Taking the NBCOT Exam

Rita Fleming-Castaldy, PhD, OTL, FAOTA, answers some common questions about the certification test.

[Editor's note: Dr. Rita Fleming-Castaldy, PhD, OTL, FAOTA, presented a webinar hosted by ADVANCE on Feb. 8 on Preparing for the NBCOT Exam for OT Students. Due to the volume of questions we received, Dr. Fleming-Castaldy was unable to answer all of them during the webinar. We've chosen some of the most popular questions and asked her to answer them. Her responses are below. Dr. Fleming-Castaldy will be presenting a second webinar, Preparing for the NBCOT Exam for OTA Students, on April 4. To register for the webinar for OTA students, click here.]

1. How long do you recommend studying for the exam (how many hours per week, for how many weeks?).

There simply is no definitive answer to this question since each person's situation is different. Typically, exam candidates report studying for 4-6 weeks for about 20-24 hours per week. Two to four hour segments are typically needed to gain mastery of a topic. However, the amount of time needed to study must be individualized. It realistically depends on each person's knowledge strengths and weaknesses and life situation. If you have a complex life you will need to devote more weeks to studying than a person who can completely devote him/herself to exam preparation. If you have a lot of information to master, you need to devote more time to studying than the person who has to only review the material.

2. Are there specific areas of content you recommend focusing on?

The NBCOT exam blueprint does not identify very specific content areas. However, you can review this blueprint and its related knowledge statements on the NBCOT website. On this website NBCOT offers self-assessment tools that you can complete to obtain an overview of your general, pediatric, mental health and physical disabilities content knowledge strengths and limitations. You should be certain to have mastery in all OT foundational skills that are identified on these measures.

3. Do you have suggestions for ways to study (flash cards, practice tests, reading/outlining)?

All of these methods can work. The use of study groups and/or a study partner can also be helpful. Remember if you are preparing for the exam, you have successfully completed a rigorous academic program. Therefore, use the study skills that enabled you to succeed in your most challenging coursework. The NBCOT exam is not the time to change your study habits. Use exam preparation products that emphasize learning by doing. Students report that practice in answering challenging exam items and the review of the in-depth analysis of answer rationales that some exam preparation textbooks and courses provide contribute greatly to the development of the competences needed to correctly answer NBCOT exam items.

4. As a follow up to the above question, are there specific strategies you recommend to prepare for the clinical simulation questions?

If you have adequate content knowledge, the CS items should be no more difficult than the MC items. Timing is the key factor with these items since you do not want to spend too much time on them and run out of time to complete the 170 MC items. Therefore, I recommend you practice taking these items in a timed manner (about 10 minutes/item, no more than 12 minutes/item) using a computer-based exam format. I provide extensive hints on taking the CS and MC items in my publications about the exam. My text also has CS items on its disc (6 in the 2009 text, 9 in the 2012 text). See the provided reference list.

5. Can you briefly review item scoring?

The items are not worth a set number of points nor are the sections spilt to equate to 50% of the score. The NBCOT exam is criterion referenced which means that your exam performance is compared to a pre-set standard. Simply put, if you perform at or above this standard, you will pass. If you perform below it, you will fail. The exam score is based on the accumulated weighted scores of the MC items and CS problems across all exam domains. These scores range from 300 to 600 points with a score of 450 required to pass the exam.

Since there are no points deducted for a wrong answer on the MC items, do not leave any blanks in this section. However, points are deducted for wrong answers in the CS items so do not select an answer if you are uncertain about it.

6. Are there specific OT texts you recommend reviewing? What about peer-reviewed articles or OT assessments?

Since the NBCOT exam is based on a practice analysis completed in 2008, the latest information in peer-reviewed journals will not be on the exam. NBCOT does not provide a list of assessments that may be on the exam. The NBCOT website does have a list of textbooks that are used as a basis for the exam items. However, many students report being overwhelmed by the number of texts and amount of information included in these resources. Helping students study in a more effective and an efficient manner was the reason I became involved with the publication of review and study guides for the NBCOT exam. Exam candidates report that our presentation of comprehensive content in an outline format is very helpful.

Rita Fleming-Castaldy, PhD, OTL, FAOTA, is an associate professor in the Occupational Therapy Department at the University of Scranton. She is the editor of the National OT Certification Review and Study Guide, the National OT Assistant Certification Review and Study Guide, and the Occupational Therapy Certification Exam Course Manual and serves as an instructor and the research and development consultant for TherapyEd, a major national Occupational Therapy examination preparation company.


Fleming-Castaldy, R. (2010, November 8). The NBCOT examination: Top strategies for success. OT Practice.
Fleming-Castaldy, R. (2010, March 8). Passing the new NBCOT exam: Rumors, realities and strategies for success. Advance for OT Practitioners, 6-8, 10.
Fleming-Castaldy (Ed.). (2009). National occupational therapy certification exam review and study guide, 5th edition.. Evanston, IL: TherapyED/IER. (6th edition will be published shortly) nd
Fleming-Castaldy (Ed.), (2009). Occupational therapy certification exam course manual, 2 edition. Evanston, IL: TherapyED/IER. (3rd edition will be published shortly)
National Board for Certification in Occupational Therapy. (2008). Executive summary for the practice analysis study: Occupational therapist, registered. Retrieved August 9, 2010, from http://www.nbcot.org/pdf/executive-summary-for-the-practice-analysis-study-otr.pdf.
National Board for Certification in Occupational Therapy. (2012). The certification exam handbook and application 2012. Gaithersburg, MD: Author.


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I am looking for a study partner for COTA exam via internet or phone.

Kay July 09, 2014

I am looking for a study partner for the NBCOT exam for OTA. If interested you can email me at rikes21977@aol.com

Norika HaslamNovember 28, 2012
Brooklyn, NY, NY

Looking for someone to study with in the Chicago south suburbs area. If interested, e-mail me at lydiaattalla@gmail.com

Lydia AttallaOctober 22, 2012

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