One of the criticisms that has been leveled against the ABIM recertification exam is that some of the topics covered aren’t relevant to the practice of general internal medicine. In February 2015, ABIM announced that they would be making adjustments before the fall exam; since then, they have conducted meetings with general internists and have gotten feedback both on the exam itself and on the score report issued to diplomates after they have completed the exam.

Now, ABIM has updated their blueprint and provided a detailed topic guide of what is and isn’t covered on the exam, and has revealed their new score report.

These changes will take effect beginning with the Fall 2015 Internal Medicine MOC exam.

Content Distribution

At a high level, ABIM explains what has and hasn’t changed in the recertification exam:

The purpose of the MOC exam is to evaluate whether a certified general internist has maintained competence and currency in the knowledge and judgment required for practice. The exam will emphasize diagnosis and management of prevalent conditions, particularly those for which practice has changed in recent years. A lesser emphasis will be placed on rare conditions, with a focus on those in which physician intervention can have important consequences for patients. For conditions that are usually managed by other specialists, the focus will be on recognition rather than on management.

Looking at the topics covered, we see the biggest changes to the ABIM recertification blueprint in the following subject areas:

Hematology — down 2 percentage points, from 6% to 4%
  • OB/GYN — down 3 percentage points, from 6% to 3%
  • Nephrology/Urology — up 2 percentage points, from 4% to 6%

Other topic areas (Cardiology and Psychiatry, for instance) have changed by only one percentage point.

The new content distribution in the MOC exam is mostly aligned with the ABIM initial certification exam blueprint, deviating by only one or two percentage points down or up.

ABIM notes that the “content selection priorities … are subject to change.”

ABIM blueprint changes 4.008

How Does NEJM Knowledge+ Content Align with the New ABIM Blueprint?

The differences between the ABIM initial certification blueprint, the new recertification blueprint, and NEJM Knowledge+ content are slight (i.e., no more than 3 percentage points’ difference in the size of any one subspecialty). We continue to monitor changes in guidelines, respond to users’ comments in the product, and adjust our content accordingly.

Detailed Outline of Content

If you’re ever looking at a practice question and wondering “will this kind of question actually be on the exam?” you may find your answer on the detailed pages of the ABIM Blueprint document. New in this version is not only a list of topics and subtopics (which ABIM provided on the old blueprint), but, for every subtopic, an indication on the likelihood of which aspects of the subtopic will be on the exam. Those aspects are diagnosis, testing, treatment/care decisions, risk assessment/prognosis/epidemiology, and pathophysiology/basic science.

Here’s just a small sample of Allergy/Immunology as an example of the detail you’ll see in this 46-page PDF:

sample detail

If you read this chart row by row, you can see that ABIM is unlikely to write a question on testing for aspirin idiosyncrasy in relation to anaphylaxis, but highly likely to write questions on diagnosing and treating anaphylaxis caused by stinging-insect hypersensitivity. This information could perhaps guide how you study for the exam.

On the other hand, though the blueprint is highly detailed, you’ll find a lot of yellow — medium importance topics that ABIM expects to write “some” exam questions to address. There’s a lot of ground to cover in internal medicine, and not everything will be on the exam.

New Score Report for the ABIM Recertification Exam

According to ABIM, which conducted focus groups and one-on-one conversations, many physicians found that the old score report had too much technical jargon. It “missed the mark” in some key ways. Physicians want more-specific information regarding the exam questions they missed. At the same time, they want the report to be simplified and more useful.

ABIM is designing their score reports to be “jargon-free.” Lengthy explanations have been replaced with links, and narrative reporting of your topic-level performance and decile has been replaced with visually easy-to-read, skimmable graphs and charts.

The new score report, which ABIM provided on their website, has three pages.

Your score on the exam is clearly displayed right under PASS or FAIL on page 1.

Score-Report-section 1-1

You can also see how you performed compared with others on a simple bar chart.

Score-Report-section 1-2

On pages 2 and 3, you can see which topic areas you struggled with (ABIM has removed your decile, which used to appear next to your percent correct by topic).

Score-Report-section 2

Score-Report-section 3

Will physicians find this new blueprint more aligned with their actual practice and what they really need to know? Will they be relieved to see a simplified score report after taking their recertification exams?

Time will tell.

Share your thoughts on these changes from ABIM in the comments below.

More from the Learning+ Blog:

ABIM Pass Rates: Behind the Declines

ABIM Results Decoded

ABIM Changes MOC Requirements