While you juggle third-year residency and plan your next career step, “study for boards” may drop to the bottom of your to-do list, despite its importance. Then, as the year winds down and the date looms for your internal medicine certification exam, many third-year residents feel overwhelmed by the high stakes and embark on intense studying.
But you can take a more expedient approach to the next several months. The key? Regard every day of your residency as a study tool. With a few small adjustments of habit, you can make your time on the wards more rewarding, with a big payoff when you take the exam.
Our brains acquire and retain knowledge best under certain conditions: when we need the knowledge at that moment in time and when the new information has context. This has significance for you over the next several months. Patients you see each day can lead you to the knowledge that you need to pass the internal medicine certification exam. In the process, you can balance formal “studying” with daily opportunities in patient care for building and consolidating your knowledge.
Consider this routine interaction: A 45-year-old patient asks when he should begin colon cancer screening. It’s on his mind because his father was diagnosed with colon cancer at age 42. You look up the most current guidelines and direct him to an answer. In the moment, the information has immediate relevance and context for you. You associate this knowledge with the patient, and it sticks with you.
An ideal thought process after every patient encounter is to ask yourself, “What is the main clinical point of what I just did or observed?” Next, you can take another mental step to put that patient scenario in context with the disease state you are addressing. The final, critical step is one you should take shortly afterward: Read relevant content.
Nightly Reading Consolidates Knowledge for the Internal Medicine Certification Exam
Experienced medical educators offer third-year residents simple advice: Read, at the end of every work day. Turn to relevant literature while a patient interaction is fresh in your mind. You may not have the time (or the specific need) for this at the bedside moment. But later that day, while the day’s cases are still fresh in your mind, seek out information that relates to clinical scenarios you encountered.
“This means that when you are in the ICU and you have an intubated patient, read about how to help your patient with ARDS or best practices to prevent ventilator-associated pneumonia. In a general medicine rotation, when you are caring for a patient with Clostridium difficile, read about the best treatment options and the latest studies to prevent a recurrence,” says Chris Smith, MD, director of the internal medicine residency program at Beth Israel Deaconess Medical Center and deputy reviewer of NEJM Knowledge+ Internal Medicine Board Review. Seek out review articles, clinical studies, guidelines, case reports, and learning modules relating to what you saw that day, he advises. Any materials that are in sync with the day’s cases will help you build a scaffolding of knowledge. Dr. Smith also recommends accessing board review question banks and working through related questions for further clinical context and review while the topics are top of mind.
After counseling your patient on colon cancer screenings, for example, you could read the guidelines again to review their application to the broader population. This is the ideal reinforcement to consolidate and retain knowledge. You are more likely to remember this information while your mind is open to the topic of colon cancer screening, with the context of a real patient scenario in mind, than if you were to study the guidelines during a cram session a few months later.
By making this reinforcement of knowledge a daily habit, you will consolidate and build knowledge. With the C. difficile patient on your general medicine ward, for example, you would think about how to treat the patient now and expand your learning by asking yourself (and reading up on) what you would do if this recurred. While you are indeed memorizing facts, you are also actively learning in context, which helps expand the depth and breadth of your understanding of the topic. Learning this way aids in complex decision making that contributes to good patient care. On the ABIM certification exam, most of the questions mirror this multistep decision-making process.
Even confident, successful test takers — and especially those who tend to put off “studying” — will find themselves well served by the habit of daily reading and reflection.
Use Your In-Training Exam as a Guide for the Internal Medicine Certification Exam
The in-training exam that is given by most residency programs during year 2 to gauge progress in training also can serve as a guide and an opportunity. Residencies use the exams to evaluate their programs and identify areas for program improvement. Because the exam is mapped to the blueprint for the ABIM internal medicine certification exam, your personal results may provide insight into your areas of strength as well as those that need attention — particularly because your results show your performance in the 11 major content areas and list questions you answered incorrectly.
If you did poorly on your in-service exam, don’t panic. But do take the time to assess what went wrong and how you can correct it. Ask yourself:
- Was that one day an anomaly? Were you fatigued or distracted? Or, is this a true pattern for you as a test taker?
- Have your more recent rotations bolstered your knowledge in areas that were weak?
Try taking another in-training exam (which may be allowed at the discretion of your program director) or trial exam through a board prep product to get yourself on track and for a realistic view of your strengths and weaknesses. It may bolster your confidence. You may be surprised by what you have learned during the past year of patient care.
When it comes to the internal medicine certification exam, some new doctors feel overwhelmed by the vast amount of reading they think they must tackle and by the many options for studying. Daily, targeted reading in tandem with patient care will help. But a study plan also is important.
Take a Strategic Approach to Studying for Your First ABIM Certification Exam
Whether your experiences as a student characterize you as a crammer, planner, or episodic studier, you will need a study strategy for the months ahead. Start by thinking about what has worked well or poorly for you in the past. Even if you’ve always gotten by with cramming, it’s worth considering whether this is a realistic strategy given the complexity and breadth of the internal medicine certification exam. Take into account how an ABIM certification exam may be different from other tests you’ve taken. While matching your study style with certain tools is helpful, nearly every strategy will share these common steps:
- Take a practice test to assess your areas of strength and weakness.
- Become familiar with the ABIM blueprint for the internal medicine certification exam.
- Focus your review efforts on topics that make up a significant portion of the ABIM exam but are a weakness for you.
- Assess which study tools and strategies have worked for you in the past and what additional options are available for the ABIM certification exam.
- Make a plan for how you will study and review a few months before the exam. Then, stick to it.
Throughout this process, it is important to remember that a one-day, multiple-choice test is not the ultimate statement on whether you are a good or a bad doctor. “I know people who have great mastery of knowledge, who have excellent bedside manner, and you’d want them for your doctor — but they struggle with exams,” says Dr. Smith.
Even so, being able to show mastery of knowledge in this multiple-choice format is still an essential step in your career. A good review plan, study aids that work for you, and the determination to stick with it for the next several months will go far. As you look ahead to the exam, don’t overlook the opportunities to build and reinforce knowledge in your daily work. Every day and every patient interaction — bolstered by daily relevant reading — prepares you for your boards.
Mark your calendar to register for the Internal Medicine Certification Exam. Registration begins December 1 and runs through February 16 (with late registration through March 1, 2015). To schedule your exam, register at the ABIM website. The exam is administered in August, 2015.
Where Does NEJM Knowledge+ Fit In?
NEJM Knowledge+ offers relevant and digestible explanations on every case-based question, with links to useful source material. And, you can work your way through each specialty module as you encounter it in your rotations. For example, if you are on an endocrinology rotation, you can skip right to that specialty module in NEJM Knowledge+. The system adapts to your performance and prioritizes the most relevant questions, based on your own confidence indicators, and you can revisit questions you struggled with by using the “most challenging learning objectives” report.