Medical Board Exam: How to Prepare for IM Board Certification

Internal Medicine Board Certification Requirement #1: Complete the requisite predoctoral medical education

Students in the United States and Canada must have graduated from a school accredited by the Liaison Committee on Medical Education (LCME), the Committee for Accreditation of Canadian Medical Schools, or the American Osteopathic Association. Graduates of international medical schools must have either certification from the Educational Commission for Foreign Medical Graduates (ECFMG) or comparable credentials from the Medical Council of Canada.

Internal Medicine Board Certification Requirement #2: Meet the graduate medical education training requirements

A total of 36 calendar months of training is required and must be completed in a U.S. or Canadian graduate medical education program accredited by the Accreditation Council for Graduate Medical Education (ACGME), the Royal College of Physicians and Surgeons of Canada, or the Professional Corporation of Physicians of Quebec.

Internal Medicine Board Certification Requirement #3: Demonstrate clinical competence in the care of patients

The ABIM requires that candidates for certification in internal medicine demonstrate adequate performance in the six core competencies defined by the American Board of Medical Specialties (ABMS)/ACGME for all physicians: patient care and procedural skills, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice.

Residency program directors are required to complete clinical competence evaluations each year for internal medicine residents, and to be eligible for board certification, residents must achieve satisfactory ratings in each of the six competency areas during the final year of training. Additionally, the program director must attest that the trainee is competent to practice in an unsupervised manner at the end of training. You can learn more about the required evaluation process.

Internal Medicine Board Certification Requirement #4: Meet the procedural and licensure requirements

The ABIM requires demonstration of competency and safe performance of a limited number of medical procedures to be eligible for initial certification. You can learn more about the procedural requirements. Candidates for board certification must also possess a permanent, valid, unrestricted, and unchallenged medical license in the United States or Canada.

Internal Medicine Board Certification Requirement #5: Pass the ABIM Internal Medicine Certification Examination

The examination is a secure examination administered in a dedicated testing center. It consists of a maximum of 240 questions and takes approximately 10 hours to complete (including breaks). Learn more about the certification examination.

When should I take the internal medicine board certification exam?

This is a highly personalized decision. Most residents will take the initial certification examination at the first possible opportunity following completion of training. This is logical since your knowledge of the overall field of internal medicine should be high immediately following residency, particularly if you have studied regularly and possibly had additional board review as part of your training. Those entering a subspecialty fellowship often take the exam at this point in order to allow more focused concentration on subspecialty content without needing to go back and review the remainder of general medicine.

However, others choose to wait for several reasons, including gaining additional time to study or to obtain some degree of clinical experience before taking the exam. This may be an option particularly for those with a “gap” between the end of residency and the start of a fellowship in which they may be working for a period of time in practice prior to the start of additional training.

Deciding to delay the certification exam is generally a decision based on the balance between feeling adequately prepared for the exam and not having too much time elapse between the beginning of board eligibility and the potential loss of general medical knowledge. Consultation with an experienced medical educator such as your program director may be helpful in making the best timing decision for your circumstances.

What happens if I fail the medical board exam?

If you fail the examination, you can ask to have your examination rescored. This is a relatively expensive process and one that rarely yields any significant change in your exam score given that the ABIM is quite meticulous in its scoring practices. It should therefore be requested only under unusual circumstances if you believe that an error might have reasonably been made.

As long as you continue to meet all of the applicable licensure, professional standing, and procedural requirements, you may re-take the examination up to a total of 3 consecutive attempts. However, those who fail 1 or 2 consecutive initial certification exams in the same discipline and do not register for the exam in the third consecutive year will be able to register for the exam the next time it is offered, and the three consecutive attempt cycle will begin again.

If you fail the exam, it is important to attempt to identify the likely reason you had difficulty. This will help guide preparation for a retake examination. Discussion with an experienced medical educator, such as your residency program director, may be helpful an analyzing the cause and developing a remediation approach.

Although there is considerable expense associated with retaking the examination following a failure, it is important and reassuring to know that the eventual pass rate for the initial certification examination is greater than 95%.