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Passing the CHT Exam: Journey of a Small Town, Rural Therapist

Written By:

Jenna Rosenquist OTR/L, CLT, CHT

Virtual Hand to Shoulder Fellowship Graduate

Personal History: I graduated from the University of North Dakota with a master’s degree in occupational therapy in May of 2010. I was introduced to hand therapy early in the program from a professor who was a certified hand therapist. She described parts of her clinical career and how she had a working relationship with a hand surgeon. This professor explained how she completed an initial assessment, assisted as needed during surgery, and then provided hand therapy treatment post-op as well. Since that time in 2007, I have wanted to become a certified hand therapist!

I did not however, complete any hand therapy internships while in school. Being from the Midwest and looking for unique opportunities, I chose to complete my internships in New York City and Las Vegas instead. Post-graduation my work experience has been in physical disability settings (hospitals, inpatient rehab, outpatient, etc.) where I focus much of my treatment with patients on upper extremity rehabilitation. I also have work experience in different hand therapy clinics. I enjoy the fast pace and variety of diagnoses that you see as a therapist. My career thus far on the other hand has taken multiple turns away from hand therapy. I have been a certified lymphedema therapist since 2012 and am certified in LSVT BIG for the treatment of Parkinson’s disease since 2019. I enjoy all aspects of being an OT and the opportunities that I have had, but my desire for becoming a CHT has been in the back of my mind for the last 12 years.

In my current work environment, I am one of 3 OTs in a rural small town critical access hospital in eastern North Dakota. I get to work with clients in acute care, swing bed, long term care, outpatient, and home care settings. Sometimes all in one day! In conjunction to working with patients, I am chair of the ergonomic committee, a member on the safety committee, and I provide new employee orientation for safe transfer techniques and use of mechanical lifts within our facility. I had begun to relinquish the fact that becoming a certified hand therapist was not in the cards. Then, when searching for continuing education courses, I discovered the Virtual Hand to Shoulder Fellowship. Upon looking further into the Virtual Hand to Shoulder Fellowship and the education provided through this program, I was hopeful that this program could become my reality. Consequently, after a few discussions with my employer, I was approved to begin this fellowship asynchronously in conjunction with working full time. I was going to go through this fellowship and (hopefully) reach my long-term goal!

Virtual Hand to Shoulder Fellowship: I began the fellowship in October of 2021 in the asynchronous cohort. I completed one lessen of the fellowship each week, knowing that it would take approximately one year to complete. I delegated 4 hours during the work week to each lesson. If needed, I would read or finish up the lessen over the weekend. With each new lecture I would take notes. If it was a concept that I knew I really needed to memorize, I would also take the time to write flash cards. I was very organized throughout the fellowship, making binders, flash cards and I created a timeline that I made sure to stick to so I could stay on top of things. As time went on, I was trying to decide if I was going to take the CHT exam in November (which I felt might be rushing it) or wait and take the exam in May of 2023. With approximately 4 months until the CHT exam, I decided to take it in November of 2022. I pushed through with full force and worked ahead in the fellowship, completing 2 or more lessens each week. I completed the course work in the fellowship 3 months early so I could use the rest of my time dedicated to the concepts that I needed to improve for the exam. I completed the HTCC self-assessment to determine what areas I was less confident in. As soon as I decided I would take the exam in November (about 4 months out) I utilized my 40-minute round trip commute to work, and re-listened to most of the lectures from the fellowship. Any time that I spent in my vehicle, I was listening to lectures. This was a great way to review content, and I found that it kept my mind engaged and I was better able to visualize anatomy and concepts the second time around. I used exams and quizzes from the fellowship for studying, as well to help me keep time in preparation for the 4 hours allotted for the final exam. Resources I used for the fellowship included;

a. Rehabilitation of the Hand and Upper Extremity 7th Edition- I utilized these textbooks as review and for concepts that I knew I needed to memorize.

b. Atlas of Human Anatomy, 7th Edition- I am a visual learner and so going through my anatomy textbook was very helpful, especially when reviewing my origins, insertions, innervations, and actions of muscles.

c. Flash Cards- Over the course of the fellowship and for preparation above and beyond the fellowship, I wrote hundreds of flash cards that I would take with me most of the time and review as I was able.

Other Resources:

This is a book that I utilized as a review in conjunction with information that I received in the fellowship. I found it to be very helpful as well. I went through this entire book in the 3 months that I had prior to the CHT exam. On top of the designated 4 hours each work week, any down time I had at work I was able to study. I would study an extra 1-3 hours a night, 4-5 nights of the week after my son would go to bed. I took most Saturdays off from studying for a mental break but did spend a large portion of each Sunday (5-6 hours) studying at a local coffee shop where it was easier to concentrate and focus with a good pair of noise canceling headphones.

Quizlet, YouTube- I utilized media content on you tube in preparation for the CHT exam as well. I found it helpful to look up videos of other people’s experience, tips, or preparation. I found the app, Quizlet, to be very helpful. It is an app where you can make online flash cards or look through other people’s flash cards that they have made with easy access from your phone any time you want. I found this to be an interesting way to see what hand therapy concepts different people had on their flash cards and what they thought was important to know for the exam. This should be done with caution however, as nothing guarantees that what other people put on their flash cards is correct.

Scheduling and taking the Exam: Once I was approved to sit for the exam, the closest testing facility to me was about 30 miles from where I lived. I scheduled it for a Monday, so I could rest and use the weekend to prepare. I had made arrangements to stay with family in the same town, so I did not have to get up extra early and drive. I had driven past the testing facility, so I knew how long it would take to get there from where I was staying. In general, I felt nervous, anxious, excited and knew that I had prepared as best as I could. When the original date of my exam came, I was there early, and I was ready! I tried walking in 10 minutes early to the testing center… it was locked. I waited another 5 minutes and no one arrived to unlock the door. In the end, no one showed up to unlock and open the testing facility. I was very upset and made the appropriate arrangements with HTCC and the testing agency to reschedule two days later. On that day, because it is November in the lovely state of North Dakota, we had a blizzard that shut the state down. My test was cancelled again! By this time, it was getting close the end of my testing window for November. I was able to reschedule it for the final day the exam was available, November 12th. The only testing center available this time was one and a half hours away from my hometown in rural North Dakota. My husband drove me to the testing facility, and I was FINALLY able to sit and take the CHT exam! Even with the mishaps and reschedules, I was well prepared. For this I have the Virtual Hand to Shoulder Fellowship to thank. The content of the program is well organized and detailed information was presented by Mirella and her guest speakers! 6 weeks went by, and I found out that I passed on my first attempt! I honestly don’t think that would have been possible without having gone through the fellowship. I am very grateful that I was able to complete it! I will happily answer questions or provide encouragement to anyone wanting to become a CHT who may feel it is impossible because they don’t currently work in a hand therapy clinic. I am proof that it can be done.

To learn more about the fellowship visit us at



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