How to Study for the ABIM Certifying Exam

The best way to carve out dedicated study time for the ABIM certifying examination (ABIM-CE) from an already busy schedule is to create a study plan and adhere to it.  This blog is all about building that study strategy.

Self-assessment.  Before discussing specific ABIM-CE prep resources, the central importance of self-assessment as a valuable learning tool deserves special emphasis.  Self-assessment opportunities and materials are widely available in ABIM-CE prep tools.  

Through self-assessment, medical residents can:

• Identify knowledge gaps
• See where to focus their attention in learning
• Bolster involvement and motivation 

Internal Medicine In-Training Examination® (IM-ITE®).  The Internal Medicine In-Training Examination (IM-ITE) is a web-based, multiple-choice test used to self-assess medical knowledge of internal medicine residents during their 3-year training program and is administered each October to internal medicine residents.  The IM-ITE is sponsored jointly by the American College of Physicians (ACP), the Association of Professors of Medicine (APM), and the Association of Program Directors in Internal Medicine (APDIM). Most residency programs offer the IM-ITE yearly to all residents; on average, more than 92% of residents in internal medicine programs complete this examination each year. However, an individual resident may or may not take the examination in all 3 years. 

Residents receive a score report that provides the total percent of questions answered correctly, their percentile rank compared with their peer group at the national level, and feedback on performance in specific areas. The scores achieved reflect a resident’s fund-of-knowledge and predict how likely she/he will do on the boards. One’s scores should increase with each year of residency reflecting the growth of knowledge. Residents are not encouraged to study for the test.  IMPORTANTLY, the IM-ITE exam allows residents to understand the areas in need for improvement.  If you exceed the 75th percentile, your study plan is working well and you should continue what you’re doing. If you’re between the 50th and 75th, you have knowledge holes to fill with targeted studying.

How long to study (how best to structure your preparation)? During the three years of internal medicine training, you manage patients on the in-patient service and in outpatient clinics. You also attend lectures, clinical conferences, and have other didactic opportunities.  These activities impart a very strong foundation of preparation for the boards.  However, it is not advised to rely entirely on the knowledge you absorb and acquire during your training! No internal medicine residency program can provide a broad enough range of clinical and teaching experiences to prepare you adequately for the information covered on the ABIM board examination. Successful board preparation requires some dedicated, structured study time.  

Even though free time is at a premium and all sorts of demands compete for your attention, avoid the temptation to cram for the exam. 

• Start  6 to 8 months before the exam and modulate the intensity
• Begin by devoting 3 to 4 hours per week of study time for the first five months. 
• About three months before the exam, increase your study intensity to about 7 hours per week, continuing until a few days before the exam. 

The accumulated 150  hours of study activity should be adequate. Learning in short bursts over time and repeatedly testing yourself on what you’ve learned is much more effective for long-term recall than cramming. 

What materials and approaches to use in study preparation? Everyone’s approach to learning is based on a complex mix of factors.  There is no one “perfect” way of learning. I will go over the  variety of available resources below which include print, digital, online/live study groups, and exam prep courses. These should accommodate everyone’s learning strengths and preferences.

Study guides. Many study guides are available to aid in exam prep. They vary in structure and length. The American College of Physicians’ (ACP) Medical Knowledge Self-Assessment Program (MKSAP) is the “gold standard.” Check out Amazon for study guides from other publishers.

TrueLearn IM Prep Question bank. A robust learning and retention tool is the IM Prep question bank. IM Prep contains hundreds of case-based practice questions in the same format and targeted to the ABIM certification exam for Internal Medicine. Users may view questions by section/topic or in a randomized order.  Questions may be taken as a self-paced exam or users may opt to view them in a timed session, more like the actual board exams.  Regardless of which question bank you choose, utilizing a question bank is a critical component when studying for the exam.  Features of high-quality question banks should include: 

• Detailed explanations for both correct and incorrect answers  
• Annual updates to question contents so that they reflect the actual versions of the latest ABIM exam  
• Self-assessment tools embedded in the question bank to identify which areas need more study and review

Self-directed reading of textbooks and literature.  Peer-reviewed journal articles usually focus on detailed aspects of a disease and therefore are less helpful in studying for the broad concepts covered on the board examination. Reading textbooks of medicine (such as Cecil’s or Harrison’s) from cover-to-cover is also not feasible due to their length and depth. However, as a referral asset, they are a valuable source of detailed information about specific topics in which you may feel a need to plug knowledge gaps. 

A common practice is the underlining of “information nuggets” in textbooks and looking over them later. Cognitive research indicates this technique will not help you synthesize information coherently — and will not be useful in retrieving knowledge in the real world.

In-house resources for board exam prep. Many residency programs provide their residents in-house resources for ABIM exam prep. Two such examples include:

• ACP Board Prep Curriculum
• PEAC (Physician Education and Assessment Center)

The ACP Board Prep Curriculum is a collection of online slide sets that are used by faculty to teach a board preparation course. Residents are enrolled in Johns Hopkins Internet Learning Center. PEAC (Physician Education and Assessment Center) is a structured outpatient curriculum developed by Johns Hopkins School of Medicine.  Residents access PEAC on-demand at their convenience over the course of a year. PEAC comprises 17 modules, covering areas like hypertension and depression. Each module presents a clinical scenario focusing on understanding concepts, with links to related journal articles or abstracts, images and videos. Residents are quizzed at the outset and end of each module.

Study group. Regardless of the learning resource used in board prep, it is often helpful to participate in a small study group. A rotating moderator can lead the group in answering multiple choice questions. Study groups provide discipline, motivation, and a way to affirm understanding of specific concepts and facts. The discussion of topics among group members helps to cement command of particular topics.

Board review course. Some residents find board review courses to be helpful aids to preparation. Many residency programs provide their own board review course, usually in the last year of residency training, while some other programs may financially support attendance at an outside board preparation course for their senior residents. There are many independent courses available. However, the quality of these courses may be highly variable and they tend to be expensive. It is therefore worthwhile discussing specific course offerings with your residency program leadership before committing to a specific course. 

An alternative to attending a live course is provided by the American College of Physicians which sells a multimedia, self-study Board Prep Course organized into 49 lectures available online or on a USB flash drive.  Regardless of whether you attend a review course or not, it cannot replace the pre and post-course that is needed. Remember that a board review course is complementary and does not replace self-directed study time. 

Summary. The Internal medicine board certification exam encompasses outpatient and inpatient medicine in primary care as well as an array of subspecialties that internists frequently encounter – rheumatology, gastroenterology, dermatology, cardiology, pulmonology and neurology amongst numerous others.

Effective ABIM-CE preparation should rely on a variety of study approaches and information sources:

• Study guide
• Question bank
• In-house resources
• Study group
• Board review course

A successful exam prep strategy is built on identifying the content you need to cover for comprehensive exam prep, and portion it out into manageable increments.

Self-assessment during exam prep facilitates the identification of knowledge gaps and a means of focusing on those areas that need additional attention.