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Board Review Strategies

by Patrick C. Alguire, MD, FACP
Director, Education and Career Development, ACP

The American Board of Internal Medicine certifying examination differs from most traditional examinations in that it tests overall knowledge and the application of that knowledge to solve problems rather than simply recalling facts. To be successful, you may need view the examination differently and prepare in new ways. The following suggestions were gleaned from the article "Taking the Boards? Try these strategies for success" published in the May 1999 Observer by Christine Kelly and the collected experiences of selected program directors.

The Format: Nearly 85% of the test questions are presented as clinical scenarios that take place in ambulatory settings. The test emphases general knowledge; if you haven't seen or heard about it during your residency training, chances are slim that it will be on the board exam. Don't worry about recent studies in medical literature. Examinations are created over a year in advance of their use, so recent material will not be tested. For a breakdown of what is covered on the examination, see the ABIM's web site.

Pace Yourself: Last minute cramming for the exam is not likely to help and may hurt your chances. Despite the difficulty in motivating yourself, most residents need to begin a study program at the beginning of their second year; staring at the beginning of the third year is cutting it pretty close, and halfway through the last year is too late. Most experts recommend reading about your own patients as the bases for your study plan. In general, the frequency that you encounter certain problems during the residency program will reflect the importance they receive on the examination.

Assess Yourself: Review courses and practice examinations can help you prepare by identifying your weak areas. One of the most popular and most accurate at predicting your performance on the board examination is the in-training examination. Residents with scores falling below the 50^th percentile on the in-training examination will have the greatest probability of failing the board examination. Remediation, usually in the form of changing reading habits, can improve the likelihood of passing the board exam. In fact, and not surprisingly, there is a direct correlation on the amount of time spent reading and the ability to pass the board examination; about 5 to 7 hours per week appears to be the bottom line for success.

Study Groups: Study groups are a good method to ensure compliance with your study program. Limit the number to three or four individuals, and meet consistently, at weekly or bi-weekly intervals. The groups can be organized by problem, organ system, or chapters in the textbook. A tried and true strategy is to have each member prepare questions based on their reading and use them to test the group's knowledge. It's not at all unusual to accurately guess the content areas and types of questions that will appear on the board exam.

Review Sample Questions: Trying out sample questions can help you become a better test-taker by learning strategies to increase your odds of selecting the correct answer. About 80% of residents taking the board examination use the College's Medical Knowledge Self-Assessment Program (MKSAP) as a study tool. In addition to the questions, the accompanying syllabus presents key advances in the subspecialty and general internal medicine areas for the past three years.

Review Courses: Near the end of residency training, review courses can help solidify what you have learned during training. Do not deceive yourself into believing that a review course will make up lack of consistent and steady study habits, but rather they tend to "tie things together" and give a sense of confidence regarding preparedness for the examination. The College offers a number of board review courses and information about them is available on line.

Other Tips:

• When starting the exam, determine the number of questions and the amount of time available. Calculate how many should be answered by halfway through the time exam. Typically, you will need to answer a question every one or two minutes.
• Read the stem (the clinical vignette) carefully. Pick out the pertinent parts of the stem that will help you select the correct diagnosis.
• Pick the obviously correct answer. There are no trick questions.
• Consider race, sex, and age when selecting the answer.
• If you don't know the answer to a question, make your best guess and move on.
• Don't change the answers to questions unless you have made an obvious mistake; first impressions are generally the correct impressions.

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