We want to be your partner for success in board review and in passing the Internal Medicine Board Exam. So, we’ve put together this quick Q&A guide with everything you need to know about the ABIM Board exam or Maintenance of Certification (MOC) exam.

What is the Internal Medicine Board Exam?

The Internal Medicine board exam and Maintenance of Certification (MOC) exam are standardized tests administered by the American Board of Internal Medicine (ABIM) to evaluate the competency, skills, and knowledge of physicians who have completed their internal medicine residency. The exam covers a broad range of topics within internal medicine including cardiology, endocrinology, gastroenterology, hematology, infectious diseases, rheumatology, and more. It is made up of multiple-choice, single-best-answer questions that test both factual knowledge and clinical judgment.

Internal Medicine residents must pass this rigorous examination to become ABIM board certified for the first time. Internists who have been previously certified will need to pass the exam again every ten years OR successfully participate in ABIM’s Longitudinal Knowledge Assessment (LKA™) to remain certified.

**There are additional certification requirements including but not limited to holding and maintaining a valid, unencumbered medical license.

Internal Medicine Exam or LKA? Your Assessment Options

Internal Medicine physician with his hands around a heart.If you’re an internist who has never been certified by ABIM, your only assessment option is to take the ABIM exam. If you have been previously board certified, you have two options for MOC: 1) Take the traditional ABIM exam every 10 years, OR 2) Participate in ABIM’s Longitudinal Knowledge Assessment (LKA™). Many internists opt for the “pass it and forget about it” nature of the exam as they will only need to worry about it once every ten years. Others will prefer the challenge of continually engaging with questions by participating in the LKA.

For complete information on maintaining Internal Medicine Certification, take a look at our Guide to ABIM MOC Requirements.

What is the Structure of the ABIM Exam?

The structure of the ABIM Exam, which is administered via computer at Pearson Vue testing centers, entails a maximum of 120 questions, all of which are multiple-choice with a single best answer. If you’re a first-timer, your exam will be “closed book” and you will not have access to resources. If you are recertifying, your exam will be “open book” and you will have access to an external electronic reference. The exam is broken down into four separate sessions, each allowing you a two-hour window to tackle up to 60 questions. You will have an overall allotment of up to 100 minutes total break time to use between the sessions. Learn more about what to expect on exam day with our Survival Guide for ABIM Exam Day.

How long is the ABIM exam?

You should expect to be at the exam center for up to 10 hours, depending on how long you take to answer each set of 60 questions and how much break time you use.

Internal Medicine physician standing next to the ABIM Blueprint.ABIM Blueprint — What Content is Covered on the Internal Medicine Exam?

The topics you’ll see covered on the Internal Medicine exam are based on the ABIM Blueprint. Questions are designed to assess your knowledge about Internal Medicine as well as diagnosing and treating common conditions and recognizing ones that require referral to a specialist. To learn about the ABIM blueprint — the document that guides the ABIM in exam development — please see our ABIM exam blueprint page.

How many questions are on the ABIM Exam?

The ABIM exam contains up to 240 case-based multiple-choice, single-best-answer questions. You’ll have an average of two minutes to answer each question. One of the best ways to prepare for tackling exam day questions is with an Internal Medicine question bank. To learn more about why answering questions is the go-to study strategy for Internists, plus get information on selecting an IM QBank, read our article, Internal Medicine Question Banks — Which One is the Best Option for You?

What types of questions are on the ABIM Exam?

The test is made up of multiple-choice questions (MCQs). Each MCQ consists of a brief statement, case history, and sometimes a graph or picture, followed by a question and a list of possible options. You must choose the one answer that is better than the others; keep in mind, though, that other options may be partially correct.

How do I register for the ABIM exam?

You can register for the exam through your Physician Portal on the ABIM website. (You may need to create an account if you haven’t already.) After finishing the registration process, you will be directed to Pearson VUE’s platform where you can set up your appointment for exam day.

Internal Medicine exam cost: Internist handing out hundred dollar bills.How much does the ABIM Exam Cost?

The initial Internal Medicine Certification Exam costs $1,430. The MOC exam costs $700. The initial certification exam also includes a non-refundable late registration fee of $400. So, be sure to sign up for the exam in time! (See deadlines below.)

Where Can I Find ABIM Exam Dates?

Find exam dates and registration deadlines for the ABIM exam and LKA here.

Will I earn ABIM MOC Points?

If you’re recertifying, every attempt at taking the ABIM MOC exam earns you 20 MOC points. If you want to learn more about maintenance of certification and earning MOC points, see our comprehensive guide: ABIM MOC Requirements.

What is the ABIM Passing Score?

According to ABIM, the score for the exam must be equal to or exceed the standardized passing score, which as of 2015 was 366. ABIM exam questions include patient vignettes and are multiple-choice, single-best answer questions. Since unanswered questions are scored as incorrect, it’s essential to answer every question, even if you have to take an educated guess. Be sure to develop essential Strategies for Working Through ABIM Questions before exam day.

What is the Internal Medicine Board Exam Pass Rate?

In 2022, the Internal Medicine Board exam pass rate was 87 percent, which is a decline of six percentage points from 2020. While we don’t have definitive reasons for why the pass rate is declining, factors associated with failing the ABIM exam include starting residency training at an older age, lower scores on the Internal Medicine In-Training Exam in the first three years, and lower scores on the USMLE Steps 1, 2, and 3. If any of these factors apply to you, don’t despair! NEJM Knowledge+ Internal Medicine Board Review can help you prepare and gain the confidence you need to pass. Learn how NEJM Knowledge+ improves test scores.

How Long Do I Need To Study for the ABIM Exam?

All internists are different, but most will need to spend between 175 and 225 hours studying to pass the ABIM exam.

Internal Medicine physician next to digital medical and science icons including hearts, DNA, a hydrogen atom, test tubes, and human avatars.How hard is the ABIM exam?

Because of the complexity of the questions, the ABIM exam might arguably be the toughest test physicians encounter in their professional journey. The exam’s case-based questions demand complex clinical decision-making and two steps of logical reasoning: diagnosing first, then determining the best next action. But with the right preparation and focus, there’s no need to be daunted by the test.

What if I Fail the ABIM Exam?

First, try to set this notion aside and focus your energy on preparing for the test. One of the best things you can do to be successful is to reduce your anxiety about failure. And the best way to reduce that anxiety is to create a solid plan. Start by reading our blog post, ABIM Study Plan: Create Your Roadmap for Passing the Internal Medicine Certification Exam.

But, in the unlikely event you don’t pass the ABIM certification exam on the first attempt, you’ll get two opportunities to take the test again. And if, in the even more unlikely event you don’t succeed, you’ll be able to try again in a year. As long as you don’t give up, you’ll get through this!

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Additional Internal Medicine Board Exam Resources