I just finished my Level II fieldwork last month and I'm scheduled for the NBCOT in early July. I've been studying for about four weeks and my practice exam scores are sitting between 450 and 465. I know the passing score is around 450 but I've heard mixed things about how the practice tests compare to actual exam difficulty.
My study schedule is about two hours on weekdays and four hours on Saturdays. I'm using the NBCOT OTR practice exam bundle and TherapyEd. The TherapyEd content reviews are helpful for filling knowledge gaps but I'm not sure the question style is totally representative of what I'll see.
The domains I keep missing are pediatrics and mental health — both of my Level II rotations were in acute care so I have less clinical experience there. I scored 71% on pediatric questions in my last practice set vs. 84% on adult physical rehab questions.
Should I be worried? A few classmates are scoring in the 490s on practice and I'm not sure if I'm just looking at this wrong or if I genuinely need to shift my prep strategy in the last six weeks.
TherapyEd question style is different from the actual NBCOT. The real exam leans harder into clinical reasoning scenarios than pure knowledge recall. If you're only scoring yourself on right/wrong, try analyzing WHY each wrong answer is wrong.
450-465 on official practice exams with six weeks out is tight but passable if you fix the knowledge gaps. I was scoring 458 three weeks before my exam and passed with 489. Pediatrics and mental health are worth focusing on because they're weighted heavily.
Don't compare scores with classmates too much. Practice score variance comes down to which question bank you're using, not just how prepared you are. The 490s may mean different things depending on source.
Six weeks is enough time to close the pediatric gap if you're focused. I'd allocate 40% of remaining study time to peds and mental health. Also make sure you know your frames of reference cold — those show up everywhere.