Time Line from thinking about the NBCOT to actually getting a job

As an international OT passing the NBCOT is only the tip of the iceberg. Once you pass the NBCOT you still need to get your Visa Credential Verification Certificate (VCVC) which is valid for 5 years and is essential if you are applying for a visa to work in the US. You also need to register with the specific State that you are planning to work in. Then you need to find a job and an employer that is prepared to sponsor your visa. Then you need to apply for you visa from immigration, hope that you get it and then wait until you can start working. Typically you apply for your visa in April of a specific year and it comes into effect in October of that year. It's not an automatic process. There is a 6 month delay between application and actually being allowed to start work. Sigh. Here is a sample time line from thinking of going to the States to work as an OT and actually starting work. 

Still want to do it? Good luck. Hope we can help.

Qualifying To Take The NBCOT

In a perfect world, most of you will not need to go through this step - the pre-amble before you are allowed to register to take the NBCOT. 

If you graduated after 2007 and do not hold a Masters in OT - I'm sorry the road ends here...

1. If you graduated after 2007 and do not hold a Masters in OT from WFOT (World Federation of Occupational Therapy) recognised institution, you will not be able to take the NBCOT exam. If you are still looking to move to the States and work as an OT you will either have to acquire a Masters in your home country or some where world recognised (check this with the university you are applying to) or you could try and apply for a Masters in OT within the US. Having to do a Masters will set you back a few years and if you are looking to apply for financial aid as an international student be prepared to apply to schools at least 1-2 years in advance. You really have to be committed to working in the States as an OT to go down this route.

If you graduated before 2007 with a Bachelors or hold a Masters in OT - fun and games ahead!

2. If you graduated before 2007 with a Bachelors or hold a Masters in OT from a WFOT university then you should be eligible to take the NBCOT. However you may have to prove that your education is at the standard of American graduates who have completed their Masters in OT. As you go through the OTED (Occupational Therapy Education Determination) process you will find many hoops that you need to jump through. This is in an arduous process that I had to go through before I could register to take the exam. It also costs $500 to have this part of the application process approved - this is an expensive process - make sure you really want to do this before you get stuck in!

One of the longer steps is completing a document that states all the courses and subjects that American OT schools provide for their students and placing your equivalent course and course code next to it. So for example, usually at some point in your OT career you completed a psychology course. The form will say Neuropsychology methods, and you'll have to match that by listing a course that contains those elements. Then you will say how you were tested in the course - oral exam, case study, written papers etc. You continue with this for about 40 pages. It it also important that you get it right the first time and write out the course names for NBCOT. I listed the course codes (which is what the instructions said) on my application and they returned it saying that I had to write out the full name of the courses. I spent a lot of time writing 'Occupational Therapy Methods and Foundations 2' and the like. Get it right the first time! 

To further strengthen your proof, you need to get your university to send as detailed as possible course descriptions from their official course curricula. It's no use, you just writing course names next to the US equivalent. Sending transcripts will also help to show that you completed the requirements for each course. As I am a South African trained OT, I don't imagine that there are a lot of OTs from the same country as me trying to apply to take the NBCOT - I know of one, they are very skeptical of other countries and their training so it is important to give them as much information as possible - too much if you can - to show that you are at the same level as new graduates who take the exam. 

Concurrently, you may need to take an English language test to prove that you can speak, understand and read and write in English. Countries that are recognised as first language speakers of the English language do not need to take this test (the TOEFL). So if you are from Canada, Ireland, the United Kingdom, Australia or New Zealand you do not need to take the TOEFL. Others like myself who are not from any of the listed countries but who speak English at home, were educated in English and work in an English speaking environment are still required to take the TOEFL and spend an additional $150. Those are 4 and a half hours of my life that I'll never get back. Also bare in mind that the TOEFL is only valid for 2 years so make sure you don't do it too early and then have to do it again.

It is always a good idea to check the NBCOT website to make sure that you are up-to-date with all their requirements. I took the NBCOT exam in October 2009 and began this process in December 2008. Things may have changed but I am pretty sure that the jist is all there. The website has a specific path for internationally-trained OTs to follow so it shouldn't be too hard to navigate. However, in hindsight, I wish that there had been more info about the process online so that I knew what I was getting myself in for.

So now you've taken you English test, submitted your course curricula, transcripts, degree certificates, NBCOT forms and paid exorbitant amounts on your credit card.. now what? Now, you wait and hope to your lucky stars that they except all your paperwork in due time and allow you to take the exam. It's one roller coaster after the next.

Finding the right study guides

This is the question on everyone's mind! Personally, I bought study guides that in retrospect I didn't really need. Please learn from my mistakes and don't waste your money! For me, I always find it motivating and helpful to study using past questions and exam papers and as this exam is all about technique (rather than regurgitation of info), the ability to analyse what the questions are asking is very very important and the key to being successful in this exam.

1. The Official NBCOT Study Guide

This is an absolute must as it questions from NBCOT directly. You can borrow a copy from a friend and you can also order the guides in a group to bring down the cost per guide. If you get nothing else, this is one the to have. What I found really useful, was that at the back of the book, there are references for all the questions so especially if you don't get a questions right you can go and research where the question came from. It also can provide a starting point to study. You may also want to take the test before you start studying and a few weeks later when you are ready to take the exam (provided you have forgotten the questions) and compare your scores. Hopefully it'll be a confidence booster.

2. 2009 National Occupational Therapy Certification Exam Review and Study Guide by Rita Fleming-Castaldy

This is the book that gets everybody buzzing. When you first lay eyes on it, you think it has come down from heaven to save you because it seems to be all the years of OT study crammed into one book. You think to yourself, "wow, if only I had had this book during university, it could have been all I needed!". This, my friends, is not true, and while the 'Rita' book is a great book with many many topics and a CD-rom with practice questions, it is still a study GUIDE and not the be all and end all of OT prep. I think where many people fall down is in the reliance of this book and thinking that this is enough. Perhaps if you memorised every fact you would get through, but if you don't understand the foundations, you'll probably still struggle. Another critique comes with the practice exams. There are 3 on the CD-Rom with 200 questions on each. They are challenging questions which is good to get your brain ticking but they are not the same as the NBCOT questions and you need to know the 'Rita' book pretty well in order to answer them. Many people say that the questions in this book are much harder than those on the NBCOT exam, and whilst I agree that they are tough, I wouldn't necessarily say that the official NBCOT questions are easier, just different. Bottom line, this book is not a substitute for basic concepts and in my opinion will not get you through the exam just on its own, unless you know your foundations of OT really well.

3. Occupational Therapy Examination Review Guide by Johnson

I really recommend this book. I enjoyed working through it. The questions are quite easy, compared with some of the NBCOT ones but they cover a lot of the information needed for the exam. This book is great self-esteem booster as you can do well through using the same logic and analysis needed for the actual exam. Again, do a test (there are 4 in the book with 200 questions each) before starting to study a section and then a few weeks later and compare your scores. Johnson has also created exams divided by topics as well as all mixed with details rationales for the choice of each answer and references to explore concepts in more detail.

4. Castle Worldwide Practice Tests
As you start to near the end of your studies, keep the practice exams available from Castle Worldwide in mind. You won't receive the answers for these questions because they are quite similar to actual questions on the exam. This is frustrating but also motivational as you may end up doing more research and studying by trying to find the answers. You can buy the exams in a big pack or individually and they are valid for a year from date of purpose. This means you can buy the exam and wait until up to a year to take it. Once you take it though, you can't do it again unless you buy it again so keep that in mind. This is a great way to get into the testing frame of mind and prepare yourself for the exam and the score that you get is highly correlated to the score you may receive on your actual exam.

Essential Textbooks for NBCOT

In our research we found that the common study guides for NBCOT are helpful with the exam. In my opinion, however, I strongly feel that the difference between a pass or a fail is in the foundational information that one needs to learn. I recommend studying from a well-trusted and recognised name in all the necessary areas: physical dysfunction, paediatrics, mental health, community and possibly legislation (especially if you are unfamiliar with the US health system).

The following are textbooks representing each area where possible. If you are looking to buy a book, getting the latest or second to latest edition is probably the best as the exam has been recently updated (in 2009) and so the topics covered are from newer editions. If you have an older edition, you don't need to buy a new one. If you really feel like you are missing out, you can try and borrow a later edition from the library. This can be such a costly process (especially if you are international or taking the exam repeatedly) that is unnecessary to buy new editions of the same textbook.

1. Physical Dysfunction
Williard and Spackman's Occupational Therapy by Crepeau, Cohn and Schell
Many of the questions the physical dysfunction questions are referenced from Williard and Spackman and so it is good to be able to look up questions in this book and get expanded text on the topics.

Occupational Therapy for Physical Dysfunction by Radomski and Trombly
Again many of the questions for physical dysfunction are referenced from Radomski and Trombly. If you have both books, that's awesome. If not, having one or the other is good enough. Again you can always try and borrow the book from a friend or take it out of the library.

Pedretti's Occupational Therapy: Practice Skills for Physical Dysfunction
I didn't have access to Pedretti's when I was studying but I know it's a good resource and it did come up in the occasional question. Again, I think if you have one of the three Phys. Dysfunction books or even better, two, you won't need all three, and most likely won't have time to go through them all.

2. Paediatrics
Occupational Therapy for Children by Case Smith
I borrowed this book from a friend - a much earlier edition - and I found it very helpful regarding the IEP (Individualised Education Plan) and the feeding responsibilities required of an OT. It comprehensively covers everything a new (and advanced) OT needs to know about paeds in the States. This is a good resource to use.

3. Mental Health
Psychosocial Occupational Therapy: A Clinical Practice by Cara and MacRae
This book is great for getting back to basics on all things mental health and specific OT interventions and approaches. It also outlines all the medication and side-effects which is really useful especially if you are unfamiliar with this field or you didn't study it intensely at university. I highly recommend this book for mental health. I wish I had had it during my studies.

4. Community
Developing Occupation-Centered Programs for the Community
This is the only book that I actually bought because it wasn't available to me locally. But that's just me. It was helpful with the tricky program questions on the exam but I don't think it's actually necessary to buy if you can borrow it. I'm still glad that I had it though for the exam because it put my mind at ease that I had a good solid resource for this section.

Introduction

So to start off, let us introduce ourselves. We are two OTs who are internationally trained (in South Africa and Australia) and for various reasons, mostly involving men, we found ourselves needing to take the NBCOT. Up until last year I had never heard of the NBCOT, as such, and was only vaguely aware that in order to work in the US as an occupational therapist, one needed to take a board exam. When the time came to make the decision to move, the NBCOT loomed and after many months of stress, lots of money and energy invested and many Skype conversations, both of us passed the NBCOT comfortably. Chatting to the internet savvy OT community really helped us to conquer any perceptions we had about the exam and to actually study through Skype, email and forums/blogs. As we have both recently taken the exam (Sep and Oct 2009 respectively) we are very familiar with the process and can offer additional advice if you are an international OT wanting to take the exam. We can also explore which resources are really necessary to buy and which you can live without. Then, we can try and advise the best job search strategy especially if you are outside of the US and need a visa and job before you arrive. We hope that this becomes an interactive forum where legitimate, honest discussion and advice is imparted.