Occupational therapy educational standards, established by the Accreditation Council for Occupational Therapy Education (ACOTE), require students to demonstrate knowledge and use of the safe and effective application of physical agents. A recent change requires educators to reflect on pedagogical approaches for electrotherapeutic and deep thermal agents. With a lack of research on pedagogical approaches to teaching physical agents, research on this important topic is essential. The purpose of this study was to identify education and training methods that facilitate the development of competence with complex physical agents. This study used a mixed-methods survey design with follow-up interviews. The survey sample included 98 occupational therapists/Certified Hand Therapists with six follow-up semistructured interviews. Descriptive statistics and one-way ANOVAs were used to analyze quantitative data. Inductive coding and deductive coding guided by Miller's Pyramid and Bloom's Taxonomy were used to analyze qualitative data. One-way ANOVAs indicated continuing education and fieldwork resulted in higher levels of independence when compared with manufacturer's sales representative training (p<0.05). Continuing education, fieldwork, entry-level education, post-professional education, and on-the-job training were associated with higher competence levels than no training at all (p<0.05). Qualitative findings indicated learner demonstration and practice with instructor guidance and feedback on performance are essential for learning physical agents. Several different types of education and training are effective for developing competence in physical agents. When planning learning activities, educators should consider learner demonstration, supervised and repetitive hands-on practice, and feedback to facilitate students' abilities to safely and effectively use complex physical agents.