Original article

Association between the entrance examination score /academic performance and results of Occupational
Therapist National Examination −Based on a survey
by the Department of Occupational Therapy, Faculty of
Rehabilitation, Kobe Gakuin University−
Tamotsu Takenaka1*, Hiroshi Murao1, Jumpei Oba1, Toshimichi Nakamae1, Hiroyuki Kajita1
1

Kobe Gakuin University Graduate School of Rehabilitation

Abstract
Recently, the role of occupational therapists has increased withdiversification of medical / nursing care fields. However, the pass rate for
Occupational Therapist National Examination ranges from 70 to ＜90%. A
previous study showed that academic performance after entrance into aphysical therapist training school was associated with the national
examination score/success or failure. On the other hand, few studies havereported the association between the entrance examination score/academic
performance at occupational therapist training schools and results of thenational examination.
The purpose of this study was to clarify the association between theentrance examination score/academic performance and results of Occupational
Therapist National Examination in students belonging to the Department ofOccupational Therapy and identify the performance characteristics ofstudents who fail the national examination.
Of 172 students who entered the Department of Occupational Therapy,
Faculty of Rehabilitation, Kobe Gakuin University, between 2015 and 2018,
the participants were 106 who graduated without repeating the same year.
They were divided into two groups: success and failure groups (n＝96 and10, respectively ) based on the results of the national examination. The
participants had received the same entrance examination system andcurriculum.
There were no significant differences in the man-to-woman ratio, entrance
examination category, or entrance examination score between the twogroups. In 10 of the 70 specialized required participants taken after entrance,
the grade points in the failure group were significantly lower than in the
success group. With respect to semesters, the grade points in the 2nd, 3rd, 5th,
and 6th semesters in the failure group were significantly lower than in the
success group.
Academic performance early after entrance was associated with the resultsof Occupational Therapist National Examination, suggesting the importanceof learning specialized required subjects early after entrance.

Submitted Jun. 27. 2023
Accepted Aug. 24. 2023
*Correspondence
Tamotsu Takenaka
Kobe Gakuin University
Graduate School of Rehabilitation
E-mail:rx_58@yahoo.co.jp
Keywords
Occupational Therapist National
Examination
Grade Point Average (GPA)
ROC analysis

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Introduction
The Japanese population has decreased, and the rapid
aging of society has become marked with a decrease in
the number of births. The Government of Japan predictedthat the number of births would decrease from 840,000/
year in 2020 to 480,000/year in 2060, and that persons
aged ≥75 years would account for 1/3 of the population in
20351).
With a change in the disease structure related to anincrease in the number of elderly persons with a highmorbidity rate of chronic disease, the needs for medical
practice have changed to the necessity of maintaining /improving the quality of life while coexisting with adisease in addition to the cure of disease2) . Furthermore,
the needs for nursing prevention and welfare fields haveincreased with the change in the needs for medical
practice.
The World Health Organization ( WHO ) divided
medicine into 4 phases, and defined that therapeutic
medicine corresponded to the 3rd phase, and thatrehabilitation medicine corresponded to the 4th phase. In
rehabilitation medicine, residual disorders are accurately
evaluated, and integrated services are provided based on
the Long-Term Care Insurance Act and Act for the
Welfare of Persons with Physical Disabilities in addition
to the Medical Care Act, aiming at rearrangement of
individuals’ own lives3).
For rehabilitation medicine, multidisciplinary relationbased team practice by physicians, occupational / physicaltherapists, and nurses is necessary4) . The role ofoccupational therapists in rehabilitation medicine is toameliorate / relieve subjects’ psychophysical dysfunction
and support / improve self-care / work / learning / leisureactivities necessary for living independently5) . Due to somany roles, occupational therapists must acquire specialized
knowledge on support for nursing prevention, working,welfare equipment, living at home, and dementia6).
Recently, role expectations for occupational therapists
have been increasing with the rapid aging of society,expansion of target diseases, and diversification of support
activities for hospitals, nursing facilities, and health /educational institutions as an occupational field andcommunity-based integrated care systems6). The pass rate
for Occupational Therapist National Examination ranges
from 70 to ＜ 90%7) . The nation ( Ministry of Health,Labour and Welfare) may require undergraduate education

students to acquire knowledge and skills meeting medical
needs developing day by day. Iimura et al. reported thatenrolled students had become highly diversified with adecrease in the number of children and an increase in thehigher education institution entrance rate. In addition,
they indicated a decline in enrolled students’ academic
performance and the possibility that the number ofstudents who cannot complete the training course may
increase8).
Previous studies reported that academic performanceafter entrance into a physical therapist training school was
associated with the national examination score/success or
failure9)10) . According to a survey conducted by the
Ministry of Health, Labour and Welfare, the amount ofphysical therapists’ knowledge/level of their skills to berequired in clinical practice have been increasing, and a 4year period is necessary for physical therapist training,
not a 3-year period11).
On the other hand, few studies have reported theassociation between the entrance examination score /academic performance at occupational therapist training
schools and results of the national examination.
The purpose of this study was to clarify the association
between the entrance examination score / academic
performance and results of Occupational Therapist
National Examination in students belonging to the
Department of Occupational Therapy in our university andidentify the performance characteristics of students who
fail the national examination as early as possible after
entrance.

Methods
Among a total of 172 students admitted to the
Department of Occupational Therapy, Faculty of Rehabilitation,
Kobe Gakuin University (our university), in 2015, 2016,2017, and 2018, the subjects were 106 who graduated
without repeating the same year. They were divided into
two groups: success and failure groups (n＝96 and 10,
respectively ) based on the results of the national
examination. The same entrance examination system andeducation curriculum were used between 2015 and 2018.
As information on the entrance examination in the 106
participants, we collected the following data through the
Entrance Examination Center according to the given
procedure : the type of entrance examination ( entrance
examination based on public recommendation, special

JAHS 14(2): 53-60, 2023 54

entrance examination for Kobe Gakuin University SeniorHigh School, entrance examination based on a recommendation
for designated schools, general entrance examination, andentrance examination by the National Center for
University Entrance Examinations ) ; rating score ( fullscore: 5) at senior high school; score for English as thefirst written test, elective subject selected (from Japanese,
Mathematics, and Science) as the second written test, andscore for this subject in the entrance examination ; andgender. The score of each written test was converted to a
deviation value. It should be noted that among thesetypes of entrance examination, the special entrance
examination for Kobe Gakuin University Senior HighSchool and entrance examination based on recommendation
for designated schools include an interview, but nowritten test. Furthermore, as information about the 106
students after entrance into the university, we collected
the names of the subjects they took and their grades forthese subjects through the Educational Affairs Center,following the given procedure.
As information regarding the students’ subsequentacademic performance, their grades, S, A, B, C, D, and“/”, for each subject taken were scored 4, 3, 2, 1, 0, and 0,
respectively, as grade points. Among the subjects takenby the students, we investigated the grade points for
specialized required subjects. Next, we calculated thegrade point average estimated with required subjects( GPA-RS ) from grade points for specialized required
subjects using the following formula : GPA-RS ＝ ( Σgrade points for specialized required subjects × numberof credits ) / ( Σ number of credits from specialized

required subjects)12). We compared the GPA-RS in each ofsemesters 1-8 between the two ( success and failure )groups. In semesters with significant differences in the
GPA-RS between the two groups, we calculated the area
under the curve ( AUC ) , cut-off value, sensitivity, andspecificity from the receiver operating characteristic(ROC) curve.
For statistical analysis, we examined continuous
variables using the Shapiro-Wilk test to confirm datanormality. When the data were normal, isovariance wastested using Levene’s test. When variance was equal, theunpaired t-test was used. When it was not equal, Welch’s
t-test was performed. When the Shapiro-Wilk test did notconfirm data normality, we used the Mann-Whitney U
test. As a nominal variable, χ2 was used. A p-value of
0.05 was regarded as significant. We used the statisticalsoftware IBM SPSS Statistics Ver. 28.
As for the explanation for participants and theirconsent, we first obtained approval for the following
points from the Ethics Committee for Research Involving
Humans at the Faculty of Rehabilitation, Kobe Gakuin
University ( approval number : SORIN 20-16 ) , and thenshared this information on the website of the university:
1) the purpose and method of information use, 2) detailsof the information used, 3) scope of persons who use theinformation, 4) the name, institution, and contact addressof the principal investigator, 5) term of information use, 6)
disuse of information that allows the identification ofsubjects, and 7) the method to manage requests / claims
from the subjects specified in 6) or their representatives.

Table 1. Comparison by type of entrance examination, by rating score, by written test score, and by elective subject

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Table 2. Comparison of Grade Points for Specialized Required Subjects

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Results

Discussion

There were no significant differences in the gender ortype of entrance examination between the two groups(Table 1).
There were no significant differences in the ratingscore at senior high school, score for English as the firstwritten test, elective subject selected ( from Japanese,
Mathematics, and Science) as the second written test, orscore for this subject in the entrance examination
between the two groups (Table 1).
Concerning grade points for specialized required
subjects taken after entrance, those for 10 of 70
specialized required subjects in the failure group weresignificantly lower than in the success group (Table 2).
With respect to the GPA-RS in each semester, thevalues in semesters 2, 3, 5, and 6 in the failure groupwere significantly lower than in the success group (Table
3).
In semesters with significant differences in the GPA-RS
between the two groups, we calculated the AUC and cutoff value from ROC analysis using the success group as astate variable. These values in semester 2 were 0.78 and2.25 points, respectively. Those in semester 3 were 0.72
and 2.34 points, respectively. Those in semester 5 were0.76 and 2.50 points, respectively. Those in semester 6
were 0.72 and 2.63 points, respectively (Table 4).

Of the 172 students admitted to the Department ofOccupational Therapy, Faculty of Rehabilitation, Kobe
Gakuin University, in 2015, 2016, 2017, and 2018, 106
graduated without repeating the same year, accounting for61.6%.
According to a survey conducted by the Ministry of
Health, Labour and Welfare, the 4-year university
graduation rate for students belonging to the Departmentof Occupational Therapy is 72.4%11) . The graduation ratefrom the Department of Occupational Therapy in our
university was slightly lower than the above value. In our
university, there are a large number of students whoentered the Department of Occupational Therapy throughrecommendation-based entrance examinations, including
special entrance examination. Yanagisawa et al. suggested
that factors other than academic ability, such as a will tocontinue learning and a motivation to obtain a national
qualification, in students who entered a university basedon recommendations are reduced in comparison withstudents who entered a university through generalentrance examination10). In addition, Senba et al. reported
that students belonging to medical departments were
exposed to higher-intensity stress in comparison withthose belonging to other departments due to the large
number of credits to be acquired after entrance, long class

Table 3. Comparison of GPA for required subjects by semester

Table 4. ROC analysis result

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hours, and high ethical standards required from the timeof entrance in consideration with their necessity in clinicalpractice13) . In daily learning in the Department ofOccupational Therapy, involving the acquisition of muchspecialized knowledge and high ethical standards, university
students may feel a gap between issues to be reached andtheir own motivations on entrance and select dropout.
There was no influence of the gender difference, typeof entrance examination, rating score at senior highschool, or entrance examination on the results of thenational examination for occupational therapists. A study
found a gender difference in academic performance,
whereas Novalis et al. reported that various confounders
influenced the interpretation of the relationship between
the gender difference and academic performance, suggesting
the necessity of further investigation14)15) . Therefore,
concerning the relationship between the gender difference
and results of the national examination in this study, we
consider that there is no marked influence based on thesurvey results. Neither the rating score before entrance
nor entrance examination score influenced the results of
the national examination. Previously, Yanagisawa andNovail et al. also reported that the rating score before
entrance was not associated with the results of thenational examination for occupational therapists. Similarly,
this study showed that academic performance before
entrance into the university did not influence the resultsof the national examination for occupational therapists. We
consider that the entrance examination system of the
Department of Occupational Therapy in our university has
facilitated the selection of students with equivalentacademic abilities.
With respect to the association between academic
performance after entrance and the results of the national
examination for occupational therapists, the GPA-RS insemester 2, early after entrance, in the failure group was
significantly lower than in the success group. A previous
study conducted by the Department of Physical Therapy
in our university also showed a positive correlation
between the GPA-RS in semester 3 or later and score on
the national examination for physical therapists12) .
Furthermore, Takekata and Nakajima et al. reported thatfirst-year grades influenced the subsequent on-campus
academic performance and results of the national
examination16)17) . This study also indicated that academic
performance early after entrance influenced the results of

the national examination for occupational therapists.
Furthermore, Kitamura et al. reported the necessity ofcontinuously learning basic specialized knowledge early
after entrance18) . This study also showed that academic
performance early after entrance was associated with theresults of the national examination for occupational
therapists, suggesting the importance of learning specialized
required subjects early after entrance.
When investigating the grade points for specialized
required subjects and GPA-RS in each semester, thenumber of specialized required subjects with significant
differences in grade points between the success andfailure groups was small, but there was a significant
difference in the GPA-RS. This was possibly because the
GPA-RS was calculated from specialized required subjects
for which grade points in the failure group were lower
than in the success group, although there were no
significant differences in grade points for respective
specialized required subjects between the two groups.
Amy L. Kurowski-Burt et al. also reported the association
between the GPA during enrollment in the Department ofOccupational Therapy and results of the national
examination for occupational therapists19).
ROC analysis was conducted with respect to semesters
with significant differences in the GPA-RS between thetwo groups. The AUCs in semesters 2, 3, 5, and 6 were≥0.7, and cut-off values ranged from 2.25 to 2.63 points.
Amy L. Kurowski-Burt et al. reported first- and secondyear GPAs of ≤ 2.5 and ≤ 3.8 points, respectively, as
references19) . According to Anthony K. Akobeng, theaccuracy was high at an area under the ROC curve of ≥0.9, moderate at a value of 0.7 to 0.9, and low at a valueof 0.5 to 0.7.20) . In the Department of Occupational
Therapy in our university, it was shown that students
who pass or fail Occupational Therapist National
Examination could be identified with moderate accuracy
relatively early after entrance, that is, from semester 2,
using the GPA-RS in each semester. Therefore, in the
Department of Occupational Therapy in our university,
students at risk of failure in Occupational Therapist
National Examination should be extracted based on the
cut-off value of GPA-RS obtained in this study in the earlyphase of the second year, when semester 3 starts, after
the completion of semester 2, and individual guidance orlearning counseling by department teachers should be
performed. These strategies may improve students’

JAHS 14(2): 53-60, 2023 58

academic performance, contributing to the successful
results of the national examination. Kitamura et al. alsosuggested the efficacy of reviewing lessons for students
whose GPA-RS does not reach the cut-off value18).
In this study, data from students with repeating thesame year were not included, and only students belonging
to the Department of Occupational Therapy, Faculty of
Rehabilitation, Kobe Gakuin University, were investigated.
As the limitations of this study, data analysis involving theacademic performance of students with repeating thesame year is necessary, and the cut-off value obtained inthis study cannot be generalized to other training schools.

Conflict of Interest
The authors declare no conflict of interest.

Acknowledgments
I would like to thank the many people who provided
guidance in the preparation of this paper. I would like toexpress my sincere gratitude to them.

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