Preparation leads to confidence, and confidence leads to success. That is what Dr. Mark Nadeau has learned from his experience preparing residents to take the ABFM certification exam and from preparing for and passing the exam five times during his career.
“I think the best thing to enhance confidence before taking a high-stakes test is knowing that you have executed a well-designed study plan and that you are prepared,” says Nadeau, senior reviewer of NEJM Knowledge+ Family Medicine Board Review and a clinical professor and residency director in the Department of Family and Community Medicine at the University of Texas Health Science Center San Antonio.
“My personal approach to recertification is that it’s a great time to do an overview of a wide range of topics,” says Nadeau. Many physicians have a baseline of knowledge that would enable them to pass the exam, he notes. “But if you have any sense of competitiveness, you want to do well. I use that as personal inspiration.”
Throughout your career, you probably will take a good number of these exams, notes Nadeau. It will never seem like a good time to add ABFM exam prep to your full schedule. “Whatever phase of your career you are in, you’ll always have other things going on, personally and professionally,” he acknowledges.
The answer, he says, is to take a “lifetime approach” to keeping up with the evolving knowledge base of medicine. Making a commitment to board review as part of your professional life then scheduling it in makes it possible.
“So make a pact with yourself,” he says, “that you need to do the prep.”
ABFM Exam Prep Is Less Daunting if You Stick to a Plan
Dr. Nadeau begins studying 9 to 12 months before the exam. Other medical educators and experienced test takers agree with this time frame. But they concede that, realistically, many physicians start a bit later. Nadeau starts by doing two things:
- First, he chooses the materials he will use for his preparation.
- Then he makes a specific plan and time commitment for studying.
Whether you are a year from exam time or just a few weeks away, it’s never too early or late to commit to a plan for ABFM exam prep.
The ABFM suggests downloading and taking the “in-training” exams designed for residency programs then using your results to begin a study plan. The ABFM also offers these study time recommendations based on how you fare on the in-training exams:
- If you score more than 60 points below passing, aim to study for one hour, three times a week for 3 months, for a total of 36 hours.
- If you score between 10 and 50 points below passing, study for one hour, two times a week for 2 months.
- If you score at or above passing, study for one hour, two times a week for one month.
The ABFM notes that 36 hours, done in one-hour study sessions (the first bullet above), is more effective than six study sessions of 6 hours each. The latter is regarded as less fruitful and inefficient. The ABFM suggests committing to studying at least 2 days per week.
Similarly, at NEJM Knowledge+, our technology and adaptive learning partner, Area9, recommends frequent, short sessions. Experts in learning and retention practices at Area9 suggest three or four short sessions per week as the most effective and efficient way to learn.
Recognizing that most of us are deadline driven, NEJM Knowledge+ has a “My Schedule” feature that allows users to select their exam date or other deadline of their own choosing; the system will recommend how much time to dedicate to board preparation each week. Users can adjust their scheduled study time per week as time goes on and as commitments fluctuate.
It is important to space learning and leave time for adequate reflection to improve performance.
Busy Clinicians: Look to Your Practice First for ABFM Exam Prep
What topics should you start with?
Dr. Nadeau suggests looking first at your own practice. You will most likely not need to study the conditions and problems that you see most, especially if you keep up with and review the most recent guidelines in these areas. But even the busiest family physician is unlikely to encounter the full breadth of the specialty over the course of a year or two. So your study plan needs to reflect the full ABFM exam blueprint, to be sure you can answer questions relating to scenarios you see less frequently.
Testing yourself with in-training exams or any practice exam that is consistent with the blueprint will reveal areas of strength and weakness. NEJM Knowledge+ includes two practice exams, and we recommend using one early on in ABFM exam prep. Algorithms that underlie the NEJM Knowledge+ adaptive learning platform incorporate this information, along with your ongoing performance, to present you with questions that bolster your weak areas. You will still encounter questions in your areas of strength, but less frequently. This ensures that you continue to reinforce that knowledge without spending too much time reviewing information that you already know.
When we begin studying, we don’t always have clear understanding of what we truly know or don’t know — this is called metacognition. Finding out our knowledge gaps early in the process frees up time for the actual study and review.
Dr. Nadeau, while working through an early demo version of NEJM Knowledge+ Internal Medicine Board Review, enjoyed the section where he found himself “killing it pretty good.” When he found himself struggling, it was not as much fun, but it was instructive about what he needed to improve.
“It’s clear that [NEJM Knowledge+] is comprehensive and designed with the exam in mind. If you use it, you can feel comfortable that you’ve covered the spectrum of topic areas that you need for the exam. And you can find out where you are strong and where you need more work, where your gaps are.”
Making the Most of Residency Time for ABFM Exam Prep
For residents, just a little extra focus during day-to-day residency creates automatic ABFM exam prep. Dr. Nadeau calls it “high-stakes learning.”
He recommends that residents follow patient encounters with relevant reading: “When you are on the wards or in the clinic and you encounter something you don’t know, read about it that day or soon after you’ve seen the patient. This is a real person with a real problem, so you’ve got to get it right — the right diagnosis, the right medicine, the right dose. That is powerful motivation for learning.”
Education experts agree that learning and retention are greatest when you have a strong need to learn the information and context in which to apply it. That is why it is ideal to ask yourself after every patient encounter: “What is the main clinical point of what I just did or observed?”
Although family medicine residents don’t take boards until April of their third year and many don’t pick up the pace on studying until their third year, Dr. Nadeau reminds residents that exam preparation should not be a single push at the end. Results from the in-training exam given each October can be used “as a measurement to energize your ongoing study program.…It gives an indication of what you know and what areas will need more effort.”
Other suggestions for using your residency as a study tool apply to all specialties, including family medicine.
Set Yourself Up for Success
With recent ABFM pass rates of 92.4% for initial certification and 87.4% for recertification, statistics are in your favor. But the stakes are too high to leave it up to chance. The mental boost of knowing you are prepared is likely to make the experience smoother and more satisfying. And it’s likely to improve your confidence on exam day. But that means sticking to a schedule.
“If you say, ‘I’ll do it when I have time,’ you are unlikely to do it much,” Dr. Nadeau says. “Commit yourself to a specific amount in a specific time frame, and make it fit into your life and your schedule.”
This is not much different than the advice most family physicians give to patients about exercising. To take the analogy further: If you can find a format for studying that you can tolerate — or enjoy, even — you are more likely to do it, Dr. Nadeau says.
As you begin visualizing your own success, you’ll likely build momentum for continuing your preparation plan. “I think people do better on an exam,” Dr. Nadeau says, “if they feel confident.”
More from NEJM Knowledge+ and the Learning+ Blog:
- Internal Medicine Board Study Plan: Make Your Schedule Work for You
- Internal Medicine Certification Exam: Your Residency as a Study Tool
Please comment below to share your own successful strategies for ABFM exam prep here, or ask others how they have faced particular study challenges.