By the time you’ve finished your residency, you’ve taken – and aced – many exams. Nevertheless, the prospect of facing the ABIM certification exam may seem unnerving to you.

Why is this? You’ve taken other day-long exams before, including 2 days of testing for the USMLE Step 3 exam. But when it comes to the ABIM certification exam, you may feel that a lot more is riding on this test for you, both professionally and personally. And you might be daunted by the pass rate: In 2013, the pass rate for the ABIM certification exam was 86% among first-time test-takers, considerably lower than the 96% pass rate for the USMLE Step 3 exam among first-timers from U.S. and Canadian schools.

Regardless of whether you’re just a few days away from your first ABIM exam or have much more time to prepare for it, knowing a few key principles can help you face your first ABIM certification exam with confidence.

ABIM Certification Exam Questions: Complex But Not Tricky

What makes the ABIM certification exam different from other exams you’ve taken is the complexity of the case-based questions. Of course, knowing your medicine inside and out is crucial, but knowing how to approach these complex questions is even more important, because they make up the majority of your ABIM certification exam (and other subspecialty board exams, too, if you’re acquiring more than one certification).

The Step 3 exam contains case-based multiple-choice questions that require you to synthesize knowledge across subspecialties, but they make up a smaller portion of the Step 3 exam than they do the ABIM certification exam. And Step 3 cases tend to focus more narrowly on either an initial care encounter (taking a patient history and making a diagnosis) or a continued care encounter (requiring you to decide on prognosis or management).

The case-based questions on the ABIM certification exam typically require more-complex clinical decision making. In most, you will need to take two cognitive steps of logical reasoning: The first to make a diagnosis and the second to infer the best subsequent course of action.

Understanding how questions are constructed (with a patient vignette, the question itself, and the answer options) will help. Knowing the essential cues to look for within each part of the ABIM board question will move you toward the second cognitive step and the correct answer. This highly focused approach is particularly important if you are to proceed quickly enough through up to 70 questions in each 2-hour segment.

Despite the time constraints, it’s important not to go too fast. Failing to read the questions strategically can lead you to take mental shortcuts that throw you off track.

Don’t Be Overwhelmed by the ABIM Certification Exam

As you approach exam day, keep your anxiety in check by reminding yourself that the goal of the test is to demonstrate a defined level of competence — not to separate the top 10% of recent trainees from the rest.

Each test varies, and questions range in difficulty. ABIM explains that the minimum passing score on your test will reflect an absolute standard that depends partly on the mix of hard and easy questions for that particular exam. Most questions are case-based, but some will be shorter questions that address specific knowledge points and do not contain a patient vignette. Some questions may seem easy. Don’t doubt yourself on these.

Also, try not to be distracted by controversies surrounding certain approaches. Residents who are studying for the boards are often immersed in intellectual debate on new therapies and diagnostics during their training. But ongoing controversies and new therapeutics are unlikely to be on the ABIM certification exam because they don’t yet have the solid evidence base that is necessary for an ABIM exam question. And the ABIM certification exam rarely delves into the advanced therapeutics that only a specialist would prescribe.

Instead, focus your study on high-yield topics, including well-established treatment and screening guidelines. In the days before the exam, review common lists of facts including basic formulas (such as gaps and gradients and acid-base interpretation) and simple, specific associations (such as autoantibodies associated with various rheumatologic conditions).

Throughout your study, remember to pause and reflect on what you’re learning — a simple step that you may think you don’t have time for but has been shown to have a powerful impact on performance.

If You Still Have a Few Weeks Before Your ABIM Certification Exam

While no expert advocates studying at the last minute (i.e., cramming), the reality is that many physicians cram for exams and have relied on a week or two of intense study to prepare for high-stakes tests throughout their formal education and training. And it may be your only option if you have just a few days or short weeks before the exam.

However, if you have more than a couple of weeks, choose a study strategy that identifies areas of weakness in relation to the ABIM blueprint, places your knowledge into context (i.e., uses case-based learning), and incorporates spaced and repeated review to consolidate your knowledge. All these study strategies are more fruitful for long-term knowledge retention than cramming.

Identify your study style and adapt and optimize it for the particulars of the ABIM certification exam. And take advantage of developments in cognitive science that have contributed to a new understanding of what works best for knowledge retention and reinforcement.

What to Expect on ABIM Certification Exam Day

Knowing what to expect on exam day can ease your anxiety beforehand. Our Survival Guide for ABIM Recertification Exam Day describes specific procedures within the testing center and reminds you what to bring and what to leave at home. The guide will be helpful for first-time certifiers as well as those maintaining certification.

It’s important to enter the exam with a clear plan for how you will pace yourself (we recommend checking your own progress every 20 minutes) and what to do if you hit a question that throws you off stride. Even if you have just a week or two before the exam, it’s helpful to do a timed practice test, answering questions at the same pace as you plan to use in the exam itself.

During the week or two before the exam, it’s worthwhile to acquaint yourself with the logistics of the testing center and the exam itself. We also highly recommend doing the ABIM tutorial in advance of test day. This will familiarize you with the online exam features and the tools available to you. (You can do this tutorial in the testing center on exam day before the clock starts running on your exam, but getting it out of the way beforehand will clear your head for the actual test you’re there to take.)

Even preparing seemingly trivial mechanics in advance, such as gathering the appropriate identification cards and getting directions and parking information, will ease your mind on the day of the test. A day or two before the exam, step back even further. Stop studying and do something that you find enjoyable and relaxing — and make sure to get a full night’s sleep.

Taking the ABIM certification exam is a rite of passage. But viewing it as just one step in the lifelong continuum of your medical education may lessen the emotional load and put you in a positive state of mind as you approach the exam.