The Internal Medicine Boards : A Brief Overview
Having recently had the “joy” of sitting for the Internal Medicine Certification Examination by the ABIM, the Fool would like to say a few things and answer a few questions. People often ask what they need to study in order to pass the ABIM. Remember one thing: Money is no object. First time pass rates for the year 2004 examination were 92% for 1st time test takers. There were more than 9000 takers for the 2004 exam. Repeat ABIM test takers had a dismal 29% pass rate. Doh! That means that the first time is the charm when it comes to the internal medicine boards!
You may enjoy looking over a few statistics courtesy of the ABIM:
Pass rates for the ABIM Internal Medicine Certification Examination
Internal Medicine Residency Pass Rates (by state)
Harrison’s Internal Medicine, Textbook & Self-Assessment and Board Review
Johns Hopkins Internal Medical Board Review
Cecil Review of Internal Medicine
What is a fool to study for the American Board of Internal Medicine Exam?
So, what do you have to know for the ABIM exam? You should be generous in both your time and study materials for the ABIM. Decide early one or two main texts you want to read for the test, and pick one or more sets of questions to study. In general, the more questions you do the better. The fool recommends Medstudy Board Review for Internal Medicine as one of your core texts. Above are other recommendations. We have heard positive feedback especially on Nail the Boards! The Ultimate Internal Medicine Review 4th Ed and Frontrunners’ Internal Medicine Board Review Syllabus. In addition, if you completed residency recently we recommend reviewing all your In-Training Exams and reviewing all the questions you missed. If you spend 2 minutes reviewing each of these topics, you’ll really pick up some points. Also, get yourself a great little reference to quickly look up topics. We HIGHLY recommend Current Medicine 2008 . Not only is it concise and to the point, it’s up to date, and great for your general reference library as well
When it comes to main texts, like MedStudy, you can learn tons of stuff you wished you had known in residency. And when Medstudy says “know this!” for a particular fact, you can rest assured that you WILL see that question on the exam. Medstudy (main text) has some review questions, but they really aren’t board style, and aren’t that great.
Plan on a few sources for review questions for board style material. The fool liked the ACP MKSAP questions. However do know that some of these questions are notoriously difficult and nit-picky. Some of what they want you to know is NOT on the boards.
ABIM Exam Pearls
Hot topics that come up year after year on the ABIM:
Celiac sprue (this includes the rashes and vitamin deficiencies associated). It seems like everyone in the world has sprue!
Thyroid disease – hypo and hyperthyroidism are always popular
Lupus and it’s many manifestations
Myocardial infarcts, management, long term care
Glomerulonephritis (yes! all of the types)
Transfusion reactions (ALL types, and complications)
Zoonoses (Tularemia, RMSF, Lyme, any animal or tick borne disease!)
Stuff you don’t really need to know:
HIV medications – dont’ concern yourself learning the various cocktails, just know the big ones and the side effects
Antibiotic mechanisms, mechanisms of resistance
Details about immunology, MHC complexes, etc
Cancer staging. No questions about how to stage Hodgkin’s disease, etc…
The Final Step (sort of) in your training to become board certified in Internal Medicine!
What Does the Internal Medicine Board Examination Cover?
The examination in internal medicine has two goals. The first is to assure competence in the diagnosis and treatment of common conditions that have important consequences for patients. The second goal is to assure excellence in the broad domain of internal medicine.
Examination content is consistent with a pre-established blueprint or table of specifications. The blueprint is developed by the Board of Directors, and it is reviewed and revised annually to ensure that it is current. The foundation of the blueprint is published studies that describe the kinds of tasks internists actually perform in practice. These data on frequency then are modified to reflect both the breadth of medicine and the importance of various conditions.
Approximately 75% of the questions test knowledge in the traditional subspecialties of internal medicine (cardiology, endocrinology, gastroenterology, hematology, infectious disease, nephrology, oncology, pulmonary disease, and rheumatology). In recognition that the practice of internal medicine requires knowledge in other areas, the remaining 25% of the questions test in the following: allergy/ immunology, dermatology, gynecology, neurology, ophthalmology, and psychiatry. Independent of primary content, about 50% of the questions are chosen to guarantee coverage of content that spans these disciplines. Cross-content areas include: geriatric medicine, critical care medicine, adolescent medicine, clinical epidemiology, ethics, nutrition, occupational medicine, palliative/end-of-life care, prevention, substance abuse, and women’s health. A blueprint representing content distribution in recent years follows.
The vast majority of questions (over 75%) are based on patient presentations. The settings of the encounters reflect current medical practice, so most take place in an outpatient or emergency department setting (roughly 75%); the remainder occur in inpatient settings, ranging from the intensive care unit to the nursing home. Questions requiring simple recall of medical facts are in the minority; the majority of items require integration of information from several sources, prioritization of alternatives, and/or utilization of clinical judgment in reaching a correct conclusion.
What’s on the ABIM Certification Examination in Internal Medicine?
– Source: ABIM Website:
In answer to that question, the examination blueprint (Table 1) reveals that approximately 75% of the single-best answer, multiple-choice questions test knowledge in the traditional medical subspecialties. Recognizing that the practice of internal medicine requires knowledge in other areas, the remaining 25% of questions relate to allergy/immunology, dermatology, gynecology, neurology, ophthalmology, and psychiatry. Independent of primary content, some 40% of the questions are chosen to guarantee coverage of cross-content areas.
| Table 1. ABIM Internal Medicine Exam Blueprint | |
| Primary Content Area | % |
| Cardiovascular Disease | 14% |
| Gastroenterology | 10% |
| Pulmonary Disease | 10% |
| Infectious Disease | 9% |
| Rheumatology/Orthopedics | 8% |
| Endocrinology | 7% |
| Medical Oncology | 7% |
| Hematology | 6% |
| Nephrology/Urology | 6% |
| Allergy/Immunology | 5% |
| Psychiatry | 4% |
| Neurology | 4% |
| Dermatology | 3% |
| Obstetrics/Gynecology | 2% |
| Ophthalmology | 2% |
| Miscellaneous | 3% |
| 100% | |
| Cross-Content Area | |
| Critical Care Medicine | 10% |
| Geriatric Medicine | 10% |
| Prevention | 6% |
| Women’s Health | 6% |
| Clinical Epidemiology | 3% |
| Ethics | 3% |
| Nutrition | 3% |
| Palliative/End-of-Life Care | 3% |
| Adolescent Medicine | 2% |
| Occupational/Environmental Medicine | 2% |
| Substance Abuse | 2% |
The vast majority, about 75%, of the exam questions are based on patient presentations. The settings of the encounters reflect current medical practice, so most take place in an outpatient or emergency room setting; the remainder occur in inpatient settings, ranging from the intensive care unit to the long-term care facility. The majority of items require integration of information from several sources, prioritization of alternatives, and/or utilization of clinical judgment in reaching a correct conclusion. Questions requiring simple recall of medical facts are in the minority.
The examination blueprint, the foundation of which is published studies that describe the kinds of tasks internists actually perform in practice, is reviewed and revised annually by the ABIM Board of Directors to ensure its currency.