How I passed the NBCOT on my first try

How I Passed the NBCOT® On My First Try (and You Can Too!)

Are you finishing your occupational therapy program and are looking for a solid study plan to help you pass the NBCOT® exam on your first try? If so, this post was created just for you!

While I was studying, I personally loved reading other new OTs’ success stories in the AOTA NBCOT® exam prep Facebook group as well reading up on what to do if I failed (more on that below). I absorbed SO much information that I ended up using in my study plan, which is fully outlined in this article.

I want to note that this post is not at all sponsored and the resources I used I either learned about from OT school or from other test takers. Additionally, this post is about my experience taking the OTR exam, but many of these tips will also be helpful for you if you are taking the COTA exam. 

First Off, How Long Should You Study?

I studied for approximately six weeks after I graduated, and put in about 3-4 hours a day, 6 days a week.

I only had one or two days in the beginning of studying where I put in a full 8 hour day like I thought I was supposed to. I quickly realized I couldn’t handle that much cramming after going through the intensity of fieldwork and OT school, so I pared down my studying to a more realistic amount of time.

Honestly, I think if you have at least a solid four weeks to study, you don’t need to do full days every day. It definitely doesn’t hurt to study for full days if you’ve got the motivation, though!

Based on my classmates’ experiences and my experience, 3-4 hours a day is generally sufficient if you’re retaining the information as you read it.

These are the resources I had the most success with:

  1. The Therapy Ed Study Guide
  2. AOTA’s Online Test Prep
  3. Quizlet Flashcards

Therapy Ed

My OT program required us to purchase the Therapy Ed NBCOT® Study Guide for one of our last “wrap up” courses during our second to last semester.

Even before it was required, I’d heard so many good things about this book and how it helped quite a few people pass the NBCOT® on their first try. Even if it hadn’t been required, I very likely would have purchased it anyway, and I now recommend it to any new test taker.

I did not take the optional test prep course due to financial constraints but my classmates that took it said it was really helpful learning good test-taking strategies. If you have severe test anxiety or require extra time during exams, it might not hurt to consider it.
Something to keep in mind is that the Therapy Ed guide is DENSE. So much detail = information overload at times, as it basically covers everything you learned in OT school, plus three practice tests with the same amount of questions as the actual exam (170 multiple choice plus three clinical simulations).

You may have already heard this, but the Therapy Ed tests are HARD. I would even say harder than the actual exam. So, if you’re scoring in the 50’s and 60’s, don’t be alarmed, because almost everyone is scoring in the 60’s even right before test time.

Just a heads-up: reading this book can be a bear. It is SO, SO detailed and complex, so I would usually just read about 10 pages to maybe one chapter at a time at the most.

I can say some major “brain breaks” are needed after digging into this book, but even so, it was the most helpful and information-packed resource that I’ve found.

AOTA’s Test Prep Online

The second resource – and my personal favorite study material – was AOTA’s Test Prep online practice tests plus PDF’s on all of the main topics (hands, pediatrics, work, neuro, burns, and so on).

pass the nbcot AOTA exam prep

These PDF’s were much easier and shorter to read than TherapyEd and complemented the additional multiple choice quizzes.

I would do at least 20 questions a day (but often 50), and surprisingly had fun trying to beat my overall average and previous scores that I think I definitely saw all 1,100-something quiz questions at least once.

The answers and rationales are always provided at the end of the test, too, so I found that a lot of times I memorized the answers without even trying.

The AOTA Course alone did not have the same amount of detail and thoroughness that the Therapy Ed guide did, so I still recommend you purchase Therapy Ed, read it cover to cover once, and take those practice exams throughout your studying.

For more info about AOTA’s Exam Prep, be sure to check out our other article, Is the AOTA NBCOT® Exam Prep Right for You?

Quizlet’s NBCOT Flashcards

Third, I used Quizlet’s free NBCOT® flashcards that other students made and shared publicly for memorizing things like Rancho Levels, Allen Cognitive Levels, etc. Using Quizlet helped me break up the monotony when I needed a break from TherapyEd or AOTA’s test prep.

pass the nbcot with quizlet

One thing to keep in mind is that since these quizzes are made by students, there may be some inaccuracies with answers. I definitely would not recommend this as your sole study strategy (you’ll want at least one thorough resource), and do be on the lookout for incorrect flashcards. 

Should You Study With a Group or Alone?

This all depends on what study style has worked for you in the past.

I initially attempted group study sessions with my friends from my cohort, but we almost always just ended up talking about how stressed we were about the exam and switched to other non-exam topics.

I personally did better studying by myself because I was so distractible. You might do better with a group to keep you accountable, though!

Miscellaneous Advice

When you’re not studying, please make sure to carve out some fun and relaxing time to spend with your friends, family, and significant other if you have one, because it definitely will help to keep you sane.

As far as working goes, I personally would NOT recommend getting a full-time OT job on a temporary license and thinking you’re going to have the time and energy to study every evening.

You are going to be absolutely exhausted from working as a new OT and you will have major pressure not to fail since failing = no more temporary license = no more OT job (yikes!)

I did babysit for two families approximately 15 hours a week and ALWAYS brought my study materials and laptop, as I was primed and ready to knock out as much as I could during the kids’ nap-time and bed-time. I think doing a bit of easy part-time work is much easier on you with much less stress of losing your temporary license/job.

The Day of the Test

When it came time for test day, I did the recommended steps of going easy the day before on studying, going out for a nice dinner, and making absolute sure I went to bed early enough to get a good night’s sleep.

I made sure to dress warmly even though it was summer (because brr, air conditioning).

I brought snacks and water and followed my school’s recommendation to get up after about an hour and stretch my legs/take a bathroom break.

pass the nbcot test taking

One of my instructors strongly recommended before we graduated that everyone needs to get up at least once during the test, and I wholeheartedly agree.

I also remember her mentioning NBCOT® pass rates were higher when this was done (if I find a study on this I’ll be sure to link to it!)

One final step we were taught was to write our full names on the whiteboard they give you, followed by “OTR” before we start the exam, as well as a motivational quote like “I will pass.” 

So I took my rest break, ate a banana, and cruised along for the 3.5 hours (or however long it was) feeling pretty confident at first.

Then towards the end I started getting really stressed about not feeling like I knew any of the pediatric content (clearly I don’t work in pediatrics!).

So, like everyone else, I walked out feeling like I failed.

Feeling pretty bummed about the possibility of spending another month and another $500 retaking and retaking.

But guess what: I passed, with plenty of points to spare! 

I’m confident if you use trusted resources and give yourself enough time, with a solid study strategy, you will do the same!

But What are the Current Passing Rates?

Because I love numbers, I wanted to add in some stats for you: According to NBCOT®’s information page, 84% of test takers passed the NBCOT® in 2020 (dropping from 89% in 2019, and 91% in 2018). I was unable to locate the most up to date information for 2023, but I will continue to try to track this down.

I did find that the current fail rate, according to OT Questions, is currently 10-25% but this number includes initial fails that pass on subsequent test taking.

A Note on YouTube Studying

You may have noticed that I didn’t use YouTube videos for my studying, in part because there wasn’t a lot of unofficial NBCOT® YouTube study material available when I was studying. I love that this is another new avenue to take advantage of, but I do want to mention this:

Many OT students and new grads that I talk to mention they or their classmates are only using these YouTube videos for studying. PLEASE don’t do this!!! 

You really need at least one professionally-made resource to use as well, since these are created by experts to cover everything you need to know. YouTube videos are great to supplement your studying, but they really aren’t going to cover everything you need to know compared to a legitimate resource.

Want more pass rate information? Follow this link to see program performance data on the NBCOT certification examination by state and program level.

pass the nbcot school performance

If You Still Don’t Pass the NBCOT®:

If you don’t pass the first, second, or even the third time, it’s okay! Please don’t beat yourself up about it. Just keep at it and revamp your study strategy, try new materials, consider getting a tutor, and spend more time studying vs. working.

For more tips on what to do if you don’t pass, be sure to check out our guide on what to do if you’ve failed the NBCOT®.

No matter how many times it takes, you will pass, and you will be an amazing OT or COTA!


And that wraps up our NBCOT® study tips guide! These are my own personal experiences of studying for and passing the NBCOT®.

If you tried something totally different and it worked well for you, please share your advice in the comments below, as we can all use as many tips as we can to pass the NBCOT®!

Happy studying and best of luck to you!

This post was last updated on May 13, 2022. 

You may also like


  • caroline November 8, 2016   Reply →

    thank you for the helpful advice!

  • Kayla Meyer November 11, 2016   Reply →

    Thanks for the post and sharing your experience! I’m getting ready to finish up fieldwork next week and preparing to begin the process of studying. Your post was very insightful and has lots of great suggestions I plan to use!

    • Sarah Stromsdorfer, OTR/L November 11, 2016   Reply →

      Thanks, Kayla! Congrats on being almost done with fieldwork and best of luck beginning the studying process! I’m glad you enjoyed the post 🙂

  • Katie July 6, 2017   Reply →

    When going through the TherapyEd book, did you go chapter by chapter in order? Also, were you writing down a bunch of notes on each chapter. I agree with you, this book is a bear!!

    • Sarah Stromsdorfer, OTR/L July 6, 2017   Reply →

      Hi Katie, I went through generally a half chapter to one full chapter (at the most) daily and in order, and just read through it all one time. I did spend extra time studying the practice test questions and answers towards the end of my studying. I did devote more time to AOTA’s exam prep overall after reading TherapyEd one time through.

  • tom July 31, 2017   Reply →

    This was helpful thank you. I will be taking mine in 3 weeks time. I’m really concerned about remembering all the things I have studied even though I prepared for so long. I just needed an inspiration of other OT’s who passed the exam. Just the positivity of reading this success story of yours makes me more confident to take the exam. Thanks again. 🙂

    • Sarah Stromsdorfer, OTR/L July 31, 2017   Reply →

      I’m glad the post was encouraging and I wish you the best of luck! Just remember to relax, don’t let the stress get to you and you’ll be fine 🙂

  • T Fields August 24, 2017   Reply →

    As a Graduate student nearing the end of my MSOT program, this article was rewarding, refreshing, and helped me to relax. With the start of my last FW approaching, I can see the light at the end of the tunnel and no more darkness and doubt that I CAN AND WILL PASS…….thanks to you!

    • Sasha Ugduba November 4, 2020   Reply →

      I failed the exam by five point in June 2020. I left the test site with high confident that I have pass because it seen fairly easy as well to me it was an smooth sailing. I continue to reschedule to retake since August and the year is about to be gone. My level of confident has declined to zero due to afraid of failing and giving away $500.00. I have a hard time studying, focusing and believing causing me to have fear of failure and not wanted to retest. Any advice or help?

  • sonja Lottie December 9, 2017   Reply →

    Hi. My name is Sonja Lottie. I’m here at the library now study out of the purple book. I pretty stress because my mind works that way. The problem I am having is sticking with a study plan. when I score low I feel that my plan is not working. I just can’t stick to my plan I keep changing. I really feel like I need some help. Thank you for your post, it did make me feel better. I know that I am capable!! ty again.

    • Sarah Stromsdorfer, OTR/L December 17, 2017   Reply →

      I’m glad the post helped! For some quick tips, you could try sticking to the same study plan to get into a routine, or try switching it up (as long as you stay on task 5 days a week!). Just keep at it daily and you should be fine! You’ve got this 🙂

  • Jean Hubbard March 17, 2018   Reply →

    It’s refreshing to hear others tips and methods when studying for the NBCOT exam, especially when these method allow you to succeed in passing. Kudos
    As a graduate preparing to take my exit exam, which appears more stressful then the test. Your advice and methods gives anyone seeking it, some good tips to organize their own study study plan.
    Thank you!!!

  • Tonya Lewis Jones October 15, 2018   Reply →

    Thank you so much for this post! I sit for the OTA exam in a few short days and you can imagine where my stress level is right now. I know I must stay calm and trust the study process. Easier said than done! I too am using Therapy ed and AOTA exam prep and hope these two tools will bring me through. I must say I’m fastly approaching study burnout. Thanks again, your testimony about the process is dead on!

    Tonya in Columbia, South Carolina

    • Sarah Stromsdorfer, OTR/L October 16, 2018   Reply →

      You’ll do great! Don’t feel bad about the study burnout; your exam is so soon so don’t feel bad about giving yourself some much needed study breaks, especially the day before 🙂 Best of luck Tonya, you’ve got this!

      • Kimaya J October 4, 2022   Reply →

        I failed the COTA exam and I haven’t tried to retake for 3 years because i had some personal issues. Now I want to take it again but I’m so overwhelmed I don’t know where to start . I am so mad at myself. Any advice for me please 🥺🥺

        • Sarah Stromsdorfer, OTR/L October 31, 2022   Reply →

          Hi Kimaya, I’m sure it’s super overwhelming to jump back in after 3 years. Just try not to think about the length of time it’s been and start diving into studying your materials (which may need to be updated) on a consistent basis to get a routine going. Once you start the studying process I hope you’ll feel a bit less overwhelmed and will feel ready to get your exam scheduled! You got this 🙂

  • Tonya Lewis Jones October 26, 2018   Reply →

    Thanks for the encouragement and support! However, my first attempt at the exam was not a successful one. I’ve taken a few days to allow the inflammation from the sting of the disappointment to subside some. I don’t know where to go from here. I’m foggy and unclear. Any suggestions?

    Thanks, Tonya

  • Edna R Brooks November 3, 2018   Reply →

    On the exam how was the question? Such as was there any question asking to choice the best 3 that would be appropriated for ……

    • Sarah Stromsdorfer, OTR/L November 7, 2018   Reply →

      It’s been a few years since I’ve taken the exam but I’m 95% sure there is only one answer per question that you’ll choose. If anyone has recently taken it, please share if this is still the case! 🙂

  • Tonya Lewis Jones November 7, 2018   Reply →

    Hi I recently took the NBCOT exam and it included at least 15 ( could have been more) multi select questions in which 3 answer choices had to be selected. 6 answer options are given to choose from.There is no partial credit given . You must select all correct answers to receive credit. Hope this helps.

  • Chris Zich January 9, 2019   Reply →

    Becareful with Quizlet as people are finding a lot of wrong answers in their cards. I ended up buying the guide and used it for my cards!!

    • Sarah Stromsdorfer, OTR/L January 14, 2019   Reply →

      Good to know, Chris! Quizlet is open source so I could see where users might have put in the wrong answer at times. I haven’t used the OTstudyguide cards so I can’t vouch for those, but I’m glad they were helpful for you!

  • Andrea November 12, 2020   Reply →

    Thanks for the helpful advice! I’m currently prepping for the NBCOT and have 26 days til I take the test :l Nervous to say the least! I’ve been using Picmonic too, I’ve found it helpful to easily remember some facts. Here’s the playlist on developmental theories if anyone wants to try it out: Good luck to everyone!

    • Sarah Stromsdorfer, OTR/L November 12, 2020   Reply →

      Thanks so much for sharing this, Andrea! Best of luck next month!

Leave a comment

This site uses Akismet to reduce spam. Learn how your comment data is processed.