Pediatrics Board Review: How to Study for the Exam

The pediatric board exam is hard and is statistically getting more and more difficult based on the declining pass rate over the last 5 years. The American Board of Pediatrics (ABP) General Certifying Examination is offered only once a year. So, if you don’t pass, this exam and preparing for it will preoccupy your mind for nearly a year before you have another shot at it. That’s why it’s important to have a solid plan in place for passing your pediatric board review.

My pediatric residency formally “prepared” me by providing weekly didactic lectures, mandatory PREP questions, and, of course, the once-yearly In-Training Examination (or ITE exam). But, to be honest, I’m not sure how well any of those prepared me for the pediatrics certifying board exam. I certainly didn’t feel that (given the choice) I would have been immediately able to pass the certifying exam upon graduation from residency. That’s a very common feeling.

Given the low and declining pass rate of the General Pediatrics Certifying Examination, it is an exam you absolutely must study for with a credible pediatric board review. Why is additional study needed? Because the board exam goes beyond basic pediatric clinical information. The exam expects us to know how to use laboratory values to differentiate between types of inborn errors of metabolism, identify Rifampin dosing for meningococcal vs. TB cases, and when and to whom to administer varicella IVIG upon exposure. In other words, the amount of core knowledge and detail that this exam goes into is far more specific than you are likely to encounter on any given day as a general pediatrician.

What Is Covered in the General Pediatrics Board Certifying Exam?

The ABP has a published content outline (which is unchanged since 2017) that serves as a guide for what content appears on their initial certification exam. Most importantly, the content outline lists the percentage of test questions that fall within each content domain. This means you can attempt to objectively determine how much time and effort to spend studying a certain topic that will only comprise 2% of the exam (rheumatology) compared to 4% of the exam (emergency medicine), or 7% of the exam (infectious diseases). The content outline specifically warns test takers not to use the outline as a study guide, rather, it’s more of a convenient way to organize the vast content required to be a general pediatrician in clinical practice.

Regarding the format of the test, it consists of 4 sections of 82-88 multiple choice questions, for a total of 330-350 questions encompassing the entire exam. You have 105 minutes to complete each section which means for each given question, you have 75 seconds. Between sections 1 and 2 and again between 3 and 4, you have the option to take a 15-minute scheduled break. Halfway through the exam, you have a lunch break scheduled for up to 60 minutes. At the beginning of the exam, there’s a brief introduction and honor code disclosure (lasting 5 minutes total) and an optional 10-minute tutorial. Including registration before the actual start of the exam and an optional 15-minute survey at the end, prepare to be at Prometric for about 9 hours on exam day.

Studying for the Pediatric Boards

How much study time you have will vary from person to person. This is often because of many factors that are out of your control: job and fellowship start date, burnout from residency, etc. Thus, it is extremely important to find as much control and structure as possible by creating a pediatric board review study plan and sticking with it.

I made up my mind that I was going to do as many practice questions as possible because there are only so many ways in which you can be asked about the vast majority of these topics and those “buzzwords” that you see on practice questions are truly seen on the real exam. My residency paid for a question bank, and I purchased another one because it was offered at a discounted rate. You don’t necessarily need two question banks, but if you are in that situation, pay close attention to when they expire—is it based on the purchase date or the activation date—and plan your study schedule accordingly.

I still had access to the American Academy of Pediatrics (AAP) PREP questions that my residency program paid for. It’s important to note that while many people think of PREP questions as the gold standard for studying for the pediatrics certifying board exam, this exam is offered by the ABP and not the AAP. As a point of difference, PREP questions can be much longer than the ABP pediatric exam questions and, because they’re from a web browser, they don’t create a real-life testing environment.

I don’t believe you need to get bogged down with too many study resources. I personally didn’t find any books/text material to be very helpful because that way to learn was too slow and passive. Reading is not learning. Reading is reading. I preferred interactive practice questions and courses over study books. Whatever study method you choose, it is important that you understand general clinical as well as specific patient presentations to succeed on the board exam. Many questions are designed around such presentations.

Create a Pediatric Board Study Plan

Below is how I designed a study schedule to prepare for my pediatric boards. Notice that my study approach changed as I got closer to the exam date.

12-14 weeks before the test

• I did two blocks of 20 questions a day. I did these on random topic tutorial mode. I’ve never had the patience to review questions after I answered them, so tutor mode allowed me to at the same time to test myself and review correct and incorrect answers through reading the question explanations. Each question block took me 45-60 minutes to complete. On weekends or days off work, I would sometimes do additional question blocks.
• I started creating flashcards/high-yield study document on topics I struggled with (ex: Diamond-Blackfan anemia vs. Shwachman Diamond syndrome). I also included in my high yield study document any helpful diagrams that were included in answer explanations. I knew I had to master the pediatric clinical presentations or clinical vignettes.
• After I completed my first pass through the entire question bank, I reset it and started going through each topic category one at a time. As this was my second pass through the questions, I didn’t care if I wasn’t blinded as to the category/organ system the question content was testing. On categories that I scored lower than 70% correct on the first pass-through, I would watch review videos/lectures on those topics.

2-3 weeks before the test

• I took a full-length practice test to make sure I had the timing of the exam down. I wanted to feel confident that my ‘natural pace’ of answering questions was sufficient to get through the real exam with a little time to spare.
• I continued to review my flashcards/high-yield study document and started to eliminate any topics that I now more clearly understood.

7-10 days before the test

• I still had an additional practice test left, but I didn’t take it because I knew that if I did poorly, it would only lessen my morale. I knew that no matter how I did on the practice exam I still had to take my ABP certifying exam that was coming up since it’s only offered once a year I knew I did not want to wait an entire additional year. Instead, I quickly clicked through all the practice test questions and then reviewed them by reading the correct answer explanation. I used them as I would study flashcards, a high-yield tactic to review a large amount of content in a short amount of time.
• I continued to review my pared-down flashcards/high-yield study document

1-2 days before the test

• I continued to review my pared-down flashcards/high-yield study document
• I reviewed biostatistics formulas and lectures
• I gathered all my materials for the test center’s testing day

Test-Taking Strategies for the Pediatric Board Examination Testing Center

By this point in your medical career, you have plenty of experience in taking medical licensing exams. Because of this, it can be easy to overlook those fundamental test-taking strategies you did while taking USMLE Step 1, Step 2 ck, and Step 3. I cannot stress this enough, don’t neglect those fundamental test-taking skills that led you to this point in your career. Be prepared when you arrive at the Prometric testing center. Arrive there at least 30 minutes ahead of time with 2 forms of ID (just in case one is surprisingly expired). Bring snacks, caffeine, and something for lunch. I also brought blue light eyeglasses to help with any eye strain, which I left at my computer terminal throughout the day to shorten any inspection time between going in and out of the testing room. Take your allotted scheduled breaks, whether that means going to the bathroom, having a snack, or just getting up and physically leaving the testing room. I did not struggle with time management during the exam, but I was shocked when I finished my exam and saw how quickly the other cohort of exam takers finished the pediatric boards at my testing center on my test day. This is an important lesson to learn: you should not allow yourself to be swayed or made to feel nervous because other test-takers around you are finishing ahead of you or, conversely, are still going through their exams as you get up to leave, having finished before they did. Everyone has their own pace. From having taken practice tests you should know and feel confident with your own pace.

As you sit down at the computer terminal in the testing room, you will have a dry-erase board and marker made available to you. During the optional tutorial section that precedes the exam, you still have the opportunity to quickly write down any “crammed” knowledge/facts on that dry-erase board. I would especially recommend doing this for those pesky biostatistics formulas such as odds ratio, number needed to treat, etc.

Comprehensive Pediatric Board Review Course

Not all board review courses are created equal. Some may have a reputation as a well-known name for preparing test takers for board exams other than pediatrics, such as emergency medicine, anesthesia, adolescent medicine, or family medicine. But this may not translate into a quality offering for pediatric board preparation. Do your homework. Choose a course or Q-Bank that has a strong guarantee. It speaks to the confidence that the company has in its exam prep offering.

Also, I advise you not to rely on question banks alone to teach you all of the content you need to pass the pediatric exam. The Pass Machine provides a pediatrics board review course that has over 1800 board style questions, lectures given by board-focused faculty, and a pass guarantee or your money back. Lectures serve as a method to improve knowledge gaps and teach knowledge in ways that will actually stick with you until test day. The audio and visual component of The Pass Machine’s lectures provides a study method that is more actively engaging than merely reading text or notes. They also have an easy-to-use mobile app which is a must-have for being able to study during unexpected downtime (believe it or not, there are lots of board review courses that don’t have mobile apps).

Many pediatric residencies will pay for a pediatric board review course, particularly since group discounts can be available. Additionally, job contracts for general pediatricians often include CME funds, serving as another way in which you can either get a board review course paid for or negotiate for it to be paid.

Pediatrics Board Review: Frequently Asked Questions

What to use to study for pediatric boards?

The most commonly used pediatrics board review resources include question bank(s), practice tests (or blocks of unused test bank questions), flashcards (either pre-made by a study company or ones you create as you’re studying), videos/review lectures, podcast lectures, textbooks or review study guides, and visual diagnosis/picture book. Podcasts can also be a helpful resource to listen to while driving or as a different study technique when your brain feels shot. Flashcards or some kind of testing app that’s accessible on your phone can be helpful during any unexpected downtime in between more formal study sessions.

What happens if I fail the pediatric boards?

Plenty of talented and capable healthcare providers have had to retake the initial certification exam for the ABP because of failure to gain board certification on the first attempt. From the time you graduate from residency, you have seven years to pass the initial certification exam. For studying and planning purposes, know that the exam is only offered once a year in October, so finding the right pediatrics board review is essential.

How hard is the pediatrics board exam?

Looking at your ITE score and percentile from your residency testing can give a general idea of how likely you would be to pass the pediatric board certifying exam if you were to do no additional dedicated studying. Expect to see the same topics and even length of questions represented on the actual pediatric board examination as you did on the ITEs.

What are the pediatric board certifying exam pass rates?

Around March of every year, the ABP releases the initial certifying examination first-time taker passing rates. According to this data, the pass rate on the board exams was 80% in 2022, which was approximately the same as in 2021. However, it’s important to note that the pass rate has been down trending over the last 5 years.