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How to Smash the NBCOT OTR Exam

From nailing down the basics to finding your study strategy and developing a preparation plan, gather tips for tackling the NBCOT OTR exam, and walk away with expert advice for test success.

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Author: Kathleen Curtis
Angel Gibson

Angel Gibson

Angel Gibson received her bachelor's degree in Kinesiology at Charleston Southern University and her associate degree in Occupational Therapy Assistant at Trident Technical College. She plans to work in acute rehab and skilled nursing alongside travel therapy to try out different settings and see the world. She plans to go back for her doctorate in rehabilitation science in a few years to become a university professor.

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A joyful woman with blonde hair, wearing a blue shirt, is holding a credit card while using a laptop in a bright, modern office with vibrant plant nearby as she studies for the NBCOT Exam.

You worked hard to make your way through occupational therapy school, passing each course and graduating with flying colors. Now you have one last hurdle on your road to OT certification: the NBCOT OTR. This exam tests your knowledge on a wide range of OT-related content areas, and with only four hours to complete it, you need to know your stuff to pass.

Over a quarter of OTs fail the NBCOT OTR on their first try, but you can avoid their fate with the right mix of information, tactics, guidance, and expert advice. Whether you’re on your second attempt or you’re a first-time test-taker, these strategies for success can help you navigate the NBCOT OTR exam from start to finish.

What is the NBCOT OTR Exam?

If you want to work as a board-certified occupational therapist, you must first pass the National Board for Certification in Occupational Therapy (NBCOT) OTR examination. The exam is administered by the National Board for Certification in Occupational Therapy, Inc., and test-takers can find exam centers throughout the U.S. To pass the NBCOT OTR, examinees must score at least a 450 out of a possible 600. 10,697 occupational therapists took the OTR test in 2019 and received a 73% pass rate, while 7,177 occupational therapy assistants took the COTA exam during the same year and received a 61% pass rate.


It’s important to make sure you’re eligible to sit for the NBCOT OTR before registering for the exam. Because the National Board for Certification in Occupational Therapy also administers the COTA exam for occupational therapy assistants, it’s key to understand the eligibility differences.

  • OTR candidates must graduate with an entry-level occupational therapy degree from an ACOTE-accredited occupational therapy program.
  • COTA candidates must graduate with an entry-level occupational therapy degree from an ACOTE-accredited occupational therapy assistant program.

Length & Format

The NBCOT OTR exam consists of 170 multiple choice questions answered over four hours. Single-response questions ask you to pick the best one answer while the multi-response requires them to pick the three best answers out of a possible six. A further section provides a responsive yes/no format.

After arriving at the testing center, you can decide to watch a tutorial before starting which does not cut into your four hours of testing time. While you are allowed to take a break, the clock does not stop, and you must complete the same check-in procedures when you arrived to re-enter the classroom.

How is the NBCOT OTR Scored?

The NBCOT OTR uses a criterion-referenced scoring system, essentially meaning the test is pass/fail. Performance is ranked on a scale between 300-600, with 450 being the minimum score needed to pass. The exam consists of 170 multiple choice questions and a three-problem clinical simulation test section. Scoring is unique in that points are not deducted if you choose an incorrect answer. This means that even if you aren’t sure about a question, you should still try to answer it rather than leaving it blank. The NBCOT OTR does not provide test scores immediately after the exam ends, instead sending an official feedback report with information about final scores via email or in the mail.

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NBCOT OTR Blueprint

Ensuring you feel properly prepared for the NBCOT OTR exam is half the battle. To do this, you’ll need to understand what you will encounter on test day and how to navigate each section of the exam with confidence and calm.

Domain #1 Evaluation & Assessment Evaluation & Assessment Acquire information regarding factors that influence occupational performance on an ongoing basis throughout the occupational therapy process. 25% of the exam 25% of the exam
Domain #2 Analysis & Interpretation Analysis & Interpretation Formulate conclusions regarding client needs and priorities to develop and monitor an intervention plan throughout the occupational therapy process. 23% of the exam 23% of the exam
Domain #3 Intervention Management Intervention Management Select intervention for managing a client-centered plan throughout the occupational therapy process. 37% of the exam 37% of the exam
Domain #4 Competency & Practice Management Competency & Practice Management Manage professional activities of self and relevant others as guided by evidence, regulatory compliance, and standards of practice to promote quality care. 15% of the exam 15% of the exam

Source: NBCOT Content Outline for the OTR Examination

Question Breakdown

The NBCOT OTR exam consists of two sections. The clinical simulation test section and a single-response multiple choice section. Getting used to this format can take some time, so we provide a few examples of what to expect on test day.

Single Response Multiple Choice Items

As the name suggests, these questions ask you to choose the one correct answer among four possible answers. Students should choose the answer which works best based on the information provided in the question. Check out the sample questions below, along with the correct answers to those questions in bold.

Sample Question #1:

During which task would a stereognosis deficit secondary to a CVA be MOST EVIDENT? (NBCOT Exam Handbook)

Sample Answer #1:

A: Getting coins from a pocket

B: Pouring water into a cup

C: Putting on a pair of socks

Sample Question #2:

A patient presents with stroke involving the hypothalamus. Which of the following are not indicative of hypothalamus function? (NBCOT Test Questions)

Sample Answer #2:

A: Maintains body homeostasis

B: Sensation of pain

C: Thirst center

D: Control of hormone secretion

Clinical Simulation Test (CST) Items

CST questions include an opening scenario with four sections of questions based on it. Students must check the “yes” or “no” box next to each answer to progress. They receive contextual information on the yes answers to help them move through the rest of the scenario.

Sample Question #1:

A first grade teacher reports that a 7-year-old student has difficulty with grade-level class work that primarily requires the use of fine motor skills to complete. A social history reveals the student lives with both parents and has an older sibling diagnosed with autism spectrum disorder who attends the same school. The OTR is scheduled to complete an initial screening to determine the appropriateness of school-based occupational therapy services for this student. What actions should the OTR take as part of this screening process? (NBCOT Clinical Simulation Sample)

Sample Answer #1:

A: Ask the parents if they have observed the student displaying autistic behaviors at home or at play

B: During a session in the designated OT room, have the student copy several words from an age-appropriate book

C: Observe the student during typical classroom activities

D: Ask the school nurse if the student has had a recent routine visual acuity exam

E: Compare the student’s corrected age to a developmental growth chart

F: Review the student’s initial kindergarten screening results

G: Review several of the student’s recent written assignments and drawings

Sample Question #2:

You are going hiking in the mountains and want to dress appropriately for the current weather. Which questions should you ask to determine the weather conditions? (NBCOT Sample Tutorial)

Sample Answer #2:

A: Does the weather forecast call for precipitation during the day?

B: Is it currently windy or calm?

C: Are the weather forecasters typically accurate with their predictions?

D: What is the current temperature in the mountain?

E: What is the expected high and low temperature for the area?

F: What is the average precipitation for the hiking area?

10 Strategies for NBCOT OTR Exam Success

Acing the NBCOT OTR exam is part knowledge, part strategy. Coming up with actionable steps both while studying and during the test can help you stay focused, stay calm under pressure, and do your best with the time you’re given. Check out some of our best tips and strategies below.

Take Simulated Practice Exams

Simulating the conditions of your actual exam day can help you recognize and prepare for any eventualities and get comfortable with the timed nature of the test. Several different timed and untimed practice tests can be found online, both free and for a fee. Taking a practice test after you finish studying for each exam subject area can help you seal that knowledge in, while taking a full, timed practice test at the end of each week can help you recognize what you know well and what still needs some work. To simulate testing day, make sure you follow all check-in protocol, leave the clock running during any breaks, and take the exam in a room with no distractions.

Utilize Practice Question Banks

Practice exams provide a good benchmark for seeing how your prep work is progressing, but everyday studying is best served by going through question banks. Several test prep companies provide these, as does the American Occupational Therapy Association. When first beginning your test prep, trying questions from each section of the exam can help you establish a baseline and figure out which areas need the most work. From there you can create a study schedule that provides ample time for your weakest areas. Practice question banks also help you develop a wider understanding of the types of questions to expect on the actual exam.

Join the NBCOT Facebook Support Group

The American Occupational Therapy Association provides the NBCOT Exam Prep Info Center on Facebook, which currently has more than 33,000 members. Here you can share your tips for studying and acing the exam, gain tips and insider tricks from those who’ve already taken the test, and ask questions along the way. The group has dozens of posts each day and offers the support you need to feel confident and prepared when testing day comes around. The group also provides a “Files” section for various study schedules, guides, and other helpful materials that can be easily accessed.

Meet OT Miri

OT Miri provides a comprehensive and regularly updated occupational therapy community and resource center for students, test takers, and occupational therapists/occupational therapy assistants. Miri offers test-taking strategies, videos, study notes, and stories from others on how they passed the exam. Once you take the test and pass it, you can also access guides on landing your first OT job, keeping up with continuing education, and thriving after you graduate. Miri works hard to keep the content free and accessible for all users and provides an inspirational story of going from missing the minimum score cutoff to passing the test with ease.

Plan for the Questions You Can’t Answer

Despite all your hard work and dedication to preparing for the NBCOT, inevitably there will be some questions that you simply don’t know the answer to. Planning ahead for this situation is the best strategy for success and can help you avoid wasting precious time that could go towards questions you feel more confident about. When studying, note which section you feel you understand the least. Try to prioritize that area in the weeks leading up to the test, but also know your limitations. When you encounter questions that you know you cannot answer, do your best to eliminate the obviously wrong answers and make an educated guess. After that, move on and focus on the future rather than the past.

Give Yourself Enough Time

To adequately prepare for the NBCOT OTR exam, you need at least 8-10 weeks of study time. This timeline doesn’t take into account additional responsibilities such as a full-time job, school, and any other personal responsibilities. Sure, you can try to cram for the test in a couple weeks, but examinees typically do far better on the test if they give themselves enough time to actually learn the material and develop sound strategies rather than trying to memorize everything. Start studying early and schedule your exam far enough out that you don’t feel stressed leading up to it.

Make a Schedule – And Stick to It

Speaking of timing, creating a study schedule is key to success. You can give yourself six months to study for the test, but it doesn’t matter if you don’t actually sit down to review material consistently. At the start of this process, take time to develop a comprehensive schedule based on how many weeks you have before the test, different sections of the exam, and the amount of time you can reasonably devote to studying each day. Post your schedule in a prominent location and check off each study session after you complete it. This will both remind you what’s left to cover and help you stay motivated through the final hurdle.

Work with a Tutor

If your budget allows, consider hiring a professional tutor who can walk through the materials with you, answer outlying questions, and help you address areas that need some work. These individuals typically possess both training and a high NBCOT score themselves, meaning they know how to get a good score and help others to do the same. If you struggle to stay motivated and focused, these professionals can help keep you on track and ensure you do the work needed to earn a score that meets your standards. Different tutoring packages exist, ranging from hourly to full-service.

Find Your Learning Style

Some students may do best by purchasing a massive test prep guide before slowly and methodically working through it. You might learn best via visual tools such as diagrams, videos, and charts. There is no once-size-fits-all approach to test-taking or test preparation, so don’t let yourself feel boxed in. Aside from making it a more enjoyable process, finding your learning style will also lead to better exam outcomes and ensure you’re as prepared as possible when test day rolls around.

Avoid Mistakes

One of the worst feelings is getting back an exam and noticing careless mistakes you’ve made that could have easily been avoided. With the stakes being so high on the NBCOT OTR, circumventing these mistakes is vital. Trying to memorize answers versus taking time to fully understand material never works, as any slight change in the question can make you question the correct answer. Similarly, failing to use the latest edition of a study resource may result in outdated questions or incorrect information.

Insight from the Expert


Angel Gibson received her bachelor’s degree in Kinesiology at Charleston Southern University and her associate degree in Occupational Therapy Assistant at Trident Technical College. She plans to work in acute rehab and skilled nursing alongside travel therapy to try out different settings and see the world. She plans to go back for her doctorate in rehabilitation science in a few years to become a university professor.

Q. What are some things that might surprise examinees about the NBCOT test?

A: What surprised me the most was the difficulty level compared to the practice questions. I felt the test questions weren’t as hard or tricky as I was expecting them to be. They required more analytical skills than I expected.

Q: What are some common mistakes made on the exam?

A: I think a common mistake may be letting nerves and anxiety get the best of you. I truly believe anxiety levels will affect how you test.

Q: Do you have any tips or tricks for acing the test?

A: For test prep my best advice would be to do a lot of practice questions! Focus on studying the rationales to the answers (right and wrong) just as much as you would with the other test contents. Take notes on why the rationale is chosen, it could be the difference between two answers you’re stuck on. Study any tips given for breaking down a question. Sometimes a question may give a lot of information in a scenario but is looking for only a particular aspect of the scenario. It’s important to focus on key words, the setting, and the stage of the OT process the question is asking about. And one more tip, build up your confidence! Talk yourself up and be encouraged! It makes a huge difference.

Q: What if a student gets a poor score? What should they do?

A: If you get a poor score, first be nice to yourself! It’s okay to be disappointed about getting a low score or not passing but don’t let it affect how you view yourself. A low score only speaks to needing to adjust some study habits/resources, not your potential of being a great OT! The next step taken should be to analyze the score report and see what feedback is given. If you decide to take the test again, adjust your study routine and find help. Help may come in the form of a mentor/study group or a tutor. There’s a ton of resources out there for this exam, you just have to research which fits your learning style and needs the best.