If you are taking or have recently taken an ABIM Maintenance of Certification exam, you are probably spending a great deal of time thinking about ABIM results. Did you do enough to prepare? Did you study the right topics? How will your exam be scored? Is the process fair? What are your chances of failing? And what happens if you fail?
First, you have somewhere in the vicinity of 3 months to take some much-needed relaxation time as you await your personal ABIM results. One reason for the waiting period is that ABIM analyzes and evaluates each exam to ensure that the results are reliable. This means that a flaw in the exam itself — a poorly worded question, for example, or a question that has been supplanted by new evidence or accepted clinical practice — will not be allowed to affect your final results.
When ABIM results are released, you will receive an email notification, and you can log into the ABIM website to retrieve your pass/fail status. A detailed score report will arrive by mail with more information, including your overall performance, your scores by several medical content areas, aggregate participation and performance data for the exam, and a description of how scores are determined.
Inside the ABIM Results
The exam scoring process is more complex than you might think. Of note is that whether you pass or fail relies solely on achieving a standardized passing score, which is established by the Internal Medicine Test Committee and approved by ABIM. A physician shared his 2012 ABIM score report, which elaborates as follows:
Overall examination performance is reported on a standardized score scale with a range of 200 to 800. The mean standardized score for first-time takers on the base test form of this examination is 500 and the standard deviation is 100. For example, a score of 600 is one standard deviation above the mean. Candidates with equal ability will achieve the same standardized score.
In other words, the pass-fail decision is based on your mastery of content rather than your rank relative to other exam takers. To determine the standard passing score, which may vary slightly from exam to exam, the testing committee undertakes a three-step process. Again, as described in an actual 2012 ABIM results score report:
First, standard-setting groups discussed the characteristics of minimally qualified or borderline candidates. Next, items on the test were reviewed and group members identified the expected performance of borderline candidates for each item. Finally, these judgments were systematically combined to derive a passing score for all examinees on the standardized score scale.
While exams are offered on multiple dates and different forms of the exam are administered, they are designed to be equivalent in content and difficulty, so that exam takers face the same challenge regardless of the date on which they take the exam.
About Your ABIM Results
While the exam is strictly pass/fail, your score report will include details — your percentages of correct answers — for each major medical content area tested. If the exam had a sufficient number of exam takers, your report will also show, in terms of decile, how your performance compared to others taking the same exam according to each major medical content area.
For some, passing may not be the only thing that matters. In the interests of lifelong medical learning, the information in your ABIM results may be useful for informing and directing your ongoing consumption of medical literature, continuing medical education (CME), and Maintenance of Certification activities going forward. The score report can also form a personal blueprint for re-examination preparation should you fail to pass on your first attempt.
At the same time, however, ABIM advises caution if you are attempting to generalize from performance on a particular content area to your specific strengths and weaknesses, owing to the smaller number of questions in each content area.
What Happens if You Fail Your ABIM Exam
While ABIM pass rates for first-time test takers have been falling, inspiring significant and sometimes heated debate and discussions around possible explanations, the first-time pass rate for initial certification seekers still stood at 86% in 2013, while the first-time pass rate for re-certifiers was 78%. As long as you put time into preparing for your exam, you have a relatively strong probability of passing on your first try. What is more, in a July 2014 letter responding to concerns around MOC changes, ABIM noted that:
First-time taker pass rates [for the recertification exams] vary because we use an absolute standard (we don’t grade on a curve with pre-defined number/percent passing), which is guaranteed to assure variation in pass rates driven by candidate variation in ability, training, motivation and preparation. Ultimate pass rates have remained fairly constant at 95-98%.
So, even if you do not pass on your first try, there is a high likelihood that perseverance will pay off. MOC candidates who do not pass may retake the exam during any future exam administration with no limit on the number of retakes. The rules are slightly different for candidates pursuing initial board certification. Since 2011, candidates who fail three consecutive initial certification exams in the same discipline over 3 years must generally wait one full year before attempting the exam again, although there are exceptions to the re-examination policy.
Another bit of good news for anyone who does not pass an ABIM certification or recertification exam is that no one really needs to know. Your ABIM results and specific scores are your private business unless you choose to release the information. Publicly available reporting by the ABIM only shows whether or not you are certified and currently meeting Maintenance of Certification requirements. While anyone can look you up by name on the ABIM website to determine your certification and MOC status, they will only be able to deduce an exam failure if they know precisely when you are attempting the exam (so be careful you who tell!).