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What You Need to Study for the Internal Medicine Boards

This is perhaps one of the most challenging questions for most residents. The vast amount of medical knowledge in internal medicine is intimidating, and the need to prepare for a comprehensive medical knowledge examination while in the process of very busy clinical training is further anxiety-provoking. One very important reassuring factor is that your residency program leadership is keenly aware of these challenges and will work hard at providing you with the didactic and clinical experiences necessary to learn the pertinent information that will be covered in the initial certification examination. However, regardless of what your program provides, you will need to study both generally and in more depth in certain areas where you are less comfortable with your knowledge; it is therefore quite helpful to have a sense of those areas where you need to focus your study.    

  • Review the ABIM Initial Certification Exam Blueprint. Although it isn't a definitive guide to what you need to know to practice internal medicine, the ABIM blueprint does tell you the content areas that will be covered on the examination, as well as the percentage emphasis on each area in terms of the number of specific topics and questions. Reviewing the blueprint may help you consider those areas where you feel your knowledge is stronger and those where you probably need additional work.  
  • Continuously assess where your medical knowledge needs improvement and study to fill those gaps. In those clinical rotations in which you have more interest and have already done a significant amount of study related to caring for patients, you may feel more comfortable in your knowledge level, as opposed to rotations where you perhaps have less interest or don’t have a good overall "feel" for the subject matter. Most clinicians can identify those areas of internal medicine where they feel less comfortable with the medical content, and this may help direct your subsequent study. 
  • Take the Internal Medicine In-Service Training Examination (IM-ITE) and review the learning objectives of questions you missed. This exam, which is given by the majority of internal medicine residency programs in the US, is an assessment tool developed to test the medical knowledge of internal medicine residents both for individual use as well as for residency programs to monitor the progress of their trainees and to ensure that their curriculum is conveying the necessary information to residents. Many programs administer the IM-ITE during all 3 years of residency training, which is helpful for residents to more frequently assess their own knowledge base and for programs to track the development of their residents over time. The IM-ITE is roughly "mapped" to the initial certification examination in terms of content areas and percentage of questions, and the questions are relatively similar in structure to those on the certification examination. The score report you and your program director receive from the IM-ITE shows your overall performance relative to others taking the internal medicine examination, and also indicates your performance in the subspecialty areas of internal medicine. Importantly, the score report shows the learning objectives of the questions you missed—information that may be quite helpful in assessing your understanding of certain topic areas. Although the IM-ITE is not able to provide reliable information predictive of performance on the certification examination, it does give some sense of your ability to answer clinically-based questions in specific subject areas that may be useful in guiding your study, particularly if taken over multiple years of residency training. In some cases you may want to consider taking elective rotations in areas in which you scored poorly.
  • Other practice tests or quizzes: Another method used by some residents to guide their study for the initial certification exam is by assessing their performance on board examination-style questions. There are many sources of these types of questions, ranging from free questions available online to more extensive (and often expensive) question banks and adaptive programs utilizing board-style questions. Several board preparation study materials have additional practice tests or quizzes incorporated into their design. For example, the Medical Knowledge Self-Assessment Program (MKSAP) produced by the ACP provides a board-style "pretest" and the ability to create "custom quizzes" using questions contained in the program.  

However, significant caution needs to be exercised when using questions derived from potentially unreliable sources since their accuracy and quality may be questionable. Additionally, it isn't clear that the results of answering random questions, particularly those without known psychometric data, accurately reflect your knowledge in a particular subject area for purposes of guiding study for the certification exam. However, questions are an important part of assessing your knowledge and studying for the examination, and this is explored further in the discussion of test-preparation strategies.