Hello, I'm an OT who has been in the field since 2009 so my experience may be a bit dated with the exam. I was the first year of test takers when they changed the exam to include the clinical scenarios portion in addition to the multiple-choice. There has been some difficulty with passing the exam since they added that clinical scenarios portion so I would definitely recommend the Fleming book as it has a CD which includes clinical scenarios. The clinical scenarios part of the exam essentially is putting you in a clinical situation where you have to make decisions and choose from a variety of about 10 options of what you would do. Some of them are the right answers which add points to your score in that section as well as wrong responses that subtract from your score...you'd know it too because the test gives you feedback like the patient cries out in pain, etc. There are also neutral responses which don't do anything either way. The best way to prepare for that section aside from the Fleming book is to think about it in terms of your fieldwork scenarios when you're actually working with the patient, if it would make sense to do that or not. After the clinical scenarios, you go into the majority of the test which is multiple-choice. I will say that aside from the Fleming book I studied from multiple sources. I went back over Case Smith because some people do get tests that are entirely pediatric and that is the best review of pediatrics hands-down. I also studied again from Trombly because there's a lot of good chapters that are intervention based which is how you would need to think about these questions. Another source that I used to study is the book from Karen Johnson and it essentially is comprised of four full-length tests. It was a good way to get exposed to the way that the questions are worded. Again the questions are intervention based: here is a problem, what is the best way of 4 solutions to solve it? There are usually 2 stupid answers and then 2 which are very very close but only 1 is correct. Finally the last thing that I did was purchase a practice online test through NBCOT. I think it was about $75. I actually was able to take the simulated test, go through the four hours of clinical reasoning and then afterword get a score letting you know if you passed or failed. I passed it as well as the real exam on the first attempt. Most of my classmates who took that test and received a passing score like I did also passed. It was a good indicator that you were ready for the real test. I did not do any of the expensive review classes because I really didn't have a lot of money. So I bought the Fleming and Johnson books, the online practice test in addition to reviewing my text books that I already had. I set aside about 6-8 weeks to study but it could be done in 4-6 weeks too. It sounds like a long time to be studying for something but you have to see it as an investment and be patient with the process. The exam at the time I took it was right around $500 including the service of sending the scores to the state; you don't want to have to pay for that again. Hope that helps! Let me know if you have any questions.
