Introduction to the NOTCE

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What is it?

The National Occupational Therapy Certification Exam (NOTCE), formerly known as the Canadian Association of Occupational Therapists (CAOT) Exam, is the nationwide written test of OT knowledge of theory and applications here in Canada.  Its prime purpose is to protect the public by assessing individuals who wish to practice occupational therapy (OT) all over the country.  Second, since OT is a regulated health profession, all regulatory organizations require the NOTCE for full registration.  It is held twice a year on the first Saturdays of July and November.  Exam sites are available nationwide.  You can choose which province you want to take the exam early in registration, although the specific location is not given until a few weeks before the exam date.  As you go on reading this, we will delve on the resources you need to read, question formats and scoring method of the NOTCE.  Essential web reads and stuff to browse and download are linked in the text.  

The Blueprint, Profile and Essentials

In order for you to be successful in any exam, there are many things to know aside from the content of the exam.  To be fully ready, one must know how the exam is written.  You might remember from highschool or college days how teachers and professors have different formulations of their quizzes.  Who gives out keywords?  Who doesn't?  Who likes essays and tables?  Who likes identification or multiple choice type of questions?  Some of those may seem minuscule to the content of the exam but it might surprise you to know that how you organize the content of your review to a certain design may score you more points than just merely memorizing the books from page 1 to the glossary page.

To start off knowing the NOTCE, let me tell you, there is nothing quite like the Resource Manual to let you have a peak at your Lady Victory.  It has it all!  The purpose of the exam, question formats, reference source and even sample exam questions.  It's like our lovable Spacky - everything essential condensed in one.  Now, the most important thing to take note of in this manual is the BLUEPRINT.  The blueprint is a graphic representation of the exam components and its framework.  In a simpler angle, I'd like to think of it as a flower in a plant box.

The Blueprint¹

It displays the dynamics of OT knowledge of the client, environment, occupation, practice process and the OT roles which we as therapists assume in the profession.  The big center where the seeds are located compose of the examinee's knowledge of the CEO and OT process.  This stands for sixty to seventy percent (60-70%) of the exam and can be found tabulated in more detail in figure 2.

The Matrix²

The colorful petals represent the six (6) major roles we assume in professional practice. These overlap at the center to show the dynamic unfolding of the roles centralized on the knowledge we know to enable our clients through the occupations they deem meaningful in their lives.  This comprises of the thirty to forty percent (30-40%) of the exam.  Lastly, the plant box nurtures the flower of knowledge and roles by supporting the practice with theories that we apply in clinics; vice versa, the applications evolve the theories we use through research.

Upon introduction to the blueprint, I'm sure more questions will surface in your mind - most especially, on the definition of each role in professional practice.  This is where we turn to the Profile of Occupational Therapists in Canada (a.k.a. the Profile) and the Essential Competencies of Practice for Occupational Therapists in Canada (a.k.a. the Essentials).  The PROFILE provides the big picture of Canada's vision for its occupational therapists and is updated/revised every so often by the council.

Canada's vision for every OT - from competent to proficient and eventually to advanced practice³

The Profile briefly defines the competencies that OTs need to achieve in practice.  These are the OT roles I have enlisted below: (1) expert in enabling occupation; (2) communicator; (3) collaborator; (4) practice manager; (5) change agent; (6) scholarly practitioner and (7) professional.

Figure in the Profile similar to the exam blueprint ⁴

There is a table after the image that delineates each component.  Though this is just a very general description of each role.  To further explain these competencies, we will need to turn to the ESSENTIALS.  You'll be able to understand more about the profile more and what are the criteria that deem all practitioners "competent".  To put it simply, the essentials is the detailed qualities that make a "competent" OT.



Resources and Reads

So now that you are familiar with the manual, profile and essentials, we will be discovering important resources for your review.  Although you might be with lots of OT resources, there are other references you might not be aware of just like the Profile and Essentials.  The first place you look into for identifying potential review materials would be the Resource Manual.  They are magnificently chronicled at the back of the manual.

The start of the reference list, perfectly written in APA format⁵

I marked all of the books I have then I browsed on the web to have information on the others.   I checked the local library if they had any occupational therapy books.  Sadly, they don't have much OT books there.  I heard from a friend thought that I can access the University of British Columbia Library where they have a large collection of allied health professional books.  If you can, borrow books to save money.

Here I list the resources that I have referenced from in my review:

1. Enabling Occupation I and II - both books are definitely a necessity to read.  You can buy it in the CAOT store or borrow it from a library that has it.  Important to note the CPPF and the OPPM.
2. Trial Occupational Therapy Exam Manual (TOTEM) and the Trial Occupational Therapy Exam (TOTE) - contains exam questions you can practice on.  Check out CAOT website for more details.
3. Occupational Therapy for Physical Dysfunction (Pedretti or Trombly) - covering for the physical dysfunction knowledge.
4. Willard and Spackman's Occupational Therapy - need I say more?  It's your Yorozuya and it has it all.
5. Quick References to Occupational Therapy - good for when you need to quickly refer to conditions
6. Conditions in Occupational Therapy - much like the "Quick References" book, this is also a nice book in which they condensed all of the conditions.
7. Group Dynamics in Occupational Therapy - best resource for knowledge on groups, from theory to application.
8. Psychosocial Occupational Therapy: Frames of Reference for Intervention - greatest reference on theory in psychosocial practice.
9. Kaplan and Sadock's Symptoms of Psychiatry - where all the psychological conditions can be found.  The resource manual has listed the DSM-IV-TR but I find this easier to remember.
10. Occupational Therapy for Children - the pediatrics Bible.
11. Ethical and Legal Dilemmas in Occupational Therapy - this book is magnificent for knowing ethical practice with case scenarios.
12.  Introduction to Splinting - the foundation for splinting.   The review questions every chapter is great for igniting your clinical reasoning skills concerning with this OT task.  Case studies available as well.
13. Cook and Hussey's Assistive Technologies - essentials on the types of assistive devices, assessment procedures. Another thing that is wonderful about this book is that it has a list of organizations in which these devices are available. I'm pretty sure that there was another book on assistive devices but I wasn't able to borrow it from the library.  Everytime I went there, it's always borrowed.
14. Measuring Occupational Performance - worried about your knowledge on assessments and performance measures?  This is the ultimate book!  It classifies them into categories and tabulates its information.  This is a definite must-read for review.
15.  Guidelines on Controlled Acts and Delegation - list of controlled acts in the profession.
16.  Regulated Health Professions Act - it is most important to know certain legislation that concerns the practice.
17.  Canadian Health Act - yet another legislation we must be aware of.
18.  Health Professions Act - another legislation on the health care world.  Pretty long but knowing it early on will help you in practice in the future.  Especially when it comes to claiming your rights as a professional and to have an idea on how the regulatory body works.
19.  Accessible Housing by Design (ramps) - a question on accessibility might come out and knowing about the design acceptable is sufficient.
20. Occupational Therapy Assessment Tools:An Annotated Index - again, another magnificent book on instruments used in practice.
21. Functional Performance in Older Adults - knowledge on geriatrics practice.
22. Conceptual Foundations of Occupational Therapy Practice - a great book that summates the most widely used body of theories in practice.
23. Research in Occupational Therapy - best book to read about research in our field.  In fact, it is very easily understood that you needn't look elsewhere.  I'm pretty sure I browsed another book about research but I totally forgot that other one.


Additional resources:
1. Occupational Therapy examination and practice preparation project for IEOTS (aka OTepp project)

A wonderful organization which helps you understand the health care system here in Canada.  It is also, as I have described in my previous post, a virtual agora in which occupational therapists worldwide gathers and shares their knowledge.  I learned a lot from the OTepp program and I have to say, I never would have imagined starting from elsewhere.  Check out their website and see for yourself how magnificent the program is.

2. CAOT's Occupational Therapy Exam Module (aka OTEM) 

This used to be offered by OTepp but it was carried over to CAOT.  It is an online discussion group which assists examinees in preparing for the exam.  It has over 100+ questions in reserve to discuss with in order to mold the quick rationalizing during the actual exam.  

3. Orientation to the Canadian Health Care System, Culture and Context 

They offer online courses for internationally educated health professionals (IEHPs) on the Canadian Health Care system.  

For your basic sciences and medical-surgical review, I suggest that you stick to resources you feel comfortable with.  After all, there can be lots I can suggest but it will be up to you and on how your reinforcement system works.  I decided to stick wiht my old books Seeley, Snell, Guyton and Gilroy for I've used them quite a lot since college; thus, retrieval of information may be easier due to the repetitive factor.

Questions and Format

The way the examiner formulate the questions are quite unique.  They present a case to you in such a way that you might be in front of the actual client.  From there, they derive 2 to 5 questions.  I suggest from here, you must have at least read the resource manual.  If not, please do.  It will be less confusing.

Now, here is the number 1 case and question example on the resource manual⁶:

Client: Mrs. C is a 66 year old woman. 

Situation: 

• She is recently divorced. 

• She lives alone in a seniors’ apartment 

• She has decreased functioning as a result of a degenerative neurological disorder 

• She was getting home-making services in her apartment 

• She was going to a geriatric day hospital to receive treatment related to physical problems 

• Her physical problems include unstable gait, decreased balance, potential risks for falls, 

decreased vision and general safety 

• She has been admitted to an in-patient geriatric unit due to increasing depression 

• On admission to the in-patient geriatric unit, she is withdrawn, irritable, expressed vague 

suicidal ideation, and has stopped doing previous leisure activities 

• Her previous leisure activities included music and sewing 

• She has few close friends who are of the same age nearby 

• She has one daughter who lives several hundred kilometers away 

ITEM 1 

What should the occupational therapist do FIRST to address Mrs. C’s depression? 

1. Arrange a visit from her friends. 

2. Challenge her with new activities. 

3. Engage her in short term, familiar activities. 

4. Suggest she attend the unit’s Friday evening social event. 

ITEM 2 

Mrs. C. tells the occupational therapist that she is upset that her decreased vision means that she is no 

longer able to sew. Using a client-centred perspective, what should the therapist do FIRST? 

1. Suggest other leisure activities using the Interest Check List 

2. Explore low vision aids and techniques that could allow Mrs. C. to sew 

3. Encourage Mrs. C. to join activities at her local Senior’s Center 

4. Assist Mrs. C. to find a volunteer to help her do her leisure activities 

ITEM 3 

At discharge, the occupational therapist will recommend that Mrs. C. attend an activity at her local 

Seniors’ Centre. Which activity would be MOST appropriate for the therapist to suggest? 

1. Music enjoyment group. 

2. Recreational dancing. 

3. Playing cards. 

4. Recreational swimming. 

ITEM 4 

Mrs. C. is often impulsive and is not following safety guidelines when walking with her walker. What 

should the occupational therapist do? 

1. Set up a behaviour modification program for Mrs. C. 

2. Continue teaching walker use, providing only 1 to 2 step instructions. 

3. Further assess Mrs. C’s comprehension and ability to remember information. 

4. Encourage Mrs. C. to regain internal locus of control and take responsibility for her safety. 

ITEM 5 

The multidisciplinary term is not confident that Mrs. C. has the functional ability needed to return to 

her apartment. Mrs. C. strongly states that she wishes to return to her apartment. What should the  occupational therapist do? 

1. Have a discussion with Mrs. C. about safety and her ability to manage at home. 

2. Arrange for increased home care services. 

3. Investigate the potential for repeated hospitalizations. 

4. Provide legal documentation of Mrs. C.’s incompetence. 

For rationale, you can refer to the resource manual.  If you change information on the following case such as this:

-Mrs. C's leisure activities include watching television and walking.

-Mrs. C has macular degeneration.

NOTE:  This change in the sample number 1 of the resource manual is by NO MEANS AN OFFICIAL ONE.  It is just formulated by me in a mere example of knowing the client and their occupation. Also, the answer and rationale I have provided is again not in the official document.

If a question surfaces on which activity would be MOST difficult for her? Which would you choose? Think first before you read ahead.

1.watching television 

2. walking outside around their house

3. dogsitting 

4. playing UNO

It might surprise you that it would be number 1 because in this activity central vision is vital.  Since Mrs. C has macular degeneration thus we know that central vision is compromised.  The other activities can be done with intact peripheral vision.  See how each case can vary differently with just those alterations? It test how well you know the client in their environment and how it affects the occupations they deem meaningful in their lives. My best advice is to see it upon yourself that you view each case as if you are facing a client.  When you move on to the next question, it means that you get to meet another client who may have similarities but they are most definitely not one in the same. 

Items and Scoring

The exam for my batch was composed of two hundred (200) questions.  I assume that it was two points if you get the answer correct and zero if you pick the wrong choice.  That means overall, the exam would be a total of four hundred and in order to pass you need 70% - that is 290.  Funny though, if you calculate the 70% from the 400 it would be 280.  They added 2.5% to make it 72.5% so yeah, it's 290 points according to the PROCEDURES MANUAL.   Also some exceptions are made for certain questions.  You see, every batch of exams, a different set of questions are pulled from a "bank" and some are "experimental".  If the experimental questions are drawn from the bank, and a lot of the examinees have varied answers rather than the expected one, the question gets reviewed and possibly thrown out of the count.   That is probably why the waiting time for your exam results is a span of 6 to 8 weeks.  A council still reviews it.  

Although in the procedures manual, they indicate that they just put on the range of 290 - 450  (I'm not sure either why it's up until 450 instead of 400) if you passed, my results came in a very detailed breakdown of the components patterned to the blueprint.  I noted that they have revised it in 2010 as indicated in the copyright page.  Maybe they have yet to change it in the manual.

Of course this amateur collation of information is useful for those who are already registered to take the examination.  Please do refer to my previous post - The Unofficial Guide to CAOT Application for IEOTs for the procedures on applying for the NOTCE.  And do check the CAOT website for updates of the resource manual and other official documents.

Footnotes:

¹Canadian Association of Occupational Therapists. (2006). National Occupational Therapy Certification Exam (NOTCE)        Resource Manual. Ottawa, ON: CAOT Publication ACE. Retrieved from the website on January 11, 2014:  http://www.caot.ca/pdfs/Exam/ExamResMan10.pdf
²Canadian Association of Occupational Therapists. (2006). National Occupational Therapy Certification Exam (NOTCE)        Resource Manual. Ottawa, ON: CAOT Publication ACE. Retrieved from the website on January 11, 2014:  http://www.caot.ca/pdfs/Exam/ExamResMan10.pdf
³Canadian Association of Occupational Therapists. (2012). Profile of Occupational Therapy Practice in Canada. Retrieved from the website on January 11, 2014: http://www.caot.ca/pdfs/2012otprofile.pdf
⁴Canadian Association of Occupational Therapists. (2012). Profile of Occupational Therapy Practice in Canada. Retrieved from the website on January 11, 2014: http://www.caot.ca/pdfs/2012otprofile.pdf
⁵Canadian Association of Occupational Therapists. (2006). National Occupational Therapy Certification Exam (NOTCE)        Resource Manual. Ottawa, ON: CAOT Publication ACE. Retrieved from the website on January 11, 2014:  http://www.caot.ca/pdfs/Exam/ExamResMan10.pdf
⁶Canadian Association of Occupational Therapists. (2006). National Occupational Therapy Certification Exam (NOTCE)        Resource Manual. Ottawa, ON: CAOT Publication ACE. Retrieved from the website on January 11, 2014:  http://www.caot.ca/pdfs/Exam/ExamResMan10.pdf

Unofficial Guide to CAOT Application for IEOTs

Since I got here in Canada, a lot of my friends have been asking about how to apply to for the National Occupational Therapy Certification Exam and so I decided to make a detailed post about it.  Just a reminder to you guys that this procedure is for World Federation of Occupational Therapists (WFOT) accredited schools; however, you are very free to read it if you would like.

BASIC WEBSITES
First and foremost, let's go over the basic websites to access the information you need in your endeavor.  I have to say, it took quite some self assertion to tie up the loose strings in this puzzle. Listed below are the websites with a simple description and the basic knowledge you can get from them:

1.  Canadian Association of Occupational Therapists

The first thing you'll see when you click the link above

The prime of them all!  Everything and anything you need to know about applying starts from here.  The steps you must take in applying is detailed there.  You can find both the application process for the WFOT accredited and the Non-WFOT in this website.  However, you can easily get lost in this website as there are a lot it covers and it is in your discretion to filter what you need to read from what you don't.  I spent hours trying to filter those stuff but don't worry, I have a smart advice about browsing the site.  So, upon entering "CAOT Central".  That blue rectangle up there in the main picture, the site will open up with this:

CAOT Central page

So, what I want you to do is ignore all other tabs aside from the one that has a red arrow pointing to it.  Once you have clicked that, the page should look something like this:

The IEOT page in the CAOT website

Okay, this time you must take your time to read and understand just what an IEOT is.  From my point of view, the explanation is as plain as day so there is really no need to divulge on its meaning.  In the next websites that you will check, the term IEOT will be a standard.  At this point however, you must note whether you come from a WFOT accredited school or not because the path you take for application is totally different as IEOTs.  So, from there you have two choices to follow.  One is to just click the eligibility requirements page I have provided here for both WFOT accredited and Non-WFOT accredited schools or you follow the other path I will provide. For the second path, you must click the National Occupational Therapy Certification Examination (NOTCE) link found on at the bottom of the first division of the site. You will be redirected to this:

The NOTCE page from the "Students" tab

From here, you must click the link that the red arrow is pointing.  This page frequently changes so this might not be the one you'll see if you're going to visit the site again in November.  However, I believe that the link to the "eligibility requirements" is always there.  After clicking the link, you will be redirected to the "International Graduates" page that is also located on the first division of the page.  From there, you'll you can easily follow the steps in applying.

2. Internationally Educated Occupational Therapist Portal

This website is specially made for IEOTs like us.  It is a great site that simplifies the things you need to go over for your overall transition of practice here in Canada.  See that encircled icons below?  Those are the things you need to go through and if you get lost during browsing (because the pages will redirect you to other websites), you just need to go back here and click on what you have yet to cover.

IEOT Portal main page

The greatest thing I love about this website is the "Success Stories" page.  I really recommend that you take time to watch their videos there.  They really give you a glimpse of what to expect in applying and in practicing occupational therapy here in Canada. And of course, they give out really handy tips.

3. Citizenship and Immigration Canada

As you may have read already from the learned from the second website I have listed, it is compulsory to emigrate to Canada. As far as I know, you need to have a permanent resident status or you have papers in process for getting into Canada to apply for the exam. In this website, you'll find it easier to navigate.  My tip is to know what type of application you want and then search the tabs located at the upper side of the main page.

See how friendly the site is?  You'll know more when you navigate through it

Let's put a little depth on what to search so that you won't get lost in the site.   If you have at least two (2) years of experience in the occupational therapy field, you can apply for the "Skilled Workers and Professionals".  The downside of this is I think you have to have an arranged employment contract.  Another important matter that may limit this choice is that the government of Canada is cutting down on getting skilled workers and professionals to migrate.  I do not really know why but that is the last I have heard.  You might want to go check the website time and again to get updates. My family and I went through the "Provincial Nominee" process.  You might want to check that out as well.

Other  Important Websites 

Aside from those three basic websites, you will need to decide on what PROVINCE to practice in.  Deciding on where to practice at this early stage is essential because there are some differences in "registering" for practice per province.  Let's say in the Western parts of Canada like The College of Occupational Therapists of British Columbia, the language requirement is English.  However, in the Eastern parts like in College of Occupational Therapists of Ontario, the better choice of language is French.  I believe that there are also provinces that do not allow temporary practice without a license and there are those many who allow it if you are already eligible for the exam.  Check out this page to know see the list of provincial regulators.


CONTACTING THE RIGHT PEOPLE

Now that you know the basic information, it is time to contact people.  At this point, there are two important people you must contact - the Exam Services Administrator in CAOT and one staff from the provincial registry (the registrar I think).  You can also e-mail them in their general mailing address that is exam@caot.ca for CAOT and again, your preferred provincial regulator.  For those interested in British Columbia, mail this address info@cotbc.org.  They will reply to you in one business day. Yes, that fast.

So, after knowing who to contact, you must learn on how to contact them.  Although you are going to contact them, you must do it with finesse.  Be sure to address them properly and as how they would like it.  For example, when Mr. Ryan Govern, the Exam Services Administrator of CAOT, replies to you and said that you can address him as Ryan, you do so.  Otherwise, you will be culturally inappropriate.  However, if he does not permit you so, you will remain calling him as Mr. Ryan.  Subsequently, you must construct the body of the letter in an organized manner.   Ideas and questions expressed clearly will get an answer with the same transparency or at least I believe so.  Of course don't forget to introduce yourself before you actually ask a question.  Lastly, sign with your whole name and your title.  If you need help in articulating yourself in writing, you better start learning now because having that skill gives you an edge.  Mr. Ryan McGovern will ask you to construct a cover letter to accompany your application form.  And you will also need to construct cover letters when you apply for jobs.  Actually, you write cover letters here for almost everything!

Also another option is to call CAOT and the provincial regulator to ask your questions but I think e-mailing is as good.  Better perhaps!  Because you can browse through it again.


DOCUMENTS NEEDED

For the documents you need, I am pretty sure it is almost everything I got from my school.  I ordered a lot of documents!  And honestly, I can't remember their descriptions but I'll try hard to list them down.  Here is the list:

1. Diploma
2. Transcript of Records
3. Certificate of Internship
4. Course Syllabus (with description)
5. Certification that the school is WFOT accredited
6. Certification of Graduation
7. Certification of Completion (?)  - hmmm...I'm not sure about this
8. Other certificates (e.g. academic scholar certificate, dean's lister certificate, etc.) although I don't think this matters much

Okay, so after contacting Mr. Ryan on applying and you have sent the application, you will need to have the documents above reviewed.  A year before, you need to pass it to BCIT but now they made it easier.  They recruited the World Education Services (WES) to assess the documents.  You can also find the WES link in CAOT.  The required assessment is the basic document by document credential report.  Other documents I have missed in the list may be listed there when you browse through the application.


THE COST

Costs will be tearjerking, I tell you.  Once your application is approved, it will cost you an immediate 500 CDN . 200 CDN for your language assessment and 120+ CDN for the credential assessment.  Add to that the money you need to get all of the documents you need in your school. One thing you need is a credit card to make payment handy but a cheque would do nicely as well.  You just need to make sure it gets to Canada safely.  If you intend to use a cheque, please do not, DO NOT send it through ordinary mail.  Send it via couriers (if they allow it).


There are a lot of information to digest, I know.  And perhaps with all of the meticulous process you need to go through, you will be discouraged.  However, I assure you that Canada is a great country to go to.  The people are willing to help you as long as you don't give up on them.   I suggest giving it a try before letting the idea go.  After all, you will only go as far as you think you'll go.

OTepp First Week

As I am currently in line for the November 2013 National Occupational Therapy Certification Examination here in Canada, I have decided to enroll in a program funded by CAOT called OTepp.   It is a program ran by the McMaster University in Ontario that assists internationally educated and returning occupational therapists integrate into the Canadian practice.  It consists of five (5) modules that started this January 2013 up until June, just before the July examination. I was a little late to register because of the status of my papers so I joined in the third module.

Interested in the program?  Click the link

We are currently studying evidence -based practice in which we are taught how to critically appraise articles to be used in practice.  In a virtual classroom!  I am so fascinated by this new experience that I can hardly contain my smile every start of the session. (Not that they could see my ridiculous smile though)  It really surprised me as well just how many Filipinos were engaged in the program.  And yes, it is perhaps one of the main reasons why I am happy with the classes.  Hearing a familiar accent calms me down and it reassures me (somehow) that we are one in the same.  We are seeking help to re-enter the world of occupational therapy.  Striving hard to re-ignite the flames of passion for the profession in a highly unfamiliar setting.

 Truly, support groups like this for internationally educated health care professionals like us is truly a blessing!      Can't imagine starting from nowhere.  Next week, I'll be posting about the process I underwent to apply for eligiblity to CAOT.