Predictors of First-Attempt NBCOT Success: A Multivariable Analysis of Occupational Therapy Graduates

Document Type (Journals)

Original Research

Abstract

First-time pass rates on the National Board for Certification in Occupational Therapy (NBCOT) examination have declined in recent years, highlighting the need to better understand factors associated with licensure readiness. This study examined academic, internal, and external predictors of first-attempt NBCOT success among occupational therapy graduates. A retrospective, cross-sectional survey design was used with a sample of 40 graduates from a single institution. Participants completed a post-examination survey assessing academic performance (graduate grade point average [GPA]), self-management skills (time management), external demands (workload, stress, support), study behaviors, and engagement with preparation resources, including the Occupational Therapy Knowledge Examination (OTKE). Descriptive, bivariate, and multivariable logistic regression analyses were conducted. Graduate GPA (OR = 2.34, p = .03), time management (OR = 1.85, p = .04), OTKE participation (OR = 3.12, p = .02), and study duration (OR = 0.63, p = .03) were significant predictors of first-attempt success. Perceived stress and external workload were not independently significant; however, subgroup analyses suggested that higher workload may disproportionately affect students with lower GPA. The multivariable model demonstrated improved predictive performance (AUC ≈ 0.75) compared to GPA alone. Findings support a multidimensional, systems-based understanding of NBCOT readiness, emphasizing the combined influence of academic performance, self-management skills, and structured preparation strategies. Results highlight the importance of early identification of at-risk students and the integration of targeted preparation and support within occupational therapy education.

Biography

Kristina Hartsook, DrOT, OTR/L, BCP is a passionate occupational therapy educator and Academic Fieldwork Coordinator specializing in pediatrics, fieldwork education, and family-centered care. Scholarship interests include licensure readiness, clinical education, early autism identification, and equity-driven interdisciplinary practice, with leadership roles in professional association fieldwork initiatives.

Sean Brim, PhD, OTD, MOT, OTR/L is an occupational therapist with over 10 years of clinical experience. His research focuses on occupational therapy education and student success, particularly factors influencing NBCOT exam performance, as well as wellness interventions, educational disruptions, and emerging practice areas in primary care and health behavior change.

Arlenys Loffredo, MS, OTD, OTR/L is an instructor at USAHS Miami and EdD candidate. She is passionate about supporting student success, including NBCOT preparation initiatives, and fostering trauma-informed, student-centered learning. Her work emphasizes wellness, inclusion, and developing resilient occupational therapy practitioners.

Declaration of Interest

The authors report no declarations of interest.

Recommended Citation

Hartsook, K., Brim, S., & Loffredo, A. (2026). Predictors of First-Attempt NBCOT Success: A Multivariable Analysis of Occupational Therapy Graduates. Journal of Occupational Therapy Education, 10 (3). Retrieved from https://encompass.eku.edu/jote/vol10/iss3/14