What My NBCOT Exam Actually Felt Like (and How I Thought Through the Questions)

One of the biggest questions I get is: “What was the NBCOT exam really like?”

So I wanted to share my honest experience, not to scare anyone, but to help you frame how to think about this exam.

Overall exam balance

From my experience, the exam felt like a fair balance across all four major areas:

• Adult rehab

• Pediatrics

• Mental health

• Geriatrics

Nothing felt wildly overrepresented, and nothing felt completely absent. That said, many of the scenarios, regardless of population, were framed in a way that required clinical reasoning rather than recall.

How the questions were actually asked

As most of you already know, the NBCOT rarely asks:

“What is X?” or “Define Y.”

Instead, almost every question felt like:

• If this is X, what is the best / most appropriate / first thing to do?

• What else do you need to consider?

• Which option is most OT-appropriate in this context?

Because of that, my studying couldn’t rely on pure memorization, especially since I didn’t have enough time to memorize everything anyway. I had to shift my focus to concepts and realistic OT thinking.

How that changed the way I studied

For example, when studying dementia, instead of trying to memorize every single stage detail, I broadly focused on:

• What OT’s role looks like at each stage

• How cognition impacts safety, ADLs, and caregiver education

• What interventions make sense given the person’s function, not just the diagnosis

That same mindset carried across diagnoses: What would an OT realistically prioritize in this situation?

I go into this much more deeply, and very practically, in my prep binder, but the big takeaway is this:

Understanding how OT fits into the picture mattered more than knowing every detail.

A quick heads-up

There were a few diagnoses that I hadn’t heard much about or hadn’t studied deeply in school (maybe your school did/do, just not mine). Not many, but enough that it reminded me that this exam can throw in curveballs. That’s another reason why having a strong reasoning framework helps; even when the diagnosis is unfamiliar, you can still narrow down safe and appropriate choices.

My honest take on the exam

I’ll say this:

I don’t think the exam itself is hard in the traditional sense, but it is confusing.

Some questions genuinely felt subjective. There were moments where multiple answers seemed reasonable, and the challenge was figuring out:

Which answer fits the exam’s logic best?

That’s why time management, slowing down to read wording carefully, and trusting OT principles mattered so much.

Final thoughts

My study plan, and the binder I’m building, focuses less on cramming information and more on using your limited time efficiently, learning how to break down questions, and thinking the way the exam wants you to think.

If you’re studying right now and feeling overwhelmed, you’re not doing it wrong. This exam isn’t about knowing everything; it’s about applying what you know with clarity and intention.

More details (and very concrete examples) are coming soon in the binder, but I hope this gives you a clearer picture of what to expect 🤍

SOLI DEO GLORIA.