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An OT student asked if going into school-based OT advisable straight out of school, saying “a  couple people have warned against this because it requires a certain level of autonomy as a new practitioner…” Here is my answer:

I’m in my 6th month of working school-based, straight out of school. To survive, you certainly need to have some supports. I had school-based fieldwork, I chat often with a close family member who works in special education, and I’m working part-time. I still yearn for more supports. There are a lot of moving parts… a wide array of pediatric conditions, parents, assessments, reports, the variable school environment, multiple campuses, IEP meetings, never enough time in a day or resources. Be prepared to not be prepared. That said, it can be done if you have the supports. If I didn’t have my supports, it would not have worked.

At the end of my SNF fieldwork, I felt like I almost had it down. At the end of my school-based fieldwork. I didn’t feel nearly as competent, partially because of the particular experience I had (ask me about it privately) and partially because the job is more faceted.

What is a reasonable workload for a school-based occupational therapist? What percentage of time should a school-based occupational therapist be seeing clients vs performing other duties?

There are few guidelines or rules to answer these questions. That makes it especially difficult for a new occupational therapist who is working in a district on his own (like me). Here are some thoughts and datapoints for you on the subject:

From the AOTA Workforce Survey (I think the data is from 2014),  “How OT Practitioners Spend Their Time in Different Settings”

The North Carolina Department of Public Instruction created a guideline document in 2016. I found it here. You can find a local archive of it here:  Workload-document-and-formulas.2016. This creates a formula to determine workloads for occupational therapists and speech-language pathologists.

Another useful source is the OTSalary.com site. It is billed as “The only open source OT salary survey designed by and for OT practitioners. Knowledge is power.”

As part of my master’s in occupational therapy at San Jose State University, I authored a research project with my research professor. The project was to have my fellow OT students take some questionnaires about how stressed they were and how satisfied they were with their lives. I then crunched the numbers and got some interesting results!

Here is the research project I completed for my occupational therapy master’s degree:

Research Project: The Relationship Between Stress and Life Satisfaction Among Occupational Therapy Graduate Students

I’m honored to have been selected to present my research as a poster presentation at the 2016 OTAC (Occupational Therapy Association of California) conference in Pasadena, California.

Poster Presentation: The Relationship Between Stress and Life Satisfaction Among Occupational Therapy Graduate Students

Highlights:

The OT students surveyed had average stress levels (surprising for grad school!) and high life satisfaction (also surprising for grad school!). And they felt like they got the support they needed from friends and family. Read on for more deets.

72 SJSU occupational therapy students completed two self-report questionnaires: The Stress Profile  and the Satisfaction with Life Scale. The Stress Profile measures 15 areas related to stress and health risk. The Satisfaction with Life Scale measures a person’s global cognitive judgment of satisfaction with their life. The results were analyzed, looking for correlations and other relationships.

Results:
On average, participants in the study:
– had typical stress levels
– had a high life satisfaction score
– had a high level of social support (a belief that they have people in their lives on a regular basis who love and support them)
– that were living with their parents had significantly lower stress scores
– that were living with their parents reported less use of alcohol, recreational drugs and cigarettes
– that were male had significantly lower stress scores than women

The people surveyed that were most satisfied with their lives had 3 things in common, they had a good outlook on life, felt like they ate well, and didn’t think poorly of themselves. Now read that same info in master’s project-ese:

The strongest correlations between life satisfaction and individual stress factor scales were:
– High Cognitive Hardiness
– High Health Habits (especially, eating/nutrition, and exercise)
– Low Negative Appraisal

Brief definitions of those terms:

Cognitive Hardiness: a coping style… a buffer between work and stress. It has 3 attributes:
1) View of commitment rather than alienation in work and life
2) Personal control over one’s life
3) View of life change as a challenge rather than a threat

Eating/Nutrition: Whether a person practices eating what they believe to be well balanced and nourishing meals.

Negative Appraisal: Approaching life’s challenges with a negative attitude, using self-blame and criticism.

Limitations: There are lots of reasons why this research may have been be deeply flawed. The most obvious problem is that only about 1/2 the students took the questionnaire; the students who were most stressed or had the lowest life satisfaction may have chosen not to spend an hour taking our questionnaire because they were too stressed or unhappy. Or maybe not, I don’t know! Also, questionnaires are always problematic because you never really know if they are measuring what you think they are measuring for a variety of reasons, but they are way easier to administer than other testing tools. And one of the most important things I learned when performing all this research is that all research is flawed. Please take this, and all research with a giant grain of salt. Even when researchers are trying to get it right in the face of funding bias, unintentional bias, publication bias, and every kind of possible misstep, it can still be really hard to do good research!

Scheduling for school-based occupational therapy. I bought the Caselite software ($20/month) and it’s helping to reduce my stress over scheduling. It’s still a dynamic environment with multiple changing variables, but it feels more possible to manage it now. I’m not sure if I’ll buy a 1 year license ($179) but I’m glad I have it right now. I knew I needed to look for outside help when every one of the the 2 SLPs, 2 Resource teachers, and 2 SDC teachers all got crazy eyes and told me their woes when it came to scheduling.

Today, I was offered a position as an occupational therapist in a nearby public school district!

I took the NBCOT earlier this month and got back my score a few days ago. I passed!  Some folks have asked how I studied for the NBCOT exam so here you go:

I studied for about 5 weeks, 3-5 hours per day, 5 days a week. I received a score of 485 which appears to be a hair above average for first time new graduate test-takers (see image).

Tufts OT NBCOT scores 2011-2013

The most useful test prep was  AOTA NBCOT Prep. In the end, I answered 839 questions and did 23 clinical scenarios. I initially had a poor percentage correct but I reviewed them repeatedly until I understood the reasoning behind most of the questions. I focused on the questions in “DOMAIN 3: Select interventions…” because 45% of the exam is comprised of those questions. It costs $150 for a one-year subscription and it is well worth it.

The AOTA clinical simulations were very useful. One note: the AOTA responses were more helpful than the actual test responses. In the actual test, they’d usually respond with something noncommittal like, “Ok, you did the thing” instead of something like, “When you did that, you discovered a big issue.” I was initially thrown off a little by that!

When I got something wrong on the AOTA questions and didn’t know why, I tracked down the references at the end of each AOTA question. I found the book and studied the section. Having PDF copies of some of the books was very helpful to find the reference quickly.

I used a free search tool on my computer called Docfetcher  that let me search my school notes, the AOTA PDFs, and the PDF textbooks quickly.

I studied the AOTA PDFs and they were fairly helpful but not detailed enough as a study guide on their own.

Googling question content was useful.

OT Miri on Facebook and Youtube was helpful (2020 update: she now has her own website, I’m sure it’s very helpful: OTMiri.com). Watching her videos was a welcome relief from reading the whole time. Scroll down to the beginning of her Facebook feed (late 2016) and start reading. Thanks OT Miri!

I also found the Occupational Therapy Examination Review Guide 4th Edition  to be useful. I did a few hundred questions, reading their reasonings very carefully.  I found the questions in this book a bit easier than the AOTA questions; getting 70% correct at the outset instead of 40% like on the AOTA questions was a real morale booster!

I read through the NBCOT Exam Handbook  and tried out the sample test on the NBCOT website. By reading up on the instructions, I knew that I could take a 7 minute break during the tutorial that came after the clinical simulations and before the multiple choice. I read how the test is criterion-based but not really criterion-based, that let me explain to people how the score I need to get (450) isn’t really something I can actively aim for while studying. I heard from many folks that I’d need about 70% on the AOTA Prep and that turned out to be about right.

I used the highlighting and “marking” system on the actual test even though I couldn’t practice with it before the test. I couldn’t find a good demonstration of it anywhere. It lets you mark answers (ie. “I know it’s not A or C but I’ll come back to this question”) and come back to questions.

Here are some useful websites I kept on bookmark:

• Rehabilitation Measures Database  – Descriptions of pretty much ALL of the assessments
• Medscape – The website for doctors. If it’s a pathology, it’s very well described here!
• NIH List of Disorders – A lot of disorders described

I got Therapy Ed. 8th edition but I don’t recommend it. I found the study guide and the questions to be waaaaay too detail oriented. I feel that they totally missed the forest for the trees. Some friends agree with me on this, some disagree!

I sat down once and made myself a simulated exam using the AOTA NBCOT Prep… 3 clinicals and 170 questions in 4 hours. It was kinda brutal but was helpful to get my pacing. I should have done it 1 or 2 more times. On the actual exam, I ran out of time, wishing I had another 30 minutes.

The first thing I did when the clock started was make a schedule on the dry-erase paper they give you in the test center, something like this:

4:00-3:30 clinicals
5 min break while reading tutorial
3:30-3:00 1-30
3:00-2:30 31-60
5 min break
2:25-1:55 61-90
...

That’s about it. Good luck and…. you’ve got this!

I passed the occupational therapy board exam!!! I am now a registered occupational therapist!
My business card now reads Lee Sonko, MS, OTR

I expect to be licensed within a month so I can start working as an OT in California!

See my NBCOT certification below:

I hear that avocado toast is why I can’t afford a mortgage. To that I say “Yum!”

Studying for my occupational therapy board exam at Philz Coffee, drinking high-test and eating like a millennial!

August 2014-May 2016: four semesters of a very intense master’s program with a 5 hr/day, 4 days/week commute (see commuting footnote).

June 2016-May 2017: Two completed  internships, got only half way through another one due to a medical problem.

Married June 2014, two months before school started, just two years after we met.

New baby born a week before second semester started.

Two ongoing family conflicts that I won’t discuss  here. Both began around 2014. Well, the roots of each conflict probably go back way further but that’s how conflicts go.

Megan told me, almost demanded that I take some time off! So I’ve spend the last couple weeks NOT studying for the boards exam in occupational therapy. Thanks honey!

At the end of May,  my master’s degree posted. It’s now “Lee Sonko, M.S.”.

Looking forward, I just started studying for my board certification, hoping to be done in early August.

Footnote about my school commute:

Yes it was a 5 hour/day commute, Kensington to San Jose State.  Driving would have cut an hour a day but was far more stressful. When I drove, it usually took an hour for me to recover. And I couldn’t study while driving. Here was my commute: 15 minute drive down the hill, 55 minute BART from El Cerrito Plaza to Fremont Station, 45 minute bus ride to downtown San Jose, 15 minute walk to school. 2 1/2 hrs door to door. On a good day, I could study for about 45 minutes on the train and 25 on the bus. I got car sick on the bus every time I tried to study, and I needed/chose to study most of the time. It completely sucked.

Lee Sonko, Master of Science!

I received a message from San Jose State University today:

I now have two extra letters after my name!

Lee Sonko, MS

More letters to follow after I pass the board exam!