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How to Study for and Pass the Internal Medicine Boards
As the ABIM internal medicine board exam approached, we received a large number of emails from our subscribers asking us for suggestions on how best to study for the boards. The truth is, there is no one-size-fits-all path to success, although there are certainly ways to increase your likelihood of passing. Regardless of whether you are preparing for board certification or trying to achieve maintenance of certification (MOC), the best tried and true general method is to “study early and study often.” Here are the possible strategies and tactics (in no particular order) to pass the ABIM board exam:
1. Know the basic concepts of the internal medicine board exam
This is obvious, but many people simply do not review this before starting their exam preparation and rely on their ABIM study source to provide the information.
- Review the ABIM exam template and understand the topics covered in the exam
- A large percentage (33%) of the examination is composed of cardiovascular diseases, gastroenterology and pulmonary diseases.
- More than 75 percent are based on patient presentations; most take place in an emergency or emergency department; others are primarily in hospital settings, such as the intensive care unit or a nursing home.
- Although not a large part of the exam, be prepared and expect to interpret some graphic information such as electrocardiograms, radiographs, and photomicrographs (eg, blood films, Gram stains, urine sediments).
2. Use the training exam as a starting point
If you’re a resident, the Internal Medicine training exam is a good starting point to see where you stand. It is simply that: a barometer of where you stand. It will give you an idea of where you might be weak and where you might be quite strong. It will also give you an idea of how you compare to your peers. Don’t alter your ABIM study plan simply based on it, but it does give you an initial metric of areas to focus on.
3. Get a study guide to prepare for the ABIM exam
It is important to have a good study guide that is tailored to the exam. Some of the most popular and effective guides we have found are the books MedStudy Internal Medicine Board Review and Harrison’s Principles of Internal Medicine Board Review.
4. Join a study group
Study groups, if used correctly, are particularly effective because they allow you to learn from your peers and other examiners. Often, people will form study groups with their peers (ideally limited to 3-4 people) in their residency program. Tactics to use in ABIM study groups may include:
- Focus on one new internal medicine category per week. For example, focus one week on cardiology and the next on pulmonary care. The exam can be divided into a dozen categories (see the ABIM exam template). Most subspecialty questions on the Internal Medicine board exam will focus on cardiology, gastroenterology, and pulmonary care. However, don’t neglect the other areas as the ABIM wants to ensure that internists have a broad base of medical knowledge.
- Test each other with internal medicine questions you’ve written yourself. We firmly believe in the philosophy that the best way to learn is to teach. If you help others learn, your knowledge of medical concepts will be greatly strengthened.
We recognize that joining a study group is often not feasible, especially for those who are no longer in residency programs where everyone is preparing for advice. Fortunately, we live in a digital age where being part of a study group is much easier. You can connect with colleagues through Skype, Google Hangout or other channels. One of our favorite approaches is to stay informed and learn through the power of social media, particularly Twitter. In a previous post, we highlighted great Twitter handles to follow for ABIM exam review while preparing for certification. If Twitter isn’t your cup of tea, you can also connect with your peers through the Knowmedge ABIM community on Google+. Regardless of the approach you decide on, studying alongside others who are preparing for the same exam is a great motivational tool for success.
5. Get a question bank that suits your personal needs
What is the value of an Internal Medicine question bank? This is a discussion near and dear to our hearts, of course. Question banks have become a popular tool because they gather a lot of material into one question format and help create a test-taking environment. There are many question banks to choose from, so what should you look for in a qbank ABIM?
- High-quality ABIM-style questions in an exam-like format: The exam is mainly filled with clinical vignettes and also has simple questions. At a minimum, the ABIM exam question bank should have these two types of questions. Quantity is important, but the quality of questions and explanations is much more important.
- Detailed explanations that review why the wrong choices were wrong: A question bank that doesn’t give you detailed explanations is probably not worth the money and time spent. As you go through the questions, you will inevitably make mistakes – your choice from the ABIM question bank should detail why your choice is wrong and the reasoning behind the right choice.
- Ability to track your personal performance: Your choice of ABIM qbank should be able to tell you your performance overall and by category. Most question banks, not all, give you a panel broken down by category. The Knowmedge question bank has taken an additional step to break the categories into sub-categories as seen in the ABIM exam template. This allows you to review your strengths and weaknesses at a granular level. Knowing you are weak to cardiovascular disease is great; knowing that you are weak on arrhythmia questions is more valuable.
- Add-ons – Notes, laboratory values, highlighting: Depending on how you study, these can be valuable features.
ABIM direct conversation exam questions:
- No question bank – not MKSAP, not Knowmedge, not anyone – knows what will be in the actual ABIM exam. Based on the ABIM Plan, you can make assumptions about what are the highest performing areas to study. The purpose of a question bank is not to give you the exact questions that will be on the exam, but to teach you concepts that you can see on the exam and how to reason about what you don’t know immediately.
- High quality ABIM exam review questions can be found in many places; question banks are not the only place. There are study guides, books, and even free fonts. So don’t simply base your question bank decision on the questions. Besides the quality of the questions, what really sets one ABIM exam question bank apart from another is whether it will really help you build a broad knowledge base and retain the information for the exam. If you’re not comfortable reading a bunch of text, it won’t matter how great the questions are. If you’re not an audio-visual learner, Medstudy or Knowmedge videos won’t do anything for you (for clarity, the Knowmedge qbank contains text and audio-visual explanations for this exact reason). If you are an “old” student who prefers prints (USMLEWorld is definitely not for you), those who have used them know well that their software will prevent you from printing screens or copying its content. In short… don’t follow the herd – each of us learns differently and you should choose the best method for you.
6. Consider whether a review course is right for you
There are pros and cons to taking a review course for ABIM exam preparation. The pros are that it gives you a serious dose of revision in a short period of time. Focus if I wasn’t focused and some courses are absolutely great; we know that some internists are ardent supporters of some of the professors who teach these courses. The three most popular independent courses we know of are:
- Awesome Review of Dr. Habeeb Rahman – The most well-known and popular independent course. Dr. Rahman has a very unique teaching style and accompanies his lectures with his own videos. During this six-day course (Sunday to Friday), Dr. Rahman provides students with their own set of notes and practice questions.
- iMedicineReview by Dr. Shahid Babar – This three-day course (Friday, Saturday, Sunday) includes a set of 1,500 review questions.
- Unique course of Dr. Satish Dhalla – A six day course (Monday to Friday) taught by one of the Main Internists of the Nation as selected by US news
The downsides to a review course are that they are expensive (often over $1,000 plus hotel stays) and can be inconvenient to travel to and from. Regardless of whether or not you attend a review course, it cannot replace the required pre- and post-course study time. It is complementary to study time and does not replace it.
7. Review our suggested ABIM testing strategies
ABIM exam questions are not meant to trick you, but to challenge your knowledge and ability to gather your understanding of many different concepts and topics. Below are some tactics you can use while practicing questions and/or taking the ABIM exam:
- For the clinical vignettes, read the question first (last line) and then go back and read the scenario. That way, you’ll know what to look for as you read the scenario.
- Try to answer the question even before looking at the answer choices.
- Pay attention to keywords that may point you to an etiology or physical exam.
- Note key demographic information: geography, ethnicity, gender, age, occupation.
- The ABIM test isn’t meant to be complicated, but we’re all human, so sometimes we miss key words like “least likely,” so pay attention to those.
- If you are challenged by a longer clinical vignette, note the key elements and develop your own scenario; this may elicit a response.
- Most internists we talk to say that time is generally not an issue, but keep in mind that this is a timed exam and you have about two minutes per question.
We cannot emphasize enough the mantra “study early and study often”. The exam is challenging but can be cleared with diligence and proper preparation.
8. Understand and be prepared for ABIM test day
- Be prepared and be safe. No matter how you chose to study, on test day, confidence is key.
- Get a good night’s rest: Rushing at the last minute and staying up late will only stress you out more.
- Get there early, don’t risk getting stuck in traffic. It’s much better to be a little early than to be aggravated in traffic.
- Take an extra layer of clothing. The last thing you want to do is feel uncomfortable and cold because someone decided to turn the air conditioner up too high.
- Test day is long! Be mentally prepared for it. From registration to the optional survey at the end, the day will last between 8 and 10 hours (depending on whether you are certifying for the first time or taking the certification maintenance exam).
- Have some energy snacks with you to take during your break time.
- Check the ABIM exam day schedule to know exactly what to expect.
This is a basic overview of how to study for and pass the ABIM board exam. As mentioned, there is no secret sauce or method to this – you simply need to have a broad knowledge base. There is no substitute for studying early and studying often! If you are preparing for ABIM boards, we wish you all the best. We’re here to help, so if you have any questions, let us know. Happy studying!
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