so you failed the nbcot

So You Failed the NBCOT®? Get Advice To Succeed On Your Next Try

If you’re reading this, you may have just received the stressful news that you failed the NBCOT® exam.

First, take a deep breath. Don’t panic. Easier said than done, I know!

After weeks and weeks of studying and stressing, you’re likely feeling de-motivated and hopeless. These feelings are 100% normal and you should expect to feel these feelings. Feel those feelings, but then pick yourself back up.

Remember: It’s Not The Worst Thing That Could Happen!

I can assure you that even if you’ve failed the NBCOT® one, two, even four times, you will pass the NBCOT® and you will become an awesome occupational therapy practitioner.

“That’s easy for you to say. If I failed before, I’m probably NEVER going to pass!”

You may be thinking this right now. But keep in mind that at this point in time, your increased stress levels are contributing to your negative feelings.

Once you get over the discouragement in a few days, you’ll be ready to get back to planning for the next test and yes…studying.

failed the nbcot

To help you bounce back, I’ve compiled a list of the best strategies from current OTs and COTAs on AOTA’s Facebook Group about on how they managed after failing multiple times. The Facebook group is called AOTA’s NBCOT Exam Prep Info Center. It has over has 34,000(!) members there to help you and provide you with the encouragement you need.

So, if you aren’t already in the group, stop what you’re doing and join ASAP! Members share great study strategies and encouragement after they’ve failed the exam. You’ll see that everyone goes on to pass it. I learned so much from that group while studying and I definitely took in more advice than I could ever imagine.

So without further ado, here are some of my favorite insights to help you pass.

15 Tips From Successful NBCOT® Test Takers

  1. If you ran out of time on the exam, time yourself on every practice quiz to get in the habit of reading and processing information quickly.
  2. Don’t change your answers! It’s very easy to second-guess yourself but your first answer is more likely the correct answer.
  3. Practicing meditation and visualization really helped me. I wrote out a list of what I wanted (pass the exam, get a job) and read it out loud to myself each day. I know it doesn’t help with answering questions but it helps to make yourself feel confident and positive that you will obtain this in your life and that you know this material.
  4. If you’re almost out of time and have many questions left, just pick one letter (A, B, C, or D) and answer every question you have left with that same letter so you can finish the questions.
  5. Study one topic for one to several days, then review right before bed so the information sinks in overnight.
  6. Take study breaks! You don’t want to overwhelm yourself. Take weekends off.
  7. During the exam you should give yourself at least one bathroom break to decompress. Your brain needs a breather. The 10 minute tutorials are a great time to take your break since they don’t count against your time limit.
  8. During the exam, don’t overthink things. Just use the information given without making any inferences.
  9. Don’t think about fieldwork scenarios during the exam. The exam wants ‘perfect world’ answers.
  10. Take a million practice tests” (I second this!).
  11. Safety, safety, safety. Safety is always the answer, especially for the case scenarios. Always err on the side of caution.
  12. Make sure you always choose the answer that best involves the active participation of the patient/client, especially when you have the choice between two ‘correct’ answers.
  13. Remember the questions they’re asking are knowledge based, not clinical experience. Know the book answer and don’t try to interpret it too much.
  14. Take a small snack to eat during your break to replenish your body.
  15. Ask your MD about getting a prescription beta blocker from your doctor, it did me wonders. Usually test anxiety is the problem. (This one was really interesting; make sure to discuss this with your doctor if you’re experiencing high levels of anxiety during the exam).

Top Recommended Study Aids

If you’re wondering if you may not have the “right” materials, I created a little list of the same resources that come up time and time again in the study group.

1. National Occupational Therapy Certification Exam: Review & Study Guide + AOTA’s NBCOT Exam Prep

The combination of using these two resources is the strategy that I followed. The book is also known as the Therapy Ed book. This was my regimen for passing. You can do all of this again for your next exam, or do a little less since you already have several weeks of studying down.

  • Read the Therapy Ed book cover to cover once.
  • Take the 3 Therapy Ed exams and read through each rationale.
  • Read through each AOTA Exam Prep PDF’s one to two times (easier to do than Therapy Ed).
  • Take 30-50 question quizzes from AOTA’s Exam Prep daily for about five weeks.

Find the prep materials here:

For more in-depth information about my favorite study resource, you can read my unbiased review of AOTA’s Exam Prep review here.

2. Occupational Therapy Examination Review Guide

This is formally known as the “Purple Book.” This is another highly recommended resource from other test takers. There is a version for COTAs as well.

Get a copy here: Occupational Therapy Examination Review Guide

3. Pass the OT

People that have failed several times often recommend this tool for the additional web courses and tutoring. I have not taken this course but have generally heard positive reviews.

Check it out here: Pass the OT

4. Quizlet

I always recommend getting your hands on these free pre-made flashcard quizzes to help supplement your studying, especially with developmental milestones and splinting.

Visit the site here: Quizlet

Manage Your Testing Anxiety

Many failures in testing can be attributed to anxiety.  Unfortunately, there isn’t an easy, quick fix for this.

What’s helpful to cope with this stressful experience is to understand why your body inflicts this response on you.

Basically, your brain perceives the situation as a threat to your safety and survival. Because the environment is seen as a stress and a threat by your brain, it decides to try to help you by initiating the fight or flight response.

When this happens, your brain literally shuts off your neocortex – the part of the brain where deep thinking and reasoning happens. It sends all the blood and energy to your heart so you can be ready to fight – or run.

This is of course bad news since you need the deep-thinking part of your brain for recalling and analyzing information.

Just stay calm and remember that it’s normal to feel this way temporarily. It will pass in a few minutes – it always does – and you’ll be in much better shape to take the test.

failed the nbcot stay calm

My Top Tips To Staying Calm

  • Try to ignore your anxiety during the test, and instead try to focus on the questions.
  • Have confidence going into the examYou’ve been preparing for this. Remind yourself that you have this in the bag. Write your name on the board they give you followed by OTR/L or COTA. Tell yourself throughout that you will pass.
  • Breathe. Take slow, rhythmic, deep breaths while reminding yourself that you will pass.
  • Consider trying natural supplements: If you don’t use prescription medications and want to try a natural approach, I used GABA Calm lozenges during my thesis defense and found that they worked for me. Whether it was a placebo affect or not, it gave me a little more confidence about my anxiety. *Disclaimer: Always consult with your doctor before using any supplements.

Don’t Wait Too Long Between Attempts

There are many circumstances that can lead to failing the exam. Some new grads take full time jobs after school which can lead to decreased study hours. Others have real world situations like family and kids that can take away from study time.

Whatever the case is, get back in the saddle when you know you can devote full time hours studying.

Do not wait too long after the test to start studying again!

Sometimes test takers do wait a solid six months to a year to get back to the exam. Understandably, you’ll feel very overwhelmed and de-motivated to study again after a failed attempt. I totally understand.

If you can help it, though, do your best to re-take it sooner than later to retain all of the information you just studied.

Trust That You WILL Pass The NBCOT® And Become An OT

While failing the NBCOT® is a major let-down at first, remember that you aren’t the first OT or OTA that’s been through this.

And you certainly won’t be the last.

Whether you pass the first or the fourth time has no bearing on how great you’ll be as a practitioner. Don’t let it drag you down or define you.

You know you will be an OT one day no matter how many tries it takes, as long as you keep at it.

Remember that YOU GOT THIS and that you WILL pass! 

Lastly, if you have any other tips or advice that helped you, please share it in the comments. 

This post was originally published on September 5, 2016 and updated on May 19, 2021.

You may also like


  • Elsa Solomon November 2, 2017   Reply →

    Thank you for all the tips and encouragement.

  • Rachel Layton September 6, 2022   Reply →

    Thank you for all the tips and encouragement. I failed my first time and will be retaking soon. I found my results out on a Wednesday and took Thurs, Fri, Sat and Sunday off. I needed a mental break to pick my head up and not let a failing test score (by 2 points) put me down. I fell off the horse and needed to get back on! I will be using your tips and tricks for the next time around!
    Any chance you do a resource on what to do after you failed? I feel as though all the info I am studying I know!

    Thank you

    • Sarah Stromsdorfer, OTR/L September 11, 2022   Reply →

      I’m so sorry! Missing by 2 points would be so frustrating but you were SO close so try not to worry too much (easier said than done, I know). I’m sure your next time around will be better since you’ll have had the experience as well as a bit more study time. Try to give yourself a bit more of a break if you can!

  • Kayley March 23, 2023   Reply →

    Thank you so much for these tips, it has definitely encouraged me! And I get you Rachel, I hope you passed! But I just took the NBCOT for my first time and found out I failed by 3 points. Let me know if you have any specific study tips for after failing since I feel I know most of the info & have used most of the recourses already! Thanks!

Leave a comment

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