With your ABIM exam approaching, you probably have questions about what to expect on that day. Even if you’ve been through this before, it’s been a while. We hope this guide with everything you need to know will alleviate any anxiety about the unknown and help you to be at your best.

How Long is the ABIM Exam?

The ABIM exam is up to ten (10) hours long, depending on how much time you use to answer questions and take breaks.

TutorialOptional, ≤30 minutes
Instructions and
Pledge of Honesty
Up to 10 min.
Session 1Up to 2 hours (max. 60 questions)
Break 1≤100 min. total for 3 breaks
Session 2Up to 2 hours (max. 60 questions)
Break 2≤100 min. total for 3 breaks
Session 3Up to 2 hours (max. 60 questions)
Break 3≤100 min. total for 3 breaks
Session 4Up to 2 hours (max. 60 questions)
Optional SurveyUp to 10 min.
Updated June 2023

ABIM Exam Format

The ABIM Exam format consists of 240 multiple-choice, single-best-answer questions. The test involves four two-hour sessions during which you will answer as many as 60 questions each. You will have the option of taking a break after each session and will be allowed up to 100 minutes of total break time.

Internal Medicine Exam — Logistics at the Testing Center

ABIM recommends arriving 30 minutes before your appointment time and warns that late arrivals risk losing their spot. So, be sure to double-check your appointment time, confirm the address of the testing center (some cities have multiple test centers), and allot ample time for driving and parking.

The Internal Medicine Exam is conducted at Pearson test centers. Upon arrival, you’ll receive the test rules to review, which will help orient you to the exam procedures. Be prepared to produce two forms of identification: The first must be a government-issued ID with a photo, such as a driver’s license, passport, or military ID. The second ID needn’t have a photo but must have a signature; examples include a Social Security card, ATM card, or credit card. The names on the ID cards must match the name that ABIM has for you.

What to Bring to the ABIM Exam

  • Two (2) forms of ID are required, as specified above
  • Nutritious snacks and drinks for breaks between sessions
  • Sweater in case you need a light layer while taking the test (outerwear is not permitted in the exam room)
ABIM Exam Day Checklist graphic—Before exam day; Morning of the Exam; During Exam

Tap the image and then right click to download the checklist.

Security in each test center is tight and multilayered

You will sign in on a digital signature pad, place your hand on a palm-vein scanner for biometric identification (or be scanned with a wand at some centers), and have your photo taken. The test room is continuously recorded with audio and video devices. Also, be aware that exams other than ABIM certification may be going on while you are there.

You’ll receive a key for a storage locker and be asked to store your belongings in it:

  • Purses, wallets, cell phones, pagers, and watches are not allowed in the testing room.
  • Snacks and drinks also go in the locker, which you can access during breaks.
  • Outerwear, such as jackets and coats, are not allowed in the testing room, but sweaters are permitted.
  • Earplugs or headphones to block out noise are provided on request, but you’ll be asked to leave your own (other than disposable earplugs) in your locker.

As you enter the testing room, you’ll receive an erasable board for notes. An administrator will escort you to your workstation and launch your exam. Once seated in front of the computer, you’ll be prompted to review exam and security rules and pledge to follow them.

Save Time and Mental Energy: Do the ABIM Exam Tutorial at Home

The next step is an optional 30-minute online tutorial that shows you the features of the exam. This tutorial is available on the ABIM website. Watching this in advance is a valuable 30 minutes of your preparation time.

Even if you are familiar with computer-based testing, the tutorial will help you acclimate before exam day. Being accustomed to the electronic features in advance is likely to increase your efficiency during the exam and to remove a potential source of anxiety that day.

Key features of the tutorial include how to make notes, change answers, flag questions to revisit later during the session and use the navigator window to see which questions you made notes on or marked for review. Other features let you highlight and strike-through content as you go. The tutorial also shows you a Session Review Screen, which is displayed automatically after you answer the last question in each session and lists any questions you left blank or flagged earlier for review. (Note that once time runs out on a session, you cannot return to the questions in that session.)

It’s ideal to watch the tutorial early on in your board preparation so that you have it in mind as you study and prepare. Then review it again shortly before exam day to remind yourself of simple essentials, such as how to access the calculator and the table of normal laboratory values. On exam day, it’s up to you whether to watch it again in the exam center or get right to the exam.

Answering ABIM Questions

All ABIM questions are multiple-choice, with one correct answer and four distractors. Each section is likely to have a mix of patient-based case questions, which predominate, and a few shorter questions that address specific knowledge points. Some questions may have figures, video, or audio (headphones are provided). A single question may have more than one figure or video, so be sure to view each one. ABIM also reminds you to watch each video to its completion, as there is no warning signal if you navigate away before it ends.

As you go through the exam, keep in mind these basic test-taking tips:

  • Answer every question, even if you must guess. This is a pass-fail exam based on your performance on the entire exam. Unanswered questions are scored as incorrect.
  • Don’t get bogged down with a single question. If you’re spending too much time on one question, make a good guess, flag it for later in the session, and move on.
  • Don’t flag too many questions per session, or you won’t know which ones to prioritize if you have time at the end.
  • For the short questions that are not case-based, you likely will know the answer outright or you won’t. If in doubt, apply the standard strategy of eliminating answers you know are wrong, then make your best guess among those remaining.

For specific strategies to help you address the complex case-based questions that make up most of ABIM exams, see “Strategies for working through ABIM board questions.“”

ABIM exam day — 5 Ways to Manage Anxiety while taking the ABIM exam.5 Ways to Manage Anxiety While Taking the ABIM Exam

  1. Utilize Time-Tested Strategies. Although physicians are veteran test-takers, a little anxiety is to be expected. You can always count on the tried-and-true tactics for reducing stress: Get a good night’s sleep (or two) beforehand, dress comfortably, plan your route and parking ahead of time, arrive early, and know your tools and resources.
  2. Go in with a plan to pace yourself. Each testing room has a wall clock. Your computer screen also has a clock icon that indicates the time remaining in the session and that turns yellow to warn you when just 5 minutes remain. A “progress indicator” on the screen shows which item you are on and the total number of items in the session. Both the clock and the progress indicator can help you pace yourself — but if you find these desktop reminders more distracting than helpful, you can turn them off.
  3. Check your progress every 20 minutes to make sure you are on track during the session. If you find yourself ahead of your intended pace, force yourself to slow down. It may be that you are simply a brilliant exam taker, but it’s possible that you are not reading each question carefully enough.
  4. Remember that it’s okay not to know everything. Every exam is intended to have a mix of hard and easy questions, which is part of the science of exam creation and best practices in testing. Your exam may also include some “pretest” questions that will not count toward your score; you won’t know which ones they are, but these questions are being tested for use in subsequent exams. You also will not know going into the exam what percentage of correct answers you need in order to pass. ABIM notes that the minimum passing score reflects an absolute standard for that particular exam, and it depends partly on the mix of questions and their difficulty.
  5. Take advantage of scheduled breaks. Between the 2-hour sessions, you may leave the test center for a meal or snack or to stretch your legs. This is a good opportunity to take a brisk walk to alleviate test day stress. It is also a good time to drink some water, but try not to overdo it to avoid needing a bathroom break during a test session. If you do need an unscheduled break during one of the sessions, your raised hand will signal the proctor to help you pause the exam, but the 2-hour clock for the session continues to run. During breaks, avoid talking about the test with others, and especially do not rehash any particular questions. Neither you nor your colleagues will have an accurate recall of the question details, and discussing them could distract you and undermine your confidence for the next session.

ABIM Exam Test Results

You may notice that some people receive a scored report upon exiting. ABIM test-takers will not. Typically, before ABIM test reports are processed, a psychometric analysis is performed on exam data to delete any questions that did not perform well and to establish a minimum passing score. Within three months of the exam (but often earlier), you will receive an email notification that your results have been posted on the ABIM website where you can log in to learn your pass-fail status. Your scored report will come through the mail, with a breakdown of how you fared by specialty.

Good luck to all ABIM exam takers! Please take a moment to share below any tips that helped you prepare for and take the ABIM exam.

Discover how NEJM Knowledge+ Internal Medicine Board Review can help you prepare for and pass your exam, earn MOC Points and CME credits, and improve your internal medicine practice.

Additional ABIM Exam Resources