In 2022, the American Board of Internal Medicine (ABIM) began offering internists and other subspecialists the option of a longitudinal assessment as an alternative to the traditional ABIM Maintenance of Certification (MOC) Exam. At the same time, ABIM discontinued Knowledge Check-Ins. ABIM developed its Longitudinal Knowledge Assessment (LKA™) in response to feedback from diplomates and other stakeholders. To help you understand your MOC assessment options and requirements to ensure you maintain good standing, we put together this guide with everything you need to know about ABIM MOC requirements, the MOC exam, and the LKA™.

2022 ABIM Maintenance of Certification Requirements

2022 ABIM MOC Requirements: Earn points every 2 years, 100 points every 5 years, pass an ABIM assessment—the LKA or 10-year exam.

In addition to holding a valid, unrestricted, and unchallenged license to practice medicine in the United States, its territories, or Canada, Internal Medicine physicians must meet the following requirements to maintain their ABIM Certification:

  • Complete at least one (1) activity every two (2) years to earn MOC points.
    Points earned will count toward the five-year requirement of 100 MOC points (below).
  • Earn at least 100 MOC points every five (5) years.
    Twenty (20) of these points must be in the Medical Knowledge category.
  • Pass a MOC assessment:
    Option 1
    Pass the MOC Exam within ten (10) years of when you last passed.
    —OR—
    Option 2
    Participate in the ABIM Longitudinal Knowledge Assessment (LKA™) program over the course of five (5) years.

Both assessments have their own requirements and offer different benefits. The information below will help you decide which assessment is right for you.

ABIM MOC Exam

According to ABIM, MOC assessments, like the traditional ten-year exam, “evaluate whether a certified internist has maintained competence and currency in the knowledge and judgment required for practice.” The exam consists of single-best-answer questions that include a case history, an illustration or graphic, and multiple-choice answers. While the exam is challenging, 95 percent of first-time test takers passed the Internal Medicine exam in 2021. Below is an overview of key information about the ABIM MOC Exam:

  • The exam consists of case-based, single-best-answer, multiple-choice questions. On exam day, the test is broken into four sessions, each with up to sixty (60) questions. Examinees should strive to answer all questions as unanswered ones are scored as incorrect. They will have two hours to answer each set of questions. 
  • Exams are held at Pearson Testing Centers that offer private stations and in-person proctoring.
  • The test is open book: Examinees are provided with access to an external electronic reference.
  • Results are generally available within three (3) months of taking the exam, possibly sooner. If test takers are unsuccessful, they can retake the exam anytime it is offered.
  • Diplomates who have passed the exam will be reported as certified for ten (10) years. Those who do not pass will enter a one-year grace period during which they will continue to be reported as certified. They must retake and pass the exam before the grace period ends to maintain their certified status beyond the year.

Read our Guide for ABIM Recertification Exam Day to find great tips for success when taking the exam.

ABIM Longitudinal Assessment

The ABIM Longitudinal Knowledge Assessment (LKA™) is a new MOC testing option for board-certified internists that delivers a subset of questions every quarter over five years. Participants can access the assessment on any internet-connected device and take advantage of the same resources they use in professional practice, such as reference apps or books, except for another person. They can work on the assessment at the time, place, and pace of their choosing as long as they meet minimum participation requirements. Here are the fast facts:

  • The ABIM LKA™ will deliver thirty (30) questions per quarter for a total of 600 questions over five (5) years. Participants must attempt at least 500 of the 600 questions over the five (5) years, which allows them to skip 100 questions at their discretion. Four minutes are provided for answering each question. Participants also get an extra thirty (30) minutes yearly that they can add in one-minute increments if they need more time to answer a given question.
  • Examinees will have access to any resource used in their professional practice except another person.
  • Immediate feedback is given, including whether answers are right or wrong as well as rationales and references for further exploration. Beginning a year into the assessment cycle, diplomates will have access to score reports for understanding where they stand. After six months, they can access a list of the questions they have attempted along with answers and rationales, which they can revisit at any time.
  • The test is not proctored using a camera. Instead, participants sign a pledge agreeing not to obtain help from others or share any of the test questions.
  • At the end of the five-year cycle, participants who pass can choose to either start another LKA™ cycle or take the ten-year exam. Participants who are not successful with the ABIM LKA™ will enter a one-year grace period in which they will need to pass the exam if they want to continue to be listed as participating in MOC.

ABIM Blueprint for Internal Medicine MOC

The ABIM Blueprint for Internal Medicine shows the content topics and domains that are covered on both the ABIM MOC Exam and the LKA™, along with the relative distribution of questions across domains. The blueprint provides diplomates with a ‘roadmap’ of what to study and how much time to spend on each content category.

ABIM MOC Assessment Blueprint - Content Distribution

Source: ABIM (Click image)

NEJM Knowledge+ Internal Medicine Board Review is carefully mapped to the blueprint.

ABIM Exam Dates & Registration Deadlines

The ABIM MOC exam is generally offered in the Spring and Fall each year with registration opening in December the year before. Enrollment for the LKA™ also begins in December and ends on June 30th. Quarterly LKA™ questions are taken down at the end of each quarter, so questions that were removed prior to registration will be counted toward the 100 questions participants are allowed to skip during the five-year assessment cycle.

See our full list of ABIM Internal Medicine exam dates and registration deadlines for general internal medicine.

ABIM MOC Exam or LKA™

To help you determine which ABIM assessment option is right for you, we have compiled information in the table below for easier comparison.

Traditional ABIM MOC ExamLongitudinal Knowledge Assessment (LKA™)
QuestionsUp to 220 case-based multiple-choice questions broken into four sessions

Unanswered questions are scored

500/600: Diplomates can skip 100 questions during the 5-year period

30 questions per quarter over 5 years for a total of 600 questions, 500 of which will be scored

Questions that are opened will be scored

Open bookYes — Access to UpToDate®Yes — Any resources used in practice except another person
LocationPearson Test CenterAnywhere on any device with an internet connection
ProctoringIn-person proctoringParticipants are required to sign a pledge to keep questions confidential

There is no camera monitoring

Feedback/Results3 months or less to receive results

Test-takers will receive a score report showing results for each medical content area

Immediate feedback on questions: Which answers are correct, which are wrong, and rationales and references

Score reports are visible beginning in year 2 of participation

Final summative results available at the end of the 5-year cycle

TimeUp to 10 hours including 100 minutes of optional break time divided into 3 breaks4 minutes per question plus a timebank of an extra 30 minutes annually
CycleEvery 10 years5-year cycle of ongoing participation
Cost$700 for the exam plus yearly ABIM fees:

  • $220 per year for the first certificate and $120 per year for each additional certificate
  • 5% discount if paid in advance of the year it is due
Participation included with yearly ABIM fees:

  • $220 per year for the first certificate and $120 per year for each additional certificate
  • 5% discount if paid in advance of the year it is due
ABIM MOC Points Earned20 MOC points for every attempt 0.2 MOC points for every correctly answered question

Earn up to 24 MOC points per year (per certification)

NEJM Knowledge+ and ABIM MOC

With its high pass rate, many internists will prefer the one-and-done aspect of the exam, which allows them to prepare, take (and most likely pass) the exam, and then not worry about the assessment portion of MOC for ten years. Others will like the ongoing commitment to learning offered by the LKA™.

Whichever option diplomates choose, NEJM Knowledge+ Internal Medicine Board Review can help accelerate their learning to pass their ABIM MOC assessment, earn MOC Points and AMA PRA Category 1 Credits™, and engage in lifelong learning and practice improvement. 

Learn more about NEJM Knowledge+ Internal Medicine Board Review and how it can help you prepare for your ABIM assessment and meet your other ABIM MOC requirements.

Frequently Asked Questions

What is ABIM MOC?

The American Board of Internal Medicine (ABIM) requires its board-certified internists and other subspecialists to engage in lifelong learning and practice improvement through its Maintenance of Certification (MOC) program, which requires diplomates to 1) earn points every two (2) years by participating in a MOC activity; 2) earn at least 100 MOC points every five (5) years, including twenty (20) points in the Medical Knowledge category; and 3) pass a MOC assessment (either the ABIM MOC ten-year exam or the ABIM Longitudinal Knowledge Assessment or LKA™).

Is ABIM certification required to practice medicine?

While maintaining certification is not mandatory to practice medicine, many hospitals and other healthcare employers in the United States require ABIM certification. ABIM encourages physicians to participate in MOC as evidence of their commitment to lifelong learning and staying informed about the latest practices and treatments in medicine.

CME vs MOC: Are MOC points and CME credits the same?

Even though educational activities for physicians often provide both MOC points and CME credits, they are not the same. In most states, physicians are required to participate in Continuing Medical Education (CME) that earns CME credits to maintain their state medical board license. MOC Points, on the other hand, are used by medical specialty boards including ABIM to demonstrate that participating physicians are engaging in lifelong learning and staying abreast of the latest medical knowledge. Unlike CME, MOC points are not required to practice and tend to be specialty-specific.

With NEJM Knowledge+ Internal Medicine Board Review, physicians can earn up to 358 AMA PRA Category 1 Credits and 358 ABIM MOC Points.

How are Internal Medicine Physicians listed as participating in ABIM MOC?

Internists must earn points every two years to be listed as participating in ABIM Maintenance of Certification. To maintain certification, they must earn 100 total points every five years and meet a MOC assessment requirement. MOC assessment is available through the traditional ten-year exam or the Longitudinal Knowledge Assessment (LKA).

How long does ABIM certification last?

Internists who pass the traditional MOC exam will be reported as certified for ten (10) years. Physicians who are already certified and sign up for the new Longitudinal Knowledge Assessments or LKA™ will continue to be reported as certified during the five-year LKA™ period as long as they meet the participation requirements and all other MOC requirements. ABIM will determine whether participants have passed based on a performance standard at the end of the five-year period. If yes, then diplomates will remain certified, and the cycle begins again (or they can choose to take the ten-year exam).

How much are ABIM MOC fees?

ABIM annual fees are $220 for the first certificate and $120 per year for each additional certificate. Physicians receive a 5% discount if they pay their fees by December 31st of the year prior to when they are due. There will be a $40 late fee if they are paid after the due date. The cost for the ABIM MOC exam is an additional $700.

How are individuals with indefinite certification reported?

Diplomates with a certification that is valid indefinitely (certified prior to 1990) who do not participate in MOC program requirements will be reported as “Certified, Not Participating in MOC Requirements.” They will not be reported as “Not Certified.”

What is the ABIM MOC Exam?

The American Board of Internal Medicine (ABIM) Maintenance of Certification (MOC) exam is a summative assessment that measures whether internists and other subspecialists are keeping their medical knowledge current. ABIM diplomates who do not participate in the ABIM Longitudinal Knowledge Assessment (LKA) must retake the exam every ten (10) years to stay certified.

How long is the ABIM MOC Exam?

The ABIM MOC Exam takes approximately ten (10) hours to complete, including 100 minutes of optional break time.

How many questions are on the ABIM Recertification Exam?

The ABIM recertification exam has up to 220 case-based, multiple-choice questions that are broken into four two-hour sessions. Unopened questions are scored as incorrect, so examinees should strive to answer all of the questions.

What is a passing score for the ABIM MOC Exam?

366: According to ABIM, the score for the exam must be equal to or exceed the standardized passing score, which as of 2015 was 366.

What happens if I fail my ABIM MOC Exam?

Individuals who do not pass the ABIM MOC Exam will enter a one-year grace period during which they will continue to be reported as certified but must retake and pass the exam to maintain their certified status beyond the year.

How many MOC points are awarded for taking the ABIM MOC Exam?

Diplomates receive 20 ABIM MOC points for each attempt at the exam.

How many CME credits will be awarded for the ABIM MOC Exam?

Diplomates are eligible for 60 AMA PRA Category 1 Credits™ after passing the ABIM MOC Exam.

What is Longitudinal Assessment?

Longitudinal assessment is a formative method of evaluation, based on adult learning principles, that administers shorter, technology-enabled assessments over time to not only assess knowledge of the content but also facilitate learning and retention of the content.

What is the ABIM Longitudinal Assessment?

The ABIM Longitudinal Knowledge Assessment (LKA™) is a new testing format from the American Board of Internal Medicine (ABIM) that allows participants to answer questions incrementally and at their own pace. They can work on the assessment on any internet-connected device in any location using the same resources they use to provide care and treatment for patients except for another person.

What are the eligibility criteria for participating in the ABIM Longitudinal Knowledge Assessment (LKA™)?

Internists who are currently board certified, not in a grace period, meeting all other requirements of MOC, and in the year their assessment is due are eligible.

How many questions are on the ABIM LKA™?

The ABIM LKA™ consists of 30 questions per quarter over five years for a total of 600 questions, 500 of which will be scored. Participants may choose to skip up to 100 of the 600 questions over the five-year LKA™ cycle. If more than 100 questions are skipped or left unopened, they will be scored as incorrect.

What is a passing score for the ABIM LKA™?

ABIM has not provided a numeric passing score for the ABIM LKA™ but indicates that it will be determined based on a performance standard. Participants who meet the performance standard can start their next LKA™ five-year cycle. Participants who do not meet the performance standard but are adhering to all other MOC requirements will enter a one-year grace period during which they will need to pass the traditional ten-year MOC exam to stay certified beyond the year.

What happens at the end of the Five-Year LKA™ cycle?

At the end of the five years, ABIM will make a summative determination of whether the participant has passed. Participants who pass will continue to be reported as certified and can continue to participate in the LKA™ program for five (5) more years, or take the ten-year exam. Participants who do not pass will enter a one-year grace period and must pass the ten-year exam within that time.

Can I participate in the Longitudinal Knowledge Assessment (LKA™) if I have allowed my certification to lapse?

Physicians who have allowed their certification to expire can participate in the LKA™ but will remain reported as not certified until a pass-fail judgment has been made at the end of the five-year LKA™ assessment cycle.

What is the ABIM grace period?

The ABIM grace period grants physicians who attempted but did not pass the ABIM LKA™ or the ABIM Recertification exam an additional year to pass by taking or retaking the MOC exam. Physicians will continue to be reported as certified during the grace period as long as they adhere to all other MOC requirements.

What accommodations are available for the LKA™?

Information about accommodations offered by ABIM for the LKA can be found on the ABIM site.

For more information about ABIM MOC requirements, visit ABIM.org.