The National Board for Certification in Occupational Therapy (NBCOT) exam demonstrates your understanding of everything you learned in occupational therapy (OT) school.

The courses and program curriculum, labs, and fieldwork experiences are all represented on this comprehensive exam. Occupational therapy school helps to prepare you to pass the NBCOT exam successfully, and it's ideal to start preparing from the start of your OT program.

What Is the NBCOT Exam

To practice occupational therapy in the US, you must pass the NBCOT exam. To be eligible to take the exam, candidates must have earned an entry-level occupational therapy degree from an Accreditation Council for Occupational Therapy Education (ACOTE) accredited occupational therapy program.

ACOTE sets the standards for all occupational therapy program curricula, which ensures that each program covers the knowledge and skills needed for entry-level practice in occupational therapy.

The NBCOT exam is based on the practice application of this knowledge, creating a strong alignment between the OT program curriculum and the exam.

OT Courses and Curriculum

To understand the connection between OT school courses and curriculum and the NBCOT exam, let's consider what's covered on the exam. The exam is divided into four domains:

  • Evaluation and Assessment (23 percent)
  • Analysis, Interpretation, and Planning (23 percent)
  • Select and Manage Interventions (38 percent)
  • Competency and Practice Management (16 percent)

Evaluation and Assessment

Evaluate and assess factors that impact occupational performance, such as bodily functions and structures, human development, and functional skills.

Analysis, Interpretation, and Planning

Formulate conclusions by synthesizing evaluation and assessment results to establish a need for services and a client-centered intervention plan. Monitor and modify the intervention plan throughout the occupational therapy process.

Select and Manage Interventions

Select appropriate client-centered interventions and understand how to prepare and adapt intervention techniques to support engagement throughout the occupational therapy process.

Competency and Practice Management

Manage professional activities as guided by evidence-based practice, regulatory compliance, and standards of occupational therapy practice.  

Now, let's consider what occupational therapy program courses and curricula teach. An entry-level occupational therapy degree will typically be either a Master of Occupational Therapy (MOT) or an Occupational Therapy Doctorate (OTD). Both degree programs prepare students for the NBCOT exam.

MOT and OTD programs provide graduates with the skills necessary to enter clinical practice and with comprehensive knowledge encompassing the four domains covered on the NBCOT exam. Entry-level OTD programs include additional coursework in leadership, research, and advocacy as well as the requirement to complete a capstone project.

In addition to program-specific courses, both the MOT and OTD programs require students to complete prerequisite courses for admission. The specific prerequisite courses vary by program. However, the courses typically include some of the following:

  • Human anatomy and physiology
  • Neuroanatomy
  • Kinesiology
  • Statistics
  • Biology
  • Medical Terminology
  • Abnormal Psychology
  • Human Development

Prerequisite courses provide the foundational knowledge needed to advance into an occupational therapy program and to understand the domains covered on the NBCOT exam. In addition to courses, OT programs typically require approximately 40 hours of observation in a clinical setting before admission.

The observation time is another prerequisite and an opportunity to see occupational therapy practitioners in action, evaluation, planning, providing interventions, and following guidelines, as well as collaborating with other health care professionals and teams.

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OT Labs

Entry-level occupational therapy programs are available in many formats, including hybrid and accelerated formats, which allow for online learning of didactic coursework. Labs, or hands-on, experiential aspects of coursework, however, are on-site learning experiences.

Occupational therapy program labs are where you begin to apply the foundational knowledge learned in didactic courses to learn and practice applied clinical skills. Examples of the assessment, analysis, intervention, and competency skills practiced in OT lab courses include learning:

  • Proper body mechanics for patient transfers
  • Fabrication of  hand and wrist braces
  • Measuring range of motion with a goniometer
  • Using standardized tests to evaluate skills and occupational performance
  • Assessing pain, strength, and neurological functioning
  • Application of intervention strategies to prevent injury, promote healing, and support occupational performance

Fieldwork

All accredited entry-level occupational therapy programs require supervised, on-site fieldwork. Occupational therapy fieldwork is divided into two levels:

  • Level I Fieldwork is completed throughout the OT program.
  • Level II Fieldwork is typically completed after all other coursework has been completed. Level II fieldwork includes 24 weeks of full-time, on-site experience in a clinical setting.

Your fieldwork experiences are the time to apply the foundational knowledge from the occupational therapy program coursework and to learn the clinical reasoning skills necessary to practice as an occupational therapist.

Between the Level I and Level II fieldwork experiences, students are exposed to various clinical settings and diverse client populations. The skills that you'll practice and refine are in alignment with the four domains on the NBCOT exam, including:

  • Demonstrating clinical reasoning skills to evaluate and assess occupational performance, and identify factors that may be limiting it.
  • Analyzing and interpreting data, based on evidence from the evaluation process, to determine an appropriate intervention plan.
  • Selecting appropriate and client-centered intervention strategies and managing interventions by adapting strategies throughout the occupational therapy process.
  • Demonstrating competency in evidence-based occupational therapy standards of practice and demonstrating practice management by understanding and adhering to regulatory compliance guidelines.

Exam Preparation Starts in OT School

Each aspect of an accredited occupational therapy program, whether that be an entry-level MOT or OTD program, is in alignment with the four domains covered on the NBCOT exam.

Classes and OT coursework, along with prerequisites, provide you with the foundational knowledge needed as an occupational therapist. On-site lab experiences are opportunities to learn and practice clinical skills.

Occupational therapy fieldwork experiences bring foundational knowledge and clinical skills together in a clinical setting. Understanding the four domains as early as possible in the occupational therapy school journey is an effective way to prepare for the NBCOT exam from prerequisites through graduation.