The complex questions that appear on medical board exams pose challenges for every test taker — even those who are highly experienced. There are up to 70 questions in each 2-hour segment of an American Board of Internal Medicine (ABIM) exam, so you need to make the most of your time and knowledge. Taking practice exams will help you sharpen your approach so that you’ll be well prepared when taking the actual ABIM exam.

First, Know What You’ll Be Facing

Preparing for this exam requires a lot of studying and reviewing, so of course, it’s important to know which subject matter will be tested (see the ABIM exam blueprint section below). But knowing how you’ll be tested is also important, because that information will enable you to become comfortable with the testing method before the day of the actual exam.

Most medical certification exams, and all ABIM exams, are made up of multiple-choice questions. The majority are case-based scenarios that require reasoning and decision making. Each question has three distinct parts:

  • The patient vignette or question scenario
  • The lead-in or the question itself
  • The answer options, which include one correct answer and several distractors

Knowing to look for essential cues within each part of the question and applying specific strategies can help lead you to the correct answer.

Second, Practice for the ABIM Exam

There are two approaches to practicing for the ABIM exam. The first approach makes use of question banks, and the second involves the use of simulated, timed practice exams.

Question Banks

Question banks are available online from many educational sources. NEJM Knowledge+ makes use of an adaptive and customized learning system that helps you learn and retain a broad body of knowledge. It first tests your knowledge by presenting the most relevant and critical information in each specialty through a variety of question formats. Then, on the basis of your response times to questions and your reported level of confidence overall or by topic area (see chart below), it zeroes in on areas in which you need more study. It also reminds you to recharge your knowledge at optimal times.

Assess Learning

You can tailor your learning experience with the NEJM Knowledge+ system. Use the top slider (in the teal area) to rate your confidence in the specialty overall — and the other sliders to rate your confidence in specific topic areas within that specialty.

The questions in NEJM Knowledge+ Internal Medicine Board Review cover all the topics listed in the ABIM blueprint in roughly the same proportions you can expect to see on the ABIM exam. There are over 1,600 case-based questions, as well as shorter versions of these questions and also fill-in-the-blank versions. As learners complete each question, they have immediate access to key learning points, detailed feedback, and references.

Simulated, Timed, Practice Exams

To help you prepare for exam day, some educational sources offer useful practice exams that simulate the actual ABIM test environment. In addition, the ABIM has a 30-minute, maintenance of certification (MOC) exam tutorial that you can take online. After viewing case-related videos and/or figures, the tutorial asks you to diagnose each example case by checking off your findings under each of several tabbed categories. Taking the ABIM tutorial will help you become familiar with the MOC exam, which will greatly improve your efficiency on the day of the actual exam.

In addition, NEJM Knowledge+ offers two practice exams that have been designed to help you prepare for your actual ABIM board exam experience. Each practice exam contains 60 case-based questions similar to the format of the NEJM Knowledge+ Question of the Week.

The practice exams in NEJM Knowledge+ are meant to be taken in sequential order. It is suggested that you take the first practice exam at the beginning of your preparation for a board exam, and the other as you get closer to the actual exam date. While you’re taking the practice exam, you can skip questions and return to them later or change your answers as much as you want within the 2-hour time limit. Although you can pause the exam at any time, you’ll gain the most benefit from taking each test in a single sitting. When you complete the exam, you’ll be able to review the results and see your proficiency against the mean proficiency of your peers. You’ll also be given the option to enter a review mode in which you can see key learning points and get detailed feedback and citations for each question.

Timed exam_score report

Third, Know the ABIM Exam Certification/Recertification Blueprint

When taking an ABIM exam, it’s always helpful to know the makeup or blueprint of the test. What topics will be tested, and what percentage of questions will be chosen from each topic area? The ABIM has a complete list of all the exams and their blueprints.

In June 2015, the ABIM blueprint was updated to reflect changes to the Fall 2015 MOC exam. The contents of the internal medicine recertification exams and their relative proportions are as follows:

Medical-Content Category% of Previous MOC Exams% of Fall 2015 Exam
Allergy/Immunology2%2%
Cardiovascular14%15%
Dermatology3%3%
Endocrinology, Diabetes, and Metabolism9%10%
Gastroenterology9%10%
Geriatric Syndromes3%3%
Hematology6%4%
Infectious Disease9%10%
Medical Oncology6%6%
Miscellaneous2%1%
Nephrology/Urology4%6%
Neurology3%4%
Obstetrics/Gynecology6%3%
Ophthalmology1%1%
Otolaryngology/Dental Medicine1%1%
Psychiatry4%3%
Pulmonary Disease9%8%
Rheumatology/Orthopedics9%10%
Total100%100%

To see a general breakdown of topics covered under each category, go to:

Internal Medicine Certification Examination Blueprint (pdf)

Internal Medicine Maintenance of Certification Examination Blueprint (pdf)

What are your experiences with practice exams? Have they helped you prepare for the boards?