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Do programs have the option of choosing between a paper-and-pencil or web-based exam?

No, only the web-based exam will be offered.

What is the blueprint for the IM-ITE?

The IM-ITE consists of 300 questions, and is modeled after the blueprint for the American Board of Internal Medicine’s certification exam. Here is the breakdown of topics:

Content Area Percentage of Multiple-Choice Questions
Cardiology 13.5%
Endocrinology 6.5%
Gastroenterology 9.5%
General Internal Medicine 15%
Geriatric Medicine 6%
Hematology/Oncology 11.5%
Infectious Diseases 9%
Nephrology 6%
Neurology 4%
Pulmonology/Critical Care Medicine 10%
Rheumatology 9%
Total 100%

How much exam time will be allotted for answering questions and how much time will be allotted for breaks?

The total testing time is 9 hours, with 7 hours allotted for completing all test questions. The examinees are encouraged to take advantage of the scheduled breaks to avoid testing fatigue. There are optional 10-minute scheduled breaks after examinees complete sections 1, 2, 4, 5, and 6, and an optional 60-minute lunch break after examinees complete section 3. Examinees should be encouraged to take a break during the allotted time scheduled for breaks. If an examinee takes a break when exam is being administered (that is, an unscheduled break), he or she will lose testing time because the timer on the exam will continue running.

If I register a candidate to take the exam on one date, can I switch the date as long as the candidate tests during the examination window?

Yes, you can switch the date on which an examinee takes the exam as long as he/she takes the exam during the examination window.

Can the window be extended beyond the approved exam dates?

No, the exam cannot be extended beyond the approved exam dates.

What is the purpose of the IM-ITE, and who should take it?

Residents may use the results to identify areas of deficiency that require further learning, to compare their performance with that of their peers in training programs throughout the world, and to help career choices. Program directors may use the results to provide educational counseling to residents, develop curricula, and validate the need for planned curricular changes. Physicians may use the results to help them prepare for the maintenance of certification examination.

The IM-ITE is designed for residents at the midpoint in their training, but residents at all postgraduate training years are encouraged to participate. In addition, faculty members, program directors, and other physicians and health care professionals with an interest in internal medicine may take the examination to test their medical knowledge against that of residents or to prepare for the maintenance of certification exam.

The program director decides who will take the exam. The sponsoring organizations impose no requirements. More than 26,000 residents from 12 countries participate in the exam.

The examination is neither a qualifying nor a certifying instrument. It should not be used for determining who should be promoted, who should be eligible to take the American Board of Internal Medicine certifying examination, or who may be qualified for postresidency fellowship training. It is designed only as a self-assessment tool.

However, program directors are encouraged to include IM-ITE results in semiannual reviews of resident performance and reporting on attributes of the Medical Knowledge competency. As part of the Internal Medicine Milestone Project, this activity may contribute to a residency program’s participation in the Next Accreditation System (NAS) to determine the overall progress of residents. However, the release of any score, either at an individual or aggregate level, to any person or organization outside the residency program, is strictly prohibited.

How is the IM-ITE developed?

The IM-ITE is written by a committee of 11 expert physician-authors, including four representatives from the American College of Physicians and six representatives from the Alliance for Academic Internal Medicine (AAIM). The final committee member is a rotating representative from ACP or AAIM.

Preparation for the IM-ITE begins 18 months before administration. Each committee member reviews and writes questions in one or more of the 11 subspecialties listed on the content blueprint (see next three paragraphs) and according to well-established principles of exam construction. All questions used in any examination have undergone several reviews and revisions.

The internal medicine questions are written at the level of proficiency expected from second-year residents and cover a wide spectrum of knowledge in internal medicine, including acute and chronic care, in-patient and ambulatory problems, and essential clinical skills. The exam emphasizes a range of content areas considered important during the training of a general internist, including cardiology, endocrinology, gastroenterology, general internal medicine (including, but not limited to, dermatology, ophthalmology, preventive medicine, psychiatry, geriatrics, women's health, nutrition, medical ethics, and biostatistics), geriatric medicine, hematology/oncology, infectious diseases, nephrology, neurology, pulmonary and critical care medicine, and rheumatology.

Are second-year residents required to take the IM-ITE before other residents?

The IM-ITE is administered annually at each training site during a prescribed period. Program directors select the day within this period that is most convenient for them. If the examination cannot be administered to all residents on the same day, programs are encouraged to administer it to second-year residents initially, although this is no longer a requirement. The purpose of these guidelines is to ensure uniform, secure examination administration conditions, which are important if the exam is to provide accurate scores and norms for gauging resident and program performance.

Should residents study for the IM-ITE?

The goal of the IM-ITE is to gauge progress in training, not to achieve a certain level of performance. Examinees, therefore, are advised not to study for the exam. Studying may result in an inaccurate self-assessment of the training experience and an inability to plan appropriately for correcting deficiencies.

What are the steps I need to take to prepare for the IM-ITE?

The major steps involved to prepare for the IM-ITE are as follows:

  • Programs will receive a Program Information Form from ACP in late March to get the ball rolling. This form will allow you to indicate your interest in registering for the exam and will ask for contact information granting you access to the IM-ITE Registration Site in late May.
  • To avoid scheduling issues, Program Directors/Coordinators/Administrators should secure test rooms as soon as they know the dates on which they will be testing and have an idea of how many residents they will need to accommodate.
  • Programs Directors/Coordinators/Administrators should select Chief Proctors to monitor the exam and give them information on their general responsibilities, exam dates, and time commitment required, before registration opens in late May. Providing this information to Chief Proctors is important so that they are prepared to receive the Chief Proctor's login information and can schedule time to monitor the exam.
  • The IM-ITE Registration site will be accessible in late May. At that time, programs who previously participated in the exam will be able to update their existing roster of residents with additions and deletions, and newly participating programs will be able to type in the names of their participating residents into the registration site. If you are registering your program for the first time or it has been more than two years since your program last participated, contact Kim Kerns ( for instructions on how to register your residents online. Program directors must make payment to the American College of Physicians, using a form provided at the registration site. Payment will be due at that time. Programs will be asked to provide the Chief Proctors' contact information.
  • In early August, ACP will mail out the Chief Proctor's login information to the Chief Proctors followed by a link to the Chief Proctor's Manual.
  • Within a two-week period of the exam, the Chief Proctors, in coordination with their IT staff, conduct the workstation certification process for institution and personal laptops.

What is the cost of examination, and what is the refund policy?

The cost of the exam is $130 per examinee. There is an additional $30 fee for late registrations. ACP has a strict no-refund policy for the IM-ITE. Once you have registered your examinees and paid, your payment will not be refunded.

How are special accommodations handled?

When necessary, alternative arrangements for administering the IM-ITE will be made for examinees with disabilities. Test accommodations will include, but will not be limited to, the following:

  • Enlarging the typeface of computerized text
  • Extending the testing time for an individual
  • Having an individual take the exam at an alternate time and place within the examination cycle
  • Having an individual authorized by the ACP read the IM-ITE to the examinee
  • Having an individual authorized by the ACP enter the answers on the computer for the examinee

The deadline for submitting special accommodation requests is 7/31/20.

What does the workstation certification process involve?

Workstation certification for institution-based computers is required prior to the examination. This process checks that the computers to be used for testing meet the requirements for web-based testing and provides feedback for correcting problems if computers fail to meet the requirements. At the end of the check, the computer connects to a short sample. A separate version of workstation certification is available for examinee-owned personal laptop computers and may be done remotely 7 to 14 days before the examination.

Does the IM-ITE have to be administered in a computer lab?

The IM-ITE can be administered in the computer lab, lecture hall, or classroom of any registered institution provided your test facility can meet the technical requirements. Also, programs should run the workstation certification process on a few "extra" computers, which should be available in the testing room(s) in the event any computers malfunction during testing. The IM-ITE CANNOT be given in commercial testing sites.

Can examinees use virtual machines or thin clients during the exam?

Testing on virtual machines or thin clients is not supported. Programs can use laptops or desktops.

What is a Satellite Program and how do I set one up?

If your residency program will test examinees at both your main location and a satellite location you wil need to send notification to prior to completing registration. The satellite test site will be set up as an extension of your parent institution, with an alphabetical addition to your program number to distinguish it.

Is the requirement to secure technical staff from my institution mandatory?

Yes, procuring IT staff to assist with technical issues in the weeks prior to and on test day is mandatory. However, IT staff do not need to be present for the duration of testing on test day, but must be available if they are needed.

Will NBME technical assistance be available on test day?

Yes, the NBME will be available on test day to address technical issues should they arise, except on Labor Day Monday. The NBME will also be on call to provide support to our international programs 24/7, except for Labor Day Monday. Each institution must procure dedicated technical support staff with administrative privileges prior to and on test day(s) to assist with technical issues.

What is the difference between a Chief Proctor and an Assistant Proctor?

Each site must have one Chief Proctor and may have an unlimited number of additional proctors depending on the needs of the Chief Proctor. The Chief Proctor is responsible for performing any actions that affect ALL examinees, such as starting the exam session, ending the exam session, and submitting the Test Administration report via the Chief Proctor Resource Site. The Chief Proctor is also responsible for recruiting Assistant Proctors for the test session.

An Assistant Proctor who is assisting a Chief Proctor in the same testing room does not require a dedicated computer station. However, and Assistant Proctor who is assigned to a separate testing room requires his or her own computer workstation to monitor the exam. Assistant Proctors may also relieve the Chief Proctors and other Assistant Proctors monitoring exam rooms to allow them to take breaks. Assistant Proctors who are being recruited to simply circulate and monitor examinee behavior do not need a separate login. Both Chief and Assistant Proctors should be identified during registration.

Can an Assistant Proctor start the exam on a computer stationed in a separate testing room?

No, the Chief Proctor must initiate the exam, after which the Assistant Proctor is able to log on to monitor the exam from his or her computer screen.

What types of information should the Chief Proctor communicate to the Assistant Proctors prior to test day?

The Chief Proctror should schedule a meeting with all proctors prior to test day. The following items should be reviewed at the meeting:

  • The examination time schedule and all administrative procedures
  • The location of the test site and the time Assistant Proctors are to report to the test site
  • The functionality of the computer testing system
  • The tasks assigned to each Proctor or Assistant Proctor
  • Procedures for identifying and admitting examinees into the examination
  • Procedures for handling walk-ins (any examinee that was not pre-registered)
  • Handling late arrivals
  • Procedures for the distribution and collection of Examinee Instruction Sheets

What materials will be made available to Chief Proctors to help them prepare for test day?

In August, ACP will email to Chief Proctors login information and a link to the Chief Proctor's Manual, which will contain instructions on how to perform the workstation certification process, examinee instruction sheets, and a link to the examinee practice exam. Fourteen days before the exam administration, Chief Proctors will receive the ticket number and URL necessary for accessing the workstation certification utility. This utility will check workstations for compatibility with web-based testing and must be run on all institutional and student-owned laptops that will be used for the exam.


How do I obtain prior IM-ITE score reports?

You can obtain prior score reports by contacting Kim Kerns at 215-351-2568, or

IM ITE score reports are available dating back to 2013.  All prior year score reports have a $25 per year processing fee.

More questions? Contact ACP by phone or email. For general information about the IM-ITE, call 215-351-2568 or send us an email at