Dr. Lizzy Coats’ journey of self-discovery, perseverance and success
KALAMAZOO, Mich.—In the United States, aspiring occupational therapists must pass the National Board for Certification in Occupational Therapy (NBCOT) exam to initially practice. It is a multiple choice/multi-selection, computer-based, four-hour exam with content encompassing what an entry-level occupational therapy (OT) practitioner should know. Given the intensity and importance of the test, many students invest significant time, money and energy preparing for and taking the exam.
For Lizzy Coats, OTD, OTR/L, the journey to NBCOT success was anything but ordinary. Dr. Coats graduated from Western Michigan University’s Occupational Therapy Doctorate program in April 2023. Dr. Coats began her summer like many of her peers: recovering from the demands of graduate school and diving into exam preparation, dedicating 5-6 hours each day to studying. However, her first attempt in August 2023 ended in disappointment when she missed the passing score by just 10 points. Undeterred, she took a small break and then resumed her rigorous study schedule, aiming to retake the test in September 2023. Unfortunately, she fell short again, missing the passing score by 14 points.
It was this second attempt that was the catalyst for Lizzy to reevaluate not only her study methods but also reflect holistically on herself. After years of struggling with attention, Dr. Coats decided to seek a formal evaluation from a doctor to determine if she had attention-deficit/hyperactivity disorder(AD/HD). AD/HD can pose challenges for tasks requiring sustained focus and information processing, both of which are essential for taking a long exam such as the NBCOT. After extensive assessment, her suspicions were confirmed. With the help of a physician, she obtained reasonable accommodations for her next attempt: a private testing room and “stop the clock” breaks, allowing her to pause without losing valuable exam time. Going into her third attempt, she expressed that her approach to studying changed, focusing more on repping out practice problems and less on learning overall content. Despite the change to her studying approach and new accommodations, Lizzy, unfortunately, did not pass her third attempt in April 2024. Reflecting on her experience, she identified two critical factors: high stress before and during the test, and accommodations that still weren’t sufficient for her—she ran out of time during the test even with stop-the-clock breaks.
Determined to learn from her previous attempts, Dr. Coats approached her fourth attempt with renewed focus and intention. She worked with a doctor to receive an additional accommodation— an extra 1 hour time to take the exam— while retaining her private room and stop-the-clock breaks. She utilized a new acronym for breaking down questions: DOCK & SCOPE. She was intentional about shifting her mindset going into the exam and transformed her stress and anxiety into a “game day” type headspace, even texting her mom “It’s game day” the day of her 4th test. To stay calm and focused, she incorporated meditation and mental imagery, visualizing herself confidently selecting the correct answers. During the exam, she took spaced breaks every hour, visualizing her success during those breaks. Finally, on July 20, 2024, more than a year after her first attempt, Dr. Coats passed the NBCOT on her fourth and final try.
In meditation of her entire experience, Lizzy credits her faith, friends, family and her dog for her emotional and mental endurance during this period of her life. She believes her challenges taking the exam have built her confidence, resilience and empathy working with her patients. She expressed that she understands what it’s like to not be understood or overlooked, and is very intentional about seeing the potential in her clients that others may not see. With the NBCOT exam in her past, Lizzy is now a thriving practicing occupational therapist at a skilled nursing facility. Dr. Coats’ journey to NBCOT success is a testament to perseverance, adaptability and the power of self-belief. Today, she’s helping others live to their fullest potential—one patient at a time.