Whether your recertification exam is in just a few weeks or a full year away, a strategic internal medicine board study plan creates a road map for efficient preparation and success.

To be truly useful, though, your plan must be one you can stick to, so that you realistically acknowledge the many demands on your time. The study aids you choose also must suit your personal study style. Of course, some basic principles apply across the spectrum of personal needs and preferences. And the right tools offer time efficiencies for most anybody.

The Ideal Internal Medicine Board Study Plan

Medical educators typically recommend making a plan that starts at least six months before your exam date, with dedicated study time set aside each week, and generally increasing the amount of time in the two months before the exam. No matter your study schedule and favored study aids, you can work these simple steps into your study plan:

  • Take a practice exam early to jump-start your study efforts and help you assess your strengths and weaknesses.
  • Choose study aids that are mapped to the ABIM blueprint.
  • Seize opportunities in your daily clinical practice to reinforce your knowledge. If you look up a new guideline during the day to verify a step for a particular patient, take a few moments at the end of the day to review the guideline again. Learning in context of a particular patient is known to solidify your learning and aid retention.
  • Practice with case-based questions, particularly those that mirror the complexity of questions on the ABIM exam.
  • Divide your study time into three or four sessions per week — each needn’t be terribly long. Our adaptive learning technology partner, Area9 Learning, which has expertise in best learning-retention practices, advises this as the most effective and efficient way to learn.
  • Do another practice exam, ideally one that simulates the pace and length of the exam, just a few weeks before the exam.

Interestingly, physicians who feel confident and successful about how they study for boards tend to create study plans that are very consistent with these principles, as we have learned from a recent survey and in follow-up discussions with them. They tend to feel that studying for boards is time well spent, for both lifelong learning and passing their exams. Most devised their study plans based on their own common sense and experience — and their methods are surprisingly consistent with what cognitive science has shown.

What You Remember and Why

In recent years, advances in cognitive science have begun to explain how we incorporate and retain new knowledge throughout our daily lives, and have even offered actionable insights and best learning practices for the very practical matter of studying for a specific exam.

Spaced learning: Learning that is spread out and repeated over time is regarded as more effective than intense learning over a short period of time. This “spaced learning” is also believed to build more enduring knowledge than one-time memorization. It is believed that repetition reinforces what already is known and consolidates new knowledge with existing knowledge.

Learn by solving problems: Learning within the context of applying new knowledge seems to aid retention. That is why, for clinicians, treating a patient may be the best way to learn and remember. It is believed that we build strong neural connections when we have an immediate need for the knowledge. This “active” learning is regarded as more effective than passive reading. The problem-solving nature of case-based questions is regarded as active learning, potentially more effective at engaging the mind and building neural connections than more passive textbook study or memorization.

The testing effect: Answering questions — even answering incorrectly at first — is a useful way both to reinforce information already learned and to add to knowledge. This is the “testing effect” — whereby your recall is improved through the very act of testing yourself. It’s the active engagement with the material that aids memory and retention.

A new book written by New York Times science reporter Benedict Carey summarizes current scholarship on the science of study. How We Learn: The Surprising Truth About When, Where, and Why It Happens offers insights that apply to many learning scenarios, from your child in grade school through college to your own lifelong learning.

Is Your Internal Medicine Study Schedule a Sprint or a Marathon?

Whether your study schedule for internal medicine boards is shaping up to be a sprint or a marathon can inform how you apply these principles of learning and retention. The realities of your schedule, along with your own personal study habits, may determine your study style — whether you are likely to be a planner, a crammer, or an episodic studier.

Planners, for example, tend to be methodical and lay out a study plan far in advance. Those qualities are very useful. But these same individuals must be careful that their attention to detail doesn’t drive them to study in such depth that they never make it past the first few topics in their internal medicine board study plan.

Crammers, on the other hand, likely found success in medical school and beyond by muscling through at the last minute on sheer intelligence and focus. But on an exam of the breadth and complexity of the ABIM boards, crammers may be tripped up and overwhelmed by the large knowledge base required.

Episodic studiers benefit from the reinforcement that their spaced learning provides. But they may need a tool that helps keep track of what they have and haven’t studied so that they move systematically through their exam road map.

Your own personal style of learning and studying (whether you learn best by reading or listening, for example) also can be taken into account and adapted as you make a study plan for your own board preparation. The intensity of a multiday, in-person review course might suit a crammer’s schedule and intensity — but that won’t be helpful if that same person learns better by reading than by listening.

The Right Tools Lead to More Efficient Study

Instinct may draw you back to whatever study system helped you pass your initial certification, and perhaps decades of prior tests, too. But more of life’s distractions are vying for your attention now than during your training, and you probably have less time to study. New tools and technologies can structure your efforts, helping you make the most of every hour. Take advantage of the ones we’ve built into NEJM Knowledge+, including:

  • My Schedule: Recognizing that most of us are deadline-driven, NEJM Knowledge+ has a built-in schedule feature. It’s strictly optional. If you think the structure in My Schedule would help you, you can select the date of your exam or some other deadline of your own choosing and the system will recommend how much time to dedicate to board preparation each week. You can adjust your scheduled study time per week and continue to make adjustments as time goes on and your commitments fluctuate.
  • Self-Assessment Dashboard: A dashboard, seen only by you, shows how much you have covered in each internal medicine subspecialty. You also can view reports that show your progress through the subspecialty modules, your proficiency in them, and time spent. While this may be interesting to you — physicians like to know their own progress — you needn’t spend time planning out what to study next. Each learning module is arranged to test your knowledge of specific learning objectives. With the click of a button, you can review the learning objectives and answer short questions to bolster your knowledge in areas that are most challenging to you.
  • Recharge: This memory-refreshing tool chooses 20 questions for your review, tailored to your specific needs on the basis of your performance. Learning experts say that we tend to gravitate to the familiar when studying, potentially wasting time studying what we already know. Using the Recharge feature bolsters your less-solid areas while reinforcing areas of strength that you have not reviewed in a while. The adaptive learning platform chooses questions based not only on your past answers but also on your confidence level (determined by your own self-rating and time spent on specific questions).

Recharge also includes fill-in-the-blank questions, which require you to answer without the aid of a multiple-choice listing, another way to absorb what you are learning. We recommend using Recharge a couple of times per month — it’s a quick and rewarding few minutes that you can fit into your internal medicine board study plan no matter where you are in your week or in your study schedule. This is just one more way to maintain the neural pathways for rapid information recall, whether you are facing a patient or a board exam.

More from NEJM Knowledge+ and the Learning+ Blog:

What’s Your Study Style?

Best Learning Practices

More Board Review Resources

Physicians Forget: How Adaptive Learning Aids Physicians’ Long-Term Memory

What type of schedule or study habits have worked for you — or not? Share your tips, mis-steps, and personal best practices with colleagues, or ask for more suggestions.