I knew years in advance that I had to take the internal medicine boards in 2015. Since my husband works in football, I knew I better not schedule the test for the fall. So, April 2015 was it.

My study plan? I had a vague idea that I’d buy the standard board review books and maybe take an internal medicine board review course. I’ve been in practice all this time, right? The material would be really familiar to me by now, right?

Six Months from the Internal Medicine Boards (Not Enough Study Time)

November 2014 rolled around. In my little bits and pieces of free time, I researched board review books. It took me a month to be able to make a decision. When I did, I got on the computer and ordered the MKSAP books with the online interactive modules. I spent a TON of money, and a cement-block sized box arrived on my doorstep a few days later. One night in December when the kids were asleep, I opened the box and eagerly flipped through the pretty books, glancing through the chapters and the questions. My stomach sank.

Oooomph. Despite being in the office four days a week, immersed in clinical duties, and constantly logged on to UpToDate, I realized there was a lot of unfamiliar material. We would be tested on clinical issues that I did not regularly encounter in outpatient primary care practice, such as practical oncology, acute cardiac care, rheumatology treatments, and so on and so on. For the first time, I felt nervous. Could I fail this test?

But, there was only one thing to do: take a deep breath and outline a plan of attack. I estimated how long I had to go through each book, reading all the chapters and complete all the questions, in order to be done before the exam date. I would need to get through a book every 2 weeks.

And so I felt better, for about 2 weeks. As the first book sat on my bedside table night after night, I realized that my plan was flawed. My plan had depended upon me actually having any free time in the day to study. I did not have any free time in the day to study. I only had a few minutes at nighttime before I passed out.

Three Months from the Internal Medicine Boards (Starting to Panic)

It was January at that point. I panicked. I started blocking off clinic time. On the days that I blocked off completely, I tried studying at home. But, one or both of my kids were sick for a few of those days, and/or Hubby was traveling for work, and/or there were huge massive snowstorms and the kids were home from school.  I got next to nothing done.

For the days that I saw fewer patients, I tried studying at work. But, urgent patient care messages and pages happened, notes and billing always needed to be completed, and I got sucked back into clinical duties. I got next to nothing done.

Only 2 Months Until the Internal Medicine Boards. (Real Panic, Real Plan!)

February. Real panic. I reached out for advice from colleagues. Buy an audio-lecture board review! Someone suggested. I bought it less expensively on a used MP3 CD, which I didn’t even know how to use. My husband burned several chapters onto CDs for me to play in my car as I commuted to and from the city for work. I was so hopeful that this would be the answer. But the lectures were long, long, long, and dry, dry, dry. I found myself spacing out and then needing to replay parts. It took me 2 weeks to get through just the cardiology lectures.

I gave up on actually reading or even listening to entire chapters and focused on just doing the questions. I let go of the idea that I needed to read the books or listen to the material before quizzing myself.  I did questions online: a few questions every early morning, in little bits of time during clinic, and every night. If I got one wrong, I read the explanation and/or that section in the online copy of the book, and put it back into my pot of “unanswered” questions, so I could review it again later.

For the nerdy Type-A personality (which is like, everyone in medicine, right?), testing yourself with questions is really fun. Seriously! You get immediate feedback from the program. You answer a question, and as soon as you click on your choice, up pops a graph showing you the correct answer and what percentage of other studying physicians picked each choice. Sometimes, this made me feel better, like “What dummy would have answered ‘D’ when it’s so obviously ‘A’?“, or worse, “Geez, EVERYONE knew that one was ‘B’. What’s wrong with me?”

This immediate feedback was completely addictive. Total dopamine surge each time. I took test questions anywhere, at work or at home, and even if I only did one, ONE LOUSY QUESTION, it was helpful to review or learn some small concept. Like the miniest of mini-modules.

The best? I loaded the board review questions onto my kids’ iPad and took it to the gym. I could get on the StairMaster (you know, the real one that looks like an escalator) and for 60 minutes, I could be completely engrossed in those test questions. Seriously, that is where I did the bulk of my best studying: on the StairMaster at the gym. I wasn’t at work, and I wasn’t at home. This was completely me-time. Being upright and active kept me awake and attentive.

I kept listening to the CDs in the car, hoping that I was absorbing knowledge subconsciously. I never got through all the CDs, only most of cardiology, rheumatology, and hematology-oncology.

I kept the books around and used them to review concepts I was missing on the test questions. I had a pile of them on my bedside table, and read only one specific subtopic at a time. Or I studied photos, especially in the dermatology book, a few at a time. That’s all I had the time or mental energy to handle.

I did take a weeklong internal medicine refresher course right before the boards, but the lectures and material were geared towards office-based primary care. It was very practical; not oriented towards internal medicine boards review. I found it more helpful as a week of blocked-off time in which to fit in more questions, and I stuck to the same topics that were being covered on the course, as there was some overlap. I think that helped: to hear about a topic, and then answer questions related to that same topic.

In summary, my board review consisted of a hodgepodge of approaches, but mostly, it was a month and a half of hammering through test questions. I did a GAZILLION questions.

When I took the internal medicine boards, I found the questions difficult; many questions seemed convoluted, complex, not straightforward. I did struggle, and I worried.

But, last week I got the news that I passed, and by a comfortable margin to boot!

In Sum, My Tips for Passing the Internal Medicine Boards

Do…

  1. Test yourself with lots of board-style questions (while at the gym, if possible)
  2. Read and reread information on topics that challenge you
  3. Block off time to study

Don’t…

  1. Expect that you will absorb medical knowledge passively through (boring) books or lectures
  2. Assume you’ll have time to fit in studying
  3. Stick to a plan that isn’t working — find what works for you and go with that

What strategies have you used that worked to help you pass the internal medicine boards?

Monique Tello, MD, is a practicing internist at Massachusetts General Hospital,and a regular contributor at Mothers in Medicine and also on her personal blog, Generallymedicine.com, as Genmedmom.

This post is part of the “Lifelong Learning” series. Posts on this topic include:

A Mid-Career Perspective on Lifelong Learning in Medicine, by John Mandrola, MD
Keeping Up with Core Medical Knowledge, by Natalie Levy, MD
Keep Learning Even When You’re Not Studying for the Boards, by Sara Cohen, MD