounds like a lot of work and review, but it actually felt very organized and structured because I was focusing on one topic at a time, making sure to master the content before moving on.

Having said that, I didn’t spend too much time on the minor details. Rather, I tried to find the most important theme among all three of these sources and focused on learning the concepts broadly. Then each night, over dinner, I taught what I had learned to my husband using simple layman’s terms, which really helped to solidify the concepts for me. The ultimate test of how well I knew the content was often measured by how well my husband understood the material I was teaching him.

In addition to the specific content review I was doing for about an hour, I allocated an additional 2-3 hours per study session just to do untimed practice exam questions and review the rationale. Since I had already gone through all the questions from the AOTA’s NBCOT® Exam Prep and Therapy Ed, I purchased the Occupational Therapy Examination Review Guide. I needed new questions to challenge myself so I went through all the 800+ questions that came with the book, paying close attention to the rationale for both the correct and incorrect answer choices. Every now and then, I went back to the AOTA’s NBCOT® Exam Prep and Therapy Ed to review the questions that I had gotten wrong in the past. Unlike the first time preparing for the exam, I spent far more time doing practice exam questions rather than reading the PDFs or the textbook and I believe this was an essential strategy that really helped me to build my clinical reasoning skills.


Learning from my first mistake, I completed a total of 3 practice exams utilizing the AOTA’s NBCOT® Exam Prep online questions and the computer-based Therapy Ed practice exams. These practice exams helped me to build up my mental and physical stamina and gave me a feel for what it would be like to sit through a 4-hour exam. However, some of the questions that appeared on these practice exams were the same ones that I had already reviewed, and therefore, did not give me a true sense of how I would perform when faced with a completely new set of questions on exam day. So I purchased the NBCOT® Practice Test,which truly felt like a simulated exam. Although I was only in the 430 score range on the NBCOT® Practice Test, I ended up scoring 488 on the actual exam.  

Note: The NBCOT® Practice Test gives you a feedback report with a scaled score, but you will not be given the answers or the rationales. However, because these questions are created using the same methodology as the actual NBCOT® exam itself, it allowed me to become more familiar and prepared for the type of questions that would appear on the actual exam.


A day before the exam, I drove to the prometric testing center to familiarize myself with the route. Then I sat in the parking lot and visualized myself passing the exam. Whenever I heard a voice that threatened my sense of confidence, I prayed for strength, peace and grace. The following morning, I woke up feeling at peace with myself. By this time, I had given more than 100% in preparing for this exam and I was proud of myself for having made it so far in life, despite having been told that I would never make it to college. So I left my “anxiety robe” at home and instead put on my armor of confidence and shield of faith. I walked into the testing center determined to stand tall and strong regardless of the outcome, trusting in the grand path of my life. Although I was still met with unfamiliar questions and tension throughout the exam, I made sure to utilize Effective Time Management an Pacing Strategies to successfully complete the exam on time. 

Looking back, I’m relieved and grateful to have passed, but what makes me truly happy and proud is the confidence, discipline and faith I built during this time to withstand and thrive through all of life’s unexpected turns and setbacks. In moments of weakness and utter devastation, I was able to discover and tap into my strengths to bring out the greatest warrior in me. Through this NBCOT® exam process, I truly learned to embrace myself and my unique journey in life. So even if I could do it all over again, I would still choose my path, my journey and my timeline.

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


So my sincere hope and prayer for you is that you would not compare yourself to others, but that you would feel empowered to walk in the direction of your dream and destiny, trusting that everything happens for a reason, even if you can’t see it at the time. Please remember that you are already living an incredible story that uniquely belongs to you- nurture it, love on it and don’t let anyone or anything make you feel less than the beautiful, capable and worthy person that you are. Be your own best advocate and fight to keep your mind and heart whole. Break down every barrier along your OT journey and actualize your greatest potential so that you may experience the joy, meaning and exhilaration of living a full, thriving and meaningful life regardless of any perceived limitations. That, my friends, is at the heart of your chosen profession and passion—occupational therapy.  

You gain strength, courage and confidence by every experience in which you really stop to look fear in the face. You are able to say to yourself, ‘I have lived through this horror. I can take the next thing that comes along.’ You must do the thing you think you cannot do.”