ABIM Exam Format: Everything You Need to Know

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You’ve finished your grueling Internal Medicine residency and are a newly minted internist, with only one last hurdle to overcome: The American Board of Internal Medicine Certification Exam (ABIM). Understanding the ABIM exam format can be vital in crossing the finish line to becoming a certified internal medicine practitioner. 

The exam is a milestone and can seem intimidating – after all, passing it proves you have the appropriate knowledge and clinical acumen to take care of your patients on your own, without the supervision of your senior resident, fellow, or attending. The more familiar you are with the exam before you take it, the better off you’ll be. You’ll know exactly what to expect on exam day, which should ease the nerves you’ll inevitably be feeling. You’ll also be able to better organize your studying and plan your time efficiently. This article will explain key components of the exam, how to study leading up to test day, and the exam day itself. 

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What Is the ABIM Blueprint?

The ABIM blueprint is a guide to the certification exam content. It specifies the medical content categories, as well as what percentage of the exam each category represents. Though it is relatively constant from year to year, the ABIM does review and revise it annually to reflect feedback from providers and training programs. You can easily find the ABIM exam blueprint and review it for yourself, and I’d recommend you do that sooner rather than later.

As you’ll see in the blueprint, cardiovascular disease is heavily represented on the exam, with topics including hypertension, structural heart disease, electrical conduction abnormalities, vascular disease, lipid disorders, and preoperative evaluation, to name a few. Other highly weighted topics are endocrinology, diabetes and metabolism, gastroenterology, infectious disease, pulmonary disease, rheumatology, and orthopedics. Within each of these categories, the major disorders associated with each topic or subspecialty are evenly represented.

Topics that carry medium weight include hematology, nephrology and urology, medical oncology, psychiatry, and neurology. Other subspecialties, including allergy and immunology, dermatology, obstetrics and gynecology, ophthalmology, otolaryngology and dental medicine, and geriatrics, are only lightly represented. Finally, there are several questions on critical care, prevention, clinical epidemiology, ethics, nutrition, palliative care, adolescent medicine, occupational health, patient safety, and substance abuse. All of the exam content seeks to ensure you have the clinical judgment skills expected at this point in your medical career.

ABIM Internal Medicine Exam Format

The ABIM Internal Medicine Certification Exam is a multiple-choice exam. Though ABIM exam takers must answer all questions, approximately 15% are experimental and do not count toward your final score. Each question has only one correct answer. 

Most of the questions on the ABIM certification exam are posed as patient scenarios and many include clinical information such as photos, radiology studies, electrocardiograms, or audiovisual physical exam findings that you must interpret. The answers involve making the correct diagnosis, ordering appropriate tests, and/or formulating a patient care plan – all things you are already accustomed to doing from your medical school and residency training. Some questions have an epidemiological focus and require you to apply basic biostatistics concepts. Even if you have not had much formal training in applied biostatistics, these questions are relatively straightforward and involve things like risk assessment and forecasting prognosis. Other questions test your basic science and pathophysiology knowledge and are more like the types of things you were tested on in medical school. 

The ABIM provides a 30-minute tutorial where you can work through sample questions. This can be useful because it gives you the opportunity to see what the real-life exam looks like. You can also practice the platform tools and view the resources you’ll have available to you during the exam, such as the table of normal lab values. Some more comprehensive board review courses also offer practice questions to ensure you are prepared for exam day.

How Long Is the ABIM Exam?

The exam will take you approximately 10 hours to complete at the testing center. You can take the 30-minute tutorial on the day of the exam, but it is optional so if you’ve already done this you can skip it and save yourself some time on exam day. 

At the beginning of the day, you will be given up to 10 minutes to read the exam instructions and complete your Pledge of Honesty. You will then have up to two hours for each of the four question blocks of the exam, along with 100 minutes of break time divided between three break opportunities. You will also be given 10 minutes to complete an optional survey once you finish the fourth exam section. 

ABIM Test Center

The ABIM Certification Exam is administered by Pearson VUE.  This is a large network of test centers located around the country, and the world, specifically geared toward certification and licensing exams. When you register for the exam, you’ll be able to schedule an appointment at a testing center in your area through the ABIM portal. Generally, there are multiple dates and times available so you can schedule your exam at a time convenient for you. 

You’ll be instructed to arrive 30 minutes early. Depending on where you are located, you should leave extra time to find parking or to allow for variability in public transportation. When I took the ABIM board exam, I did a dry run to the test center the week before my exam so I could scope out where exactly it was, how long it would take me to get there, and whether I should drive there or get there by other means (the location in downtown Boston ultimately meant an UBER ride for me). When you get there, you will need to show two forms of identification and one of them must be a government-issued ID, like a driver’s license or passport.   

Your testing center will have a waiting room, other administrative rooms, and a testing room with individual computer workstations. The waiting room will be equipped with secure storage lockers where you can stow your personal belongings. I recommend bringing plenty of quick-energy, non-messy snacks such as bars, apples, or bananas, as well as a water bottle or other drink, to keep in your locker. You won’t want to spend your precious break time scrounging for food and drinks. Keep in mind you won’t be able to bring anything into the testing room with you – not even your watch – so keep your personal belongings to a minimum. 

I have always found the Pearson VUE testing centers to be clean, well-organized, and an excellent place to take an exam. They even provide earplugs, so if small noises distract you, they’ve got you covered!

How Do I Study for the ABIM Certification Exam?

Everyone has their own best learning style, so the specifics of your study strategy will be up to you. After all, to get to the point of preparing for the ABIM board exam, you’re probably already a successful student who has passed many exams with flying colors. However, this exam may be one of the most important exams you’ve ever taken, so it’s important to understand the ABIM exam format. Once you complete your residency, most employers will expect you to make the transition from Board Eligible to Board Certified in a timely manner. In some cases, compensation and retention are based on your ability to pass your certification exam. Plus, passing the exam is a badge of honor, something you will share with every Board-Certified internist around the country for the rest of your life. So, you want to make sure you prepare well. Here are some tips:

Leave enough time and make a study schedule

As soon as I had my exam date scheduled, I looked at the ABIM blueprint to determine which topics I needed to review most, and how much time I needed to spend on each study area. I also factored in how much weight each topic carried in the overall composition of the test. Once I identified my priority areas and time allotments, I worked backward from my exam date to set up a schedule. I literally printed out a Word Calendar and wrote out a study plan for each day. By doing this, I left enough time to study everything I needed to, and I didn’t have to think too much each day about what I should be doing – I just did what was on my schedule. It was incredibly satisfying to cross off each day on my calendar as I worked my way through my study plan. 

If you don’t have the time or inclination to create your own study plan, there are many time-management tools like this one that will personalize a plan for you based on the exam blueprint and the number of hours you have each week to study.

Do a lot of practice questions

When I was studying for my ABIM boards, a big part of my daily work was practice questions. I tried to do as many as I could – at least 10 to 20 per day. I would review the answers and use the questions I got wrong or guessed on as a springboard to read up on things I didn’t know enough about or wasn’t certain of. I found this active way of studying to be much higher yield and more engaging than just reading about each topic. I was also very used to the question styles when I took my actual exam, which was helpful.

Make flashcards for key concepts

For especially important, high-yield facts, concepts, and formulas, flashcards can be a great study tool.  When I was studying for my board exam, I made good, old-fashioned paper index card flashcards, and carried them with me so I could quiz myself whenever I had a few spare minutes (waiting in line, waiting for the bus, etc.). These days, there are flashcard apps for your phone or tablet that accomplish the same thing. With flashcards, you don’t have to be sitting at your desk or in the library to study – you can do it anywhere.

Consider forming a study group

This is not something I did when I was studying for my Boards, but I wish I had. I have friends who met weekly to study with 2 or 3 others when they were preparing, and I think it’s a great idea. Not only does a study group hold you accountable, but it gives you an outlet to commiserate when you’re feeling overwhelmed or intimidated by all the material. 

Trust your training

This board exam is meant to test your skills as an internist, and a passing score verifies your hard-earned qualifications. Remember, you have been living and breathing Internal Medicine for the past 3 years – you’ve got this!

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ABIM: Frequently Asked Questions

How long does ABIM certification last?

Your initial ABIM Certification lasts 10 years. You will have to periodically do other learning activities, called Maintenance of Certification (MOC). At the end of the 10-year certification period, you will need to pass an MOC assessment, which is either another 10-year exam, or a newer option called the Longitudinal Knowledge Assessment. 

Is the ABIM board exam open book?

The ABIM Board Exam is not an open-book exam. However, normal reference ranges for labs are provided, so you do not have to memorize these. 

How many blocks is the ABIM test?

The entire exam has four 60-question blocks.

How many questions are on the ABIM Exam?

The exam consists of 240 multiple-choice questions and each has one correct answer. The questions are divided into four 60-question blocks. Access a comprehensive question bank here to prepare for the exam.

What is the ABIM Exam minimum passing score?

The ABIM Board Exam is graded on a scale. The range is 200 to 800 points, and the minimum passing score is 366. When you receive your score report, your overall performance as well as content area subscores and feedback will be provided.