I have been a board-certified gastroenterologist since 1977. Last fall, I decided to register for the internal medicine exam even though I was not required to do so at the time because I was “grandfathered in.”

A renewed interest and emphasis in general medicine had been spreading in my practice, and I felt the need to keep up with medical knowledge in order to provide up-to-date care.

At the time, the American Board of Internal Medicine (ABIM) allowed physicians who had been board certified and practicing since before 1990 to keep their certification status without undergoing the rather onerous Maintenance of Certification (MOC) process. Now, of course, the ABIM has reversed that decision and asked all physicians, regardless of age, to keep up with MOC and to take the exam.

My Experience Preparing for the Internal Medicine Exam

Last fall, when I had made the decision to recertify, I intended to prepare for my internal medicine exam either by spending around $1000 on a crash board-review course or by buying some review books.

Then NEJM Knowledge+ came along and I volunteered to be a beta user. The time and expense involved in travelling to a board-review course held no attraction for me, and I wanted a change of pace from print review products.

I can access NEJM Knowledge+ via my computer or certain mobile devices, so it seemed like a great alternative to the two study options I had been considering.

The Advantages of Adaptive Learning

The adaptive learning technology behind NEJM Knowledge+proved to be a practical and efficient way to review for the internal medicine exam. I found it to be more relaxing than working with test-review books. I liked that I could test myself, then jot down specific areas for more in-depth review. The system is both effective and easy to use.

It also presents a good mix of easier, medium, and difficult questions. If you answer incorrectly or with low confidence, it continues to show you the same questions until you demonstrate proficiency. I found that, by the second or third time I saw a question, I knew the correct answer and could feel confident about my answer.

Finding Out What I Didn’t Know

As I was going through the subspecialty modules in NEJM Knowledge+, I found there were gaps in my knowledge – things I knew less well than I thought I did. I needed to find out what these missing areas were and master them before the internal medicine exam.

With each question, the system asks you to rate your confidence in your answer. The confidence-rating options are:

  • Know it
  • Think so
  • Unsure
  • No Idea

I found that I rarely chose “No idea,” because I always had some inkling or educated guess. Nevertheless, the NEJM Knowledge+ system continually strengthened my sense of what I really knew and what I needed to research and review more.

Targeted Feedback Helped Me Learn Quickly

Detailed feedback on each question — explaining why the answer options are right or wrong for a given case or situation — gave me enough information to understand both the cases and the various answer options.

Although I have yet to make extensive use of the extra resources (such as journal citations) embedded in the NEJM Knowledge+ environment, I can see myself going back through and clicking on these links to access the New England Journal of Medicine and other top medical journals, so that I can increase my knowledge further on particular conditions and sets of treatment options.

My Progress Over 16 Weeks of Study

Because of the adaptive nature of the program, the pace of the learning will vary for each learner. I personally spent about 2 hours three or four times each week over the 16 weeks I studied. This is probably similar to what I would have spent using books alone, with or without a review course. It took me roughly 1 to 2 hours to complete the dermatology module.

It was also nice to be able to track my progress as I went along. I used Recharge (the personalized review feature) twice in the 16 weeks I was studying and found it helpful for reinforcing my memory.

Practice exams were also quite helpful as they afforded me opportunities to work through board-style multiple-choice questions in a format similar to what I encountered on the internal medicine exam.

My proficiency went from 60% initially to 80% after using the platform for 16 weeks in total.

• • •

I took my internal medicine exam on May 5, 2014. The exam was thorough but reasonable. I felt well prepared by using the NEJM Knowledge+ tool, and I would recommend it to anyone planning to take the internal medicine board exam.

Philip E. Schweitzer, MD, is a practicing gastroenterologist and member of the group Gastroenterology and Liver Associates of Riverdale in the Bronx, New York. He is an American Gastroenterological Association Fellow, a clinical instructor of gastroenterology and liver diseases at the Albert Einstein College of Medicine, and is board certified in gastroenterology and internal medicine.