Mastering The American Board of Internal Medicine Exams

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Now that you’ve completed your Internal Medicine residency, it’s time to become certified by the American Board of Internal Medicine (ABIM). Though this process may seem intimidating, in this article, I’ll tell you exactly what is required. I’ll discuss the exam you’ll have to take and the continuing educational work you’ll need to do to maintain your certification. I’ll also answer the most frequently asked questions and give you some tips and tricks to help you along the way.

ABIM Certification Requirements

You don’t need certification to practice general internal medicine if you have a valid medical license, but many employers require it. Becoming certified by the American Board of Internal Medicine shows that you hold yourself to rigorous standards and are committed to continued learning and improvement in your chosen specialty. The good news is if you’re reading this because you’ve either just completed your residency or are about to, you’ve already taken the first step towards certification. Next, you should obtain a medical license in each state you intend to work in. This must be a full license, not the limited license you practiced under when you were a resident. Be forewarned, this can be a lengthy process so plan ahead to have plenty of time to complete it. Finally, you’ll have to pass the ABIM Internal Medicine Certification Exam.  

When I finished my graduate medical education and Internal Medicine residency, I immediately started a fellowship. I was worried I wouldn’t have time to study enough for the ABIM certification exam, but with planning and preparation, it was completely manageable. I set up a study schedule, did a lot of practice questions, and I passed! In hindsight, I really didn’t have anything to worry about because the test evaluated the knowledge and skills I’d spent the past 3 years using every single day. 

Consult the ABIM Exam Blueprint

To find out what exactly you’ll be tested on in the American Board of Internal Medicine certification exam, you can review the ABIM Blueprint. This is a guide to the certification exam content, and it really helped me plan my studying.  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 exam blueprint on the ABIM website 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 medical specialties, 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 medical subspecialties, including allergy and immunology, dermatology, obstetrics and gynecology, ophthalmology, otolaryngology and dental medicine, palliative 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 care and safety, and substance abuse.  

American Board of Internal Medicine MOC Process and CME Credits

Once you’ve passed your American Board of Internal Medicine certification exam, you’ll need to keep up with educational and evaluation activities, a process called Maintenance of Certification (MOC). You’ll do a series of Continuing Medical Education (CME) activities to meet the ABIM’s MOC requirements. Physicians who regularly do CME activities can feel confident they are well-versed in the most current guidelines and recommendations for providing high-quality patient care. I find that most CME activities I do are helpful and keep me up to date in my medical specialty. They also come in a variety of forms. I’ve read articles, listened to podcasts, and watched webinars, for example. 

Each CME activity you do is worth a certain number of points, usually calculated based on how many hours you can expect to spend on it. So, for example, if you do an activity that is worth 1 CME credit, that’s likely because it should take you about an hour to complete it.  You will also see the designation “AMA PRA” for most CME credits. These are CME credits that are recognized by the American Medical Association (the AMA Physician Recognition Award program). AMA PRA Category 1 credits can be earned by doing activities developed either by the AMA or by another CME provider that has been accredited by the Accreditation Council for Continuing Medical Education (ACGME). AMA PRA Category 2 credits are earned by participating in educational activities that are not developed by an accredited provider but also have educational value, such as teaching medical students, medical writing, or participating in research.  

For the ABIM to report you as “participating in MOC,” you must earn points every 2 years, and you must earn at least 100 points every 5 years. You must also pass an assessment. You can take a traditional, 10-year MOC exam (which is very similar to your initial certification exam), or if you are eligible, you can choose a Longitudinal Knowledge Assessment (LKA), which takes place over a 5-year period. Every year, you will also need to pay your MOC fee, which is currently $220 for your first certificate and $120 for each subsequent year. This seems like a lot of work, I know, but if you keep up with it, it is manageable and can really enhance your overall patient care and medical practice.

Tips for Acing the ABIM Certification Exam

Here are some tips to help you master your ABIM Certification Exam and become board-certified in Internal Medicine.

Start preparing for the American Board of Internal Medicine board exam early

As soon you have your exam date scheduled, look at the ABIM blueprint to determine which topics you need to review most, and how much time you should spend on each study area. Then, set up a schedule. I used the ABIM blueprint as a starting point. I wrote my schedule out on a paper Word calendar, but you can also use one of the many digital resources out there. If you need help creating a study plan, time-management tools like this one will personalize a plan for you based on the exam blueprint and the number of hours you have each week to study.

Master clinical decision-making with practice questions

Internal medicine exam practice questions will allow you to familiarize yourself with the exam format and with the types of questions asked on the real exam. Though some exam questions will test your factual knowledge, most of them will also evaluate your clinical decision-making ability. I found actively learning from my mistakes while doing practice questions was a lot more efficient than simply reading over written materials.

Prepare using a comprehensive board review

The Pass Machine offers a comprehensive American Board of Internal Medicine review course. It has a large QBank with more than 3000 internal medicine practice questions, 56 hours of high-yield lectures, an illustrated course study guide, 4 hours of audio MCQs, weekly study plans, a time-management tool, and a specialized seminar series analyzing exam questions. Your study activities will also help you earn AMA PRA Category 1 CME credits and ABIM MOC points. What’s more, you’ll have the Triple Trust Guarantee – pass your exam or get a 110% refund and a free subscription renewal. As I mentioned, I found doing practice questions to be high yield, but I also used flashcards to quiz myself on key facts, and others I knew used study groups. Board review materials can be a great source of information and can be used as a springboard for other study techniques.

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Internal Medicine National Board Certification: Frequently Asked Questions

What is the pass rate for the ABIM board exam?

In 2022, the pass rate for the initial certification exam was 87%. For the MOC exam, the pass rate was 94%. As you can see, with a good study plan and trustworthy review materials, you have a high chance of success. 

How should I prepare for the ABIM board exam?

The best way to prepare for the exam is to make and stick to a study schedule, do practice questions, make flashcards for key concepts, consider forming a study group, and trust your training. I used a combination of all these techniques, and it worked for me. Also, don’t forget you’ve spent the last 3 years learning everything you need to know for the exam – it’s just a matter of reviewing things so that knowledge is at your fingertips.

What happens if you fail the ABIM board exam?

You have 3 chances to pass the exam, and as you learned above, most people are successful. If you fail your board exam and don’t pass after 3 attempts, you will need to wait one year before you can register again. This is good motivation to have an organized and effective study plan.