Product Overview

NEJM Knowledge+ Internal Medicine Board Review is designed to help you meet your certification requirements, prepare for board exams, and incorporate lifelong learning into your schedule more easily. The platform has five basic components:

  1. Learning, via the Specialty Modules
  2. Practice Exams
  3. Recharge
  4. Reports
  5. MOC/CME Center

The Dashboard

The Dashboard is your starting point every time you use NEJM Knowledge+.

Intenal Medicine Board Review Dashboard

It provides an overview of your performance on each of the features in the platform, as well as the easiest way to navigate to the features you want to use. On the Dashboard you can

  • SELECT from the available Specialty Modules. We’ve ordered them according to their relative size in our question bank and in the ABIM exams, but you can tackle them in any order you choose.
  • REVIEW your progress and proficiency overall and by specialty
  • TAKE Practice Exams
  • MONITOR your MOC and CME status in the MOC/CME Center

The menu at the bottom of every page allows you to

  • Navigate back to the Dashboard
  • Go to My Reports
  • Change your Schedule
  • Get Help
  • Learn more About Us
  • Contact Us
  • Search
  • Sign Out


Do not use the back button in your Web browser. Because NEJM Knowledge+ is an application, using your browser’s back button will cause it to close. Instead, use the teal “Back” and “Next” buttons in the platform (where available).

Don’t worry; if you use the back button and the application closes, your data will be saved. When you return to NEJM Knowledge+, you will be taken to the Dashboard.

Getting Started

Start in three easy steps.

Step 1: Use the calendar tool on the My Schedule screen to set a deadline

  • Enter the date you plan to take the board exam using the drop-down menu, set a different goal for yourself, or work without a deadline
  • With this date in mind, NEJM Knowledge+ will create a recommended study schedule based on the time remaining until your planned completion date and the amount of material an average user needs to cover
  • Follow our recommendation for time allocation, or adjust it yourself using the slider
  • You can change your schedule by going to My Schedule at the bottom of the page

Step 2: Select your first specialty from the list on the Dashboard

Step 3: Complete your Self-Assessment within the specialty by

  • Setting the top slider to indicate your confidence in the specialty overall, or
  • Using the individual topic sliders to indicate your level of confidence in each topic (which will adjust the overall)

Self-Assessment enables us to tailor your learning experience to you immediately. The system will then adjust these settings based on your actual performance.

The Self-Assessment is presented only the first time you select a specialty. It is used to optimize the initial set of questions you see. As you begin answering questions, the algorithm is continuously updated and questions are then served based on your performance.

How Adaptive Learning Works in NEJM Knowledge+

On the basis of the latest technological advances, our adaptive learning platform continually tailors your experience to your specific learning needs. NEJM Knowledge+ uses adaptive learning to ensure you don’t waste time on material you already know. Instead, the system responds to your performance by serving you material that helps you focus on those subjects where you need reinforcement and keeps you focused until you achieve proficiency. It is designed to help you retain knowledge better. For more information on adaptive learning in NEJM Knowledge+, watch this video.



To maximize your learning, NEJM Knowledge+ uses your initial Self-Assessment by specialty and by topic to create a baseline as you begin to answer questions. The adaptive learning technology at the core of the platform determines the order of the questions you will answer and continually adapts as you answer questions and improve your proficiency. This ensures a learning experience that is personally tailored to your needs and that helps you retain what you’ve learned.


To complete your Self-Assessment, select your confidence level by using the slider in the teal bar to rate your confidence in the specialty overall, or, for a more detailed assessment, use the sliders in the white area below to indicate your level of confidence in each specific topic area. The specialty confidence rating will adjust in relation to your assessment by topic.

Slide the bar to the left to indicate lower confidence. Slide the bar to the right to indicate a higher level of confidence.

To start learning:

  1. Select a Specialty from the Dashboard.
  2. Complete the Self-Assessment (if you haven’t already done so).
  3. Select Start and begin answering questions.

Answering Questions

  1. Read through the question
  2. For questions containing images, you can click or tap any image to zoom in.
  3. Select your answer.
  4. Submit your answer by choosing your level of confidence from one of the four choices: “I know it,” “Think so,” “Unsure,” or “No idea.” Your reported confidence helps the system adapt. The system will be more likely to serve you back questions where you had low confidence in your answer, even if you turned out to be correct. Your reported confidence also allows us to report on how your self-assessment matches your actual performance.

You will be presented with the correct answer, the Key Learning Point, a “More Details” link to detailed feedback, and a link to resources for further reading.

To return to the Answer and the Key Learning Point, select the teal Back button in the product (do not use your browser’s back button).

Question Sequencing

The system is designed to serve the most relevant and highest priority items early in the question stream for each specialty. These are the items, such as management of essential hypertension, that are core to internists’ knowledge and may seem relatively straightforward and familiar. The questions become more specialized and deal with issues that are less frequently encountered as you progress into each module.

Question Types

NEJM Knowledge+ uses multiple question formats. In the learning modules, you will see both case-based multiple-choice questions and short multiple-choice to ensure that your learning is maximized for long-term retention. In “Recharge”, you will see a third type of questions, the fill-in-the-blank question, which tests your recall without giving you answer options.

Additional Learning Material

The Key Learning Point explains the main takeaway from the case in a succinct sentence.

More Details provides you with detailed feedback on why the right answer is correct and why the other options are incorrect.

Clicking on Resources brings you to a list of citations for more information on the topic.

  • All New England Journal of Medicine (NEJM) sources cited within NEJM Knowledge+ can be accessed by clicking on the Free Full Text button which will open a PDF of the NEJM article referenced in a new tab in your browser. To return to NEJM Knowledge+, click on the appropriate tab in your web browser.
  • Citations to articles from other publications link to the article’s abstract in Medline in a new tab in your browser. To return to NEJM Knowledge+, click on the appropriate tab in your web browser.
  • If you are using NEJM Knowledge+ on the iPhone or iPad, links to the citations open in the Safari browser. To return to the app, double click on the home button of your iPhone or iPad and select the NEJM Knowledge+ icon again. You will return to the question you were on when you linked to the citation.
  • If you are using Android devices, a PDF file of the full-text NEJM article may be downloaded to your device, rather than displayed in a browser.

Challenge Us

One unique aspect of NEM Knowledge+ is that we have been actively keeping the knowledge contained in the product current. This involves reviewing and updating the questions and the feedback in response to new guidelines and other key developments, but it also means responding to user input through the “Challenge Us” feature. Use the “Challenge Us” button if you feel that the question, answer, feedback, or resources we provided contained an error or important omission. When you click “Challenge Us”, a pop-up text box will appear. Use the box to enter your challenge and hit “Submit.” We will review all challenges and make appropriate changes. We can’t respond to every challenge that we receive, but we do appreciate user’s feedback and help maintaining the currency and accuracy of our content, and we do try to respond where and when we can.



Refreshing your memory on material you’ve already learned can be as valuable as learning new material.

Recharge automatically selects 20 questions from areas you’ve struggled with or simply haven’t seen for a while — to reinforce your learning. Recharge draws from questions you’ve answered in the specialty areas as well as the Practice Exams (once you’ve taken them).

Because NEJM Knowledge+ builds a personalized Recharge experience based on your performance to date, you may begin to use Recharge once you’ve answered at least 20 questions.


In Recharge, you will see a new question format:

Fill-in-the-Blank Questions

These questions help you assess whether you’ve fully grasped a particular fact or concept by asking you to recall an answer without the aid of a multiple-choice listing. To answer a fill-in-the-blank question, type your answer into the gray box.

NEJM Knowledge+ is designed to accept many synonyms, abbreviations, acronyms, and even some misspellings. Of course, we can’t predict every possible correct variation, so if you type in an answer that you believe is correct and the system reports that it is incorrect, please select the Challenge Us button or Claim this as a Synonym button. Our editors will review your comments, and if your suggestion is appropriate, will add it to the list of acceptable synonyms or otherwise address any problem within the item.

You will only encounter fill-in-the-blank questions in Recharge mode.

Don’t hesitate to answer these fill-in-the-blank questions. This format is great for testing knowledge, but we won’t be including them in calculating proficiency ratings until the feature demonstrates sufficient reliability.

Progress and Proficiency

As you answer questions, NEJM Knowledge+ gathers data on your progress and proficiency. The system does this based on the learning objectives that underlie each question. In general, each longer, case-based version of a question meets a couple of distinct learning objectives (e.g., you might need to both recognize a diagnosis and know how to treat it), whereas the short multiple-choice and fill-in-the-blank versions each meet a single learning objective.


Progress measures the number of learning objectives you have achieved out of the total number there are throughout the product (your overall progress on the Dashboard), in a given specialty (also on the Dashboard) or in a given topic (in the Performance by Specialty/Topic report). This gives you a pretty accurate sense of how close you are to completing a given area. If you’ve spent an hour answering gastroenterology questions and your progress bar is one-third filled up, it will likely take another couple of hours for you to complete this module.


Proficiency measures how many learning objectives you’ve met out of the learning objectives you’ve seen throughout the product (your overall proficiency on the Dashboard), in a given specialty (also on the Dashboard) or in a given topic (in the Performance by Specialty/Topic report). This gives you a sense of how well you are doing.

Progress and Proficiency

Because the system is adaptive, your progress and proficiency scores will jump around a bit. However, as you get closer and closer to completing each module, both numbers should begin to converge toward 100%


Practice Exams

  • There are two Practice Exams in NEJM Knowledge+.
  • You must complete the first exam before you can begin the second.
  • If you are using NEJM Knowledge+ to prepare for a board exam, we encourage you to take one exam at the beginning of your preparation and the second closer to the exam date itself.
  • These Practice Exams are designed to simulate an actual board exam experience and to give you comparative performance information.
  • There are 60 questions in each exam.
  • Both are 2-hour timed tests. The clock appears in the upper right hand corner. You can pause an exam as often as you like, but for optimum benefit, we encourage you to carve out the 2 hours and complete each exam in a single sitting. To return to a paused exam, simply select it from the dashboard.
  • You may skip questions by clicking the forward arrow. You can return to skipped questions later with the reverse arrow or by navigating directly to that question via the numbered index at the bottom of your screen.
  • You may return to questions you’ve already answered and change and resubmit your answer as long as you have not closed the exam nor run out of time.
  • When you are finished taking the exam, click Close Exam. The exam will otherwise close automatically when your 2 hours have run out.
  • Once you complete each exam, you will be able to review the results and compare your score with your peers. You will also see an option for Review Mode to see how you answered each question and see the key learning point, detailed feedback, and citations, just like in the rest of the product.
  • You will see some of the questions you missed in the Practice Exams in Recharge.

Make time early on to take a timed, 2-hour, 60-question Practice Exam to see where you stand and compare yourself to your peers.


In addition to your Progress and Proficiency status on the Dashboard, NEJM Knowledge+ offers additional reporting.

Select the My Reports button from the bottom menu on any page.

Internal Medicine Board Review Dashboard

From any report page, you can use the navigation buttons on the right to switch to view other reports.

Internal Medicine Dashboard Reports

Report Options Include:

  • Specialty & Topic Performance allows you to view your performance by topic within each module. Each module that you have answered questions in is listed, with the following data: progress, total learning objectives, learning objectives remaining, estimated time remaining, and proficiency. You can expand any module in the list to see the same data by topic within that module, by selecting the green plus (+) sign to the left of the module name. See below for more details about this data reporting feature.
  • Practice Dimensions allows you to view your performance across population- and practice-based criteria such as patient age, clinical setting, chronicity, decision focus, and the ACGME competency categories. See below for more details about the data you’ll see in this reporting feature.
  • Most Challenging Learning Objectives provides you with a way to review the learning objectives tied to the questions that proved to be the most challenging for you. Select the green plus (+) sign to the left of the module name to display the learning objectives. You can then select the learning objective to review and answer those questions again.
  • Most Challenging Short Questions provides you with a way to review the short-format questions that were the most challenging for you. Click the green plus (+) sign to the left of the module name to display the question. You can then select the question to review and answer it again.
  • Confidence vs. Performance compares your actual performance with the confidence level you selected in answering each question. If you got the answer right every time you selected “I know it” when answering a question, you would have a score of 100% for “Aware that you knew the answer.” Similarly, if you selected “No idea” every time you got an answer wrong, you would see a score of 100% for “Aware that you didn’t know the answer.” The system also tells you how often you said you didn’t know the answer, but got the answer right, and how often you got the answer wrong when you thought you knew it. This helps to build metacognitive skills. The product overall helps you to become more aware of where you are over- or underconfident, and this report in particular shows you how often you are overconfident, underconfident, or appropriately confident. As you become more aware, your confidence should actually become more reflective of what you actually know.
  • The Score Report provides a way for you see your correct answer rate and metacognition within each module and topic. The report includes the number of questions answered, the number correct, the percent correct and the percent of “current unaware.” Click the green plus (+) sign to the left of the specialty to display score details by topic within the specialty.

Information Included in Reports

The Specialty & Topic Performance report and the Practice Dimensions report provide detailed information about performance:

  • Progress measures the number of learning objectives you have completed out of the total number in the product. This gives you a sense of how close you are to completing a given area.
  • Total Learning Objectives indicates how many learning objectives are available in a module or topic, or in a practice dimension category.
  • Learning Objectives Remaining shows you how many learning objectives remain. You complete a learning objective by answering questions correctly. Short questions have just one learning objective, whereas many case-based questions have two.
  • Estimated Time Remaining shows you approximately how much time it will take you to complete the learning objectives you have remaining. This estimate is based on your own progress through the learning objectives that you’ve seen along the way. The time is listed as hours: minutes (e.g., 05:22 is 5 hours and 22 minutes remaining).
  • Proficiency shows you what percentage of learning objectives you’ve completed out of the learning objectives you’ve seen while using the product. This gives you a sense of how well you are doing.


The search functionality in NEJM Knowledge+ allows you to find and review questions that you’ve answered already.

  • To find a question you’ve answered (whether your answer was correct or otherwise), click on Search in the navigation bar at the bottom of the screen, and enter a word or phrase from the question, answer options, or key learning point.
  • In search results, each question is shown with its related learning objective, to allow for easy review of the question’s topic. An indicator of the question format (case based, short, or fill-in-the-blank) will also appear.
  • Select any result in the list to preview the question in the Preview pane. Use the Go to Question button to retry the question and review the explanation text and resources.
  • Search results are limited to questions you’ve already seen in the product to maintain the unique features of NEJM Knowledge+.

Search tips:

  • Search will show only the questions you have seen already, so the more questions you answer, the more results will be returned.
  • The search algorithm will look for an exact match of the word or phrase, so if you aren’t seeing relevant results, try checking your spelling, entering fewer words, or entering synonyms for the word you’re looking for.
  • At present, the search function does not include practice exams that you’ve completed. To review questions you saw in a practice exam, you can go the Practice Exam Center and review all questions in a given completed test.



Setting a goal and committing to a schedule will help you optimize your learning. However, setting a schedule in NEJM Knowledge+ is optional. In order to use the schedule functionality, use the drop-down menu to set a deadline by selecting your exam date. Alternatively, use the calendar to select a different date. The system will use your exam date or deadline to recommend the number of hours per week you should spend using NEJM Knowledge+ for maximum efficiency. You can then use the slider to adjust the schedule to meet your personal needs. If you do not want to use the schedule functionality, deselect the check box on the bottom left of the schedule screen.



You earn MOC points and CME credits by answering questions correctly. Questions are repeated as you learn, giving you ample opportunity to earn the available points and credits.

The MOC/CME section on the Dashboard provides a summary of the points and credits you have earned.

Internal Medicine Board Review Dashboard Accreditation Center

Earning CME

All of our questions have been approved for AMA PRA Category 1 Credit. You receive one credit for every six questions you answer correctly. You can get the credit by answering the case-based question, short multiple-choice question, or fill-in-the-blank correctly, but once you’ve earned a partial CME credit associated with one form of a question, you can’t earn a partial credit again for answering a different form of the same question. In other words, if you first correctly answer the short multiple-choice format, you earn the associated CME credit, and you don’t earn any further credit for answering the fill-in-the-blank version.

Your Transcript

Select MOC/CME Center, and then select More Info under “Earning CME Credits.” Select your desired date range for the transcript, and then select “Print Transcript.”

MOC points

ABIM CME MOCSuccessful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 270 MOC points and patient safety MOC credit in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity.

How You Earn MOC Points

You automatically earn one MOC point for every six questions you answer correctly. You can earn credit by answering the case-based question, short multiple-choice question, or fill-in-the-blank correctly, but once you’ve earned a partial MOC point associated with one form of a question, you can’t earn a partial credit again for answering a different form of the same question. In other words, if you first correctly answer the short multiple-choice format, you earn the associated MOC point, and you don’t earn any further credit for answering the fill-in-the-blank version.
Internal Medicine Board Review MOC Center

When NEJM Reports Your ABIM MOC Points Earned

At the end of each day, your points will be automatically submitted to the ACCME as a batch. The ACCME automatically sends this data to the ABIM each night. You will see these updates listed as NEJM Knowledge+ Internal Medicine Board Review on your ABIM profile the following day. There will be one activity listed on your profile.

ABIM Reporting Requirements

To submit your points to the ABIM, we are required to provide both your ABIM number, and to ensure an exact match, your date of birth. NEJM Knowledge+ will keep this information confidential and secure, and we will not use it for any other purpose. You are continuously earning MOC points by answering questions correctly. If there are any problems with your ABIM data or transmission of your points, your points will remain secure in our platform until the issue is resolved.

When you sign in after purchasing the product, you may add your ABIM number and date of birth to your profile or you can also provide this ABIM number and date of birth later, by editing your profile.

Finding Your ABIM Number

You can search for and find your ABIM number at the ABIM website.

Editorial Process and Commitment

Our editorial process ensures each question is thoroughly scrutinized during multiple layers of review. Our goal is for every question to be accurate, relevant, and meaningful.

More than 300 authors and editors, all of whom are practicing physicians, take part in our rigorous editorial process.

  • NEJM Knowledge+ executive editor Graham McMahon, MD created a multidimensional series of scenarios derived from the ABIM blueprint of specialties and topics covered on the boards. Dr. McMahon associated each item with a defined series of patient characteristics (age, gender); medical condition (disease, acuity); practice environments, such as ambulatory care, intensive care, inpatient, and nursing home; competency, such as patient care and professionalism; and decision focus such as diagnosis, therapy, and interviewing.
  • Learning Objectives were matched to each of the scenarios, representing diverse areas of medical knowledge to ensure that the content reflects the topics covered in the board exams and situations that physicians regularly face in practice.
  • Groups of subspecialty fellows and attending physicians, chosen from centers for excellence in each area, wrote the questions and worked with their teams and the editorial staff to refine them.
  • Sixteen specialty section editors — acknowledged thought leaders in their fields — provided a completely independent review of each question, carefully examining questions for veracity, clarity, and relevance.
  • Internal medicine reviewers — general internists who are master clinicians and educators — were charged with evaluating questions for clinical relevance and verifying that the feedback was accurate and comprehensive.
  • Staff editors and proofreaders work with the NEJM Knowledge+ editor to bring all of the moving parts together in a clear, concise, and accurate product.
  • Our editorial process is free from outside influence. See disclosures for our authors and editors.
  • NEJM Knowledge+ content is updated as frequently as necessary. Our staff and editors constantly assess guidelines, new research, and user challenges to make content updates on an ongoing basis to ensure that the content is up-to-date and accurate.
  • We will contact you if feedback you’ve read is found to have contained an important error.

Hardware and Software Requirements

To access NEJM Knowledge+ Internal Medicine Board Review and NEJM Knowledge+ Family Medicine Board Review on your desktop, sign in through the profile page.

The desktop version is delivered through a browser window using HTML5.

Adobe Reader is required.


  • Google Chrome 30+, Safari 5.0+, Internet Explorer 10.0+, Mozilla Firefox 10.0+, Microsoft Edge
  • Recommended: Google Chrome 39+, Safari 7+, Internet Explorer 11, or Firefox 32+
  • Windows 7 (32-bit and 64-bit), Windows 8+. Windows 7+ is recommended.
  • Minimum 1 GB of RAM but 2 GB or greater is recommended
  • 2.33 GHz or faster x86-compatible processor, or Intel® Atom™ 1.6 GHz or faster processor for netbooks
  • Display resolution: 1024 × 768 or better

Mac OS

  • Google Chrome 14+, Safari 5.0+, Mozilla Firefox 12.0+
  • Recommended: Google Chrome 39+, Safari 7+, or Firefox 32+
  • Mac OS X v10.6+
  • Minimum 1 GB of RAM but 2 GB or greater is recommended
  • Intel Core™ Duo 1.33GHz or faster processor
  • Display resolution: 1024 × 768 or better


NEJM Knowledge+ apps are available for iOS and Android smartphones and tablets; Android phones may access NEJM Knowledge+ through our mobile-optimized browser version.

  • iOS devices running OS 7+(includes iPhone and iPad devices). iOS version 8+ is recommended.
  • Android version 4+ (includes smartphones and tablets). Android version 5+ is recommended. Note: Android phones will also support the browser version of each product (Chrome recommended).


We use log files to collect general data about the movement of visitors through the Site. This may include some or all of the following information: the Internet Protocol (“IP”) address of your computer or other digital device, host name, domain name, browser version and platform, date and time, and the files downloaded or viewed. We also use log files to collect and store information about your test progress and performance.

The Site also collects information through the use of “cookies” or similar technologies. Cookies are small text files that are downloaded to your device when you visit a website. Cookies allow us to recognize you when you return to our Site using the same computer and web browser. Cookies also help us to personalize your user experience and track Site activity.

Most web browsers automatically accept cookies. Browsers can be configured to prevent this, but if you do not accept any cookies from us, you will not be able to use the Site. The Site will function if you block third-party cookies.

Mobile Devices

NEJM Knowledge+ Internal Medicine Board Review is available as a free, downloadable app for the iPhone and iPad from the App Store, or for Android devices via Google Play.

NEJM Knowledge+ offers iOS and Android apps for our products. Only paid customers will be able to sign in to the apps. The experience on the iPad/tablet mirrors the full functionality of the desktop, while the iPhone/Android phone version is optimized for the smaller screen. The iPhone/Android phone apps do not include the MOC/CME Center, Accreditation Center, several of the available Reports, Search, and Practice Exams, but contain all of the adaptive learning material, including case-based and short-format questions, images, the Recharge feature that helps you retain what you’ve learned, and your Score Report.

Note: Android phones will also support the HTML5 version of each product.

You cannot use the smartphone app until you have set up your account using an iOS or Android tablet or on a desktop or laptop.

You can use NEJM Knowledge+ offline at any time, as long as you sign in while you are online. Your progress and performance, however, will only reflect what was available to the app the last time you had it open in an online state. In addition, whatever activity you engage in will not update to your other devices until you are have the app open and are back online. There are special steps you need to take to update the app. Syncing happens automatically once you have the app open and are online.

Syncing data

Account and Access Information

Duration of Your Access to NEJM Knowledge+ Internal Medicine Board Review

The purchase term is one year. You will have full access to the product and all of its features for 365 days from the purchase date. After your term is over, you will have read-only access to (and may print) the MOC and CME transcripts for 6 years.

Extending Your Access

You can purchase a one-year extension on the current version at a discounted rate at any time, up until a new version of Internal Medicine Board Review is made available. If you purchase an extension before your initial term ends, the extension term will begin when your initial term expires. You will not experience any interruption of service.

How to Update Your Account Information

To change your password, go to the Forgot Password page, enter your email address, and click “Continue.” We will send you an email with instructions for resetting your password. You will have only 10 minutes to reset the password via the link we send to you. If you’re not able to reset your password within that time frame, simply repeat the process at the Forgot Password page. Your password should be 6 to 20 characters long.

How to Change Your Password

To change your password, go to Forgot Password, enter your email address, then click “Continue.” We will send you an email with instructions for resetting your password.

Contact Us

Feel free to contact us at any time. We provide customer support 24 hours a day, 7 days a week, 365 days a year via phone and email.

Call us toll-free at 1-855-318-9303 (within the USA and Canada) or 781-434-7998. Or, send us an email at

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