What is the IM-ITE®?

The ACP Internal Medicine In-Training Examination® is a web-based self-assessment exam for residents to assess their progress.

The IM-ITE® is developed by a committee of expert physicians and is used by residents, program directors, and physicians alike. It is modeled after the American Board of Internal Medicine's certification exam. The exam is administered annually during a strictly monitored window.

The exam is designed to:

  • Give residents an opportunity for self-assessment
  • Give program directors the opportunity to evaluate their programs
  • Identify areas in which residents need extra assistance

Who should take the IM-ITE®?

The IM-ITE is designed for residents at the midpoint in their training, but over 30,000 PGY1, PGY2, and PGY3s participate each year. In addition, faculty members, program directors, and other physicians may take the examination. If you are unaffiliated with a program, but would like to take the IM-ITE, you must find a program that will permit you to take the exam along with their registrants.

What steps should a new program take to register and prepare for the IM-ITE?

  • Request a New Program Information Form by sending ACP an email at This information will help us add your new program to the contact list for registration and access to the MyNBME portal.
  • Be sure that the individual who will assist with the administration of the IM-ITE reads the information provided on ACP’s IM-ITE web page as well as all the directions provided for the registration process.

What is the topic breakdown 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:

Medical Content Category

Relative Percentage

Cardiovascular Disease


Endocrinology, Diabetes, and Metabolism




Infectious Disease


Pulmonary Disease


Rheumatology and Orthopedics




Medical Oncology


Nephrology and Urology








Geriatric Syndromes


Obstetrics and Gynecology


Allergy and Immunology




Otolaryngology and Dental Medicine






What testing and proctoring options will I have for the 2023 IM-ITE®?

Progams will have the option for in-person testing or remote proctoring and testing or a combination of both, using third-party software (Zoom, MS Teams, or Webex).

What is the 2023 IM-ITE® registration fee?

Regular registration - May 3, 2023, through July 17, 2023: $135 per registrant
After July 17, 2023: additional $30 per registrant

How do programs pay for IM-ITE® registration?

After programs submit their roster, they can generate the Program Registration Confirmation to pay by check, credit card or pro-forma invoice. Also, 5-7 business days after submission of your roster, a formal emailed ACP invoice is automatically sent to the Program Director listed in the MyNBME portal. Payment is due 14 business days after registering examinees. For questions related to invoices and payment, please contact ACP Member and Product Support at 1-800-ACP-1915 (1-215-351-2600 outside the USA/Canada) or by email at They are available Monday – Friday, 9am-5pm EST, excluding holidays.

Who do I contact if I have a question about payment for the IM-ITE®?

Please contact ACP Member and Product Support, Monday-Friday; 9am-5pm EST at 1-800-ACP-1915 (USA & Canada) or 1-215-351-2600 (outside of USA & Canada) or by email at If you know your IMITE program ID, please have it handy to expedite the process.

What happens if my program is in arrears for a prior year’s IM-ITE® registration fee?

Score reports will be withheld for the current year’s examination until the arrears are paid. Please note that ACP makes every effort to contact programs that are in arrears prior to the release date of the current year’s test scores.

What is the refund policy of the IM-ITE®?

The American College of Physicians has a strict no-refund policy for the IM-ITE. Once you have registered your examinees and paid, your payment cannot be refunded. However, if you registered examinees and they do not take the exam, you may apply the resulting credit to any walk-ins or substitutions.

What are important dates for the 2023 IM-ITE®?

  • Registration: Regular registration will open May 3, 2023. After July 17, 2023, an additional $30 fee will be charged per registrant.
  • Test Administration Window: All programs are welcome to test one day or each day during the entire testing window, Thursday, August 17, 2023, to Thursday, September 7, 2023, except Labor Day (Monday, September 4, 2023).
  • Roster verification: after the testing window closes, programs will receive an email reminding them to verify (and possibly update) the biographic information for each registrant. This will be performed by the program and not NBME or ACP.
  • Score reports will be available to programs approximately 5 weeks after the exam window closes. Score reports are not released directly to resident-examinees.


Why are programs asked for specific exam dates during IM-ITE® registration?

Although programs have the flexibility to test examinees on any date during the exam window without contacting ACP or the NBME, the selection helps determine the number of registrants on a specific date which, in turn, helps provide the best availability of technical support to programs and examinees during the testing window.

Can the IM-ITE® be administered outside of the exam window?

No. It is a secure exam and technical support staff are only available during the exam window. The exam is shut down after the last day of the exam window.

How does a program choose the date(s) for the IM-ITE® examination?

Programs select the day(s) that are convenient for all staff and examinees within the exam window. It is common for large programs to test on more than one day. Programs have the freedom to choose a new or different date for the exam – if it is within the exam window – without contacting the NBME or ACP. We suggest that programs schedule earlier during the exam window so there is flexibility to choose an additional date if necessary. The goal is for a uniform and secure test administration environment.

What is the schedule of the IM-ITE® on test day?

The total test session time is 9 hours. There are 6 sections consisting of 50 items each. Examinees will have 70 minutes of testing time for each section, with an optional 10-minute break after test sections 1, 2, 4, and 5, and an optional 60-minute lunch break at the end of test section 3. There is an optional 15-minute tutorial at the start of the exam, a 5-minute Biographic Information Survey following the Tutorial, and an untimed Resident Survey at the end of the examination.

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, an 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.

How should the Chief Proctor and Assistant Proctor(s) prepare for the IM-ITE® administration?

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.

In early August, ACP will email 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. It is strongly suggested that the Chief Proctors read the manual thoroughly. 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.

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

  1. The examination time schedule and all administrative procedures
  2. The location of the test site and the time Assistant Proctors are to report to the test site
  3. The functionality of the computer testing system
  4. The tasks assigned to each Proctor or Assistant Proctor
  5. Procedures for identifying and admitting examinees into the examination
  6. Procedures for handling walk-ins (any examinee that was not pre-registered)
  7. Handling late arrivals
  8. Procedures for the distribution and collection of Examinee Instruction Sheets
  9. Ensure that examinees return to the correct seat after breaks

What topics are covered in the IM-ITE® Chief Proctor’s Manual?

The Chief Proctor’s Manual is divided into four major sections: Prior to Test Day, On Test Day, Using the Proctoring Software, and Managing the Test Session. Each section includes a checklist that can be used as a quick guide to prepare and administer the exam. For example, the Chief Proctor can use the “On Test Day” and “Using the Proctoring Software” checklist along with the Troubleshooting tips and reference materials in the “Appendix” as a quick start guide on test day.

Section 1: Prior to Test Day covers important pre-administrative tasks such as Workstation Certification that must be performed prior to test day.

Section 2: On Test Day covers the tasks that must be performed on test day prior to the start of the exam.

Section 3: Using the Proctoring Software explains how to use the Chief Proctor Resource site to administer the exam.

Section 4: Managing the Test Session provides general information on monitoring examinees on test day.

Appendix: the appendix includes troubleshooting tips and other important supplementary information for administering the exam.

What should I do if I need technical assistance before or during IM-ITE® test day?

Contact NBME Test Administration Services as follows for questions concerning workstation certification, the proctoring software, or the administration of the exam:

Prior to Test Day

On Test Day

What should I do if I am missing a personalized IM-ITE® examinee instruction sheet?

Examinee instruction sheets can be printed out up to and including exam day using the MyNBME portal. Examinee instruction sheets for registrants added after initial registration can also be printed from the MyNBME portal.

What is the Roster Verification Process?

After the exam administration, an email will be sent to programs as a reminder of the Roster Verification Process. Programs will have the opportunity to review, update and verify the biographic information on their registration roster. This is a very important opportunity for correction of any inaccuracies as the information provided on the verified roster is an exact representation of how it will appear on the score report. This information will also be used to compute examinee percentile ranks. Changes cannot be made after the roster verification deadline.

How should the IM-ITE® score reports be used?

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 post residency 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. The release of any score, either at an individual or aggregate level, to any person or organization outside the residency program, is strictly prohibited.

Should I save IM-ITE® score reports for archival purposes for our program?

The MyNBME portal will only provide the reports for the prior 2 years, so we strongly suggest saving the score reports in a secure, known, and accessible location for reference by current and future administrative staff.

How do I obtain prior IM-ITE® score reports?

The prior 2 years’ score reports are in the MyNBME portal under Performance Feedback. Program Coordinators and Directors should have already been given access to this portal at the start of the registration period.

Score reports that are beyond 2 prior test administrations are subject to a $50 administration fee per year and require 3-4 weeks for delivery.

Score reports are only provided to a program’s verified administrative staff. Under no circumstances are they provided to a current or prior examinee.

For further assistance, please contact Kim Kerns at 215-351-2568 ( or Chuck Graver at 215-351-2553 (

What should be communicated to residents prior to IM-ITE® test day?

  • Be sure to communicate the date(s) the examination will be administered.
  • Inform the examinees of the practice test; forward them the URL as found in the Chief Proctor Manual.
  • Personal items will not be allowed at the computer workstation during the examination, including computer devices, smart phones, backpacks, coats, calculators, and food. Scratch paper will be provided by the proctor prior to the examination and collected afterwards. For a full listing, please refer to the Chief Proctor Manual.
  • Examinees must return to the same workstation after each break.
  • The score reports will be available to program directors by late October. Examinees should not contact the ACP or NBME directly to ask for their scores.

How do I request Special Accommodations for an IM-ITE® examinee(s)?

The Disability and Authorization Form will be available on the MyNBME registration site with directions for its use, along with a list of permitted special arrangements. Be sure that all paperwork is submitted before the deadline listed on the form. If you have additional questions concerning Special Accommodations, please contact ACP at

What should I do if a resident needs to take the IM-ITE® at a different location than his/her program?

Residents who will be on rotation, on vacation, or out of town on the scheduled examination day should be encouraged to return to their parent institution for the examination.  If this is not possible, the program director must take responsibility for making alternative arrangements at an alternative test site.

The program director of the parent institution should contact the program director of the alternative test site before the registration period closes and arrange for the resident to take the examination there.  Any resident testing at an alternate test site must be included on the Registration Roster of the parent institution with the appropriate alternate test site indicated. Please enter the correct residency program code number and program name in the Alternate Center column if an alternative test center is authorized. This will ensure that the Examinee Instruction Sheets for these residents are sent to the alternate testing location and the scores are reported to the parent institution.

The parent institution is responsible for payment for residents who take the examination at an alternative test site. If appropriate arrangements are not made before the deadline, the resident may not be able to take the examination.

Can a resident from another program take the IM-ITE® at our testing site?

Yes. Your test center would be considered an Alternate Center in the case of this examinee. The program director of the parent institution should contact your program before the registration period closes and arrange for the resident to take the examination.  Any resident testing at an alternate test site must be included on the Registration Roster of the parent institution with the appropriate alternate test site indicated. Please enter the correct residency program code number and program name in the Alternate Center column if an alternative test center is authorized. This will ensure that the Examinee Instruction Sheets for these residents are sent to the alternate testing location and the scores are reported to the parent institution.

The parent institution is responsible for payment for residents who take the examination at an alternative test site. If appropriate arrangements are not made before the deadline, the resident may not be able to take the examination.

What happens if I need to register someone after the IM-ITE® early registration window has closed?

You are welcome to register examinees after the early registration window has closed at any time during the exam administration window, up to and including exam day. Using the MyNBME Portal, add examinees to your roster and submit them just like your initial examinees. The program director will receive an emailed invoice for any additional examinee registration fees. After the early registration window has closed, each examinee will be charged an additional $30 fee (added to the regular registration fee). If you would like to request or pay for an invoice, please contact ACP Member and Product Support, Monday – Friday, 9am – 5pm ET at 1-800-ACP-1915 (USA/Canada), 1-215-351-2600 (outside USA/Canada), or If you know your IMITE program ID, please have it handy to expedite the process.

What if someone wants to register on the day of the exam as a “walk-in”?

Walk-in registration is discouraged.  However, if previously unregistered individuals request participation on the day of the examination and computer workstations are available, they may be permitted to take the examination. Note: Instructions for admitting Walk-In Registrants are included in the Chief Proctors Manual.  A unique ID Number will be assigned to each Walk-In Registrant on the day of the examination when the proctor enters the examinee’s information on the Chief Proctor Resource Site.  Be sure to include the email address for all faculty, practitioners, and other nonresidents who are Walk-In Registrants, and verify that the parent institution’s six-digit IM-ITE residency program code is correct.The parent institution is responsible for payment for residents who take the examination as Walk-Ins.  The parent institution’s program director will be billed for their Walk‑In examinees.  Fees paid during registration for pre-registrants who do not complete the examination are not refundable but can be applied to Walk-In examinees and examinees who are added after the registration deadline. An additional $30 will be charged for each applicant registered after the deadline, as well as for Walk‑In registrants. If you have questions on the day of the exam, please contact the NBME at 215-243-3707.

As an registrant, what should I know about the IM-ITE®? 

Before the Exam

  • You are advised not to augment your study habits for the purposes of taking this exam.
  • Special accommodations for those who need them can be made ahead of time. Be sure to alert your program director of any special needs as soon as possible. There is a deadline for this process approximately one month before the exam window opens.
  • Nursing mothers: ask your program about the “Stop the clock” option.
  • If you require timed medication breaks:  ask your program about the “Stop the clock” option.
  • A few weeks prior to the testing window, you will be able to take the online practice exam to familiarize yourself with the online testing process.

Exam Day

  • The total testing time will be 9 hours.
  • There will be 7 hours devoted to the exam itself, plus several 10-minute breaks and a lunch hour.
  • The exam will consist of 300 questions, 260 of which are scored and 40 of which are unscored practice items.
  • There is no penalty for guessing an answer. Only questions answered correctly are counted toward your score.
  • The exam will cover a number of specialties as well as general internal medicine.
  • Be sure to return to the same workstation after each break.

After the Exam

  • The score reports will be available to program directors by late October.
  • Programs will receive a report that shows the percent of questions correct for each examinee as well as each examinee's percentile rank.
  • Residents will also receive a report from their program listing the educational objectives of questions they answered incorrectly.
  • Examinees should not contact the ACP or NBME directly to ask for their scores.

Still Have Questions about the IM-ITE®?

  • Send us an email (preferred) at, or
  • Call 215-351-2553 or 215-351-2568 (Monday – Friday; 9am – 5pm ET.)

If you know your IMITE program ID, please provide it or have it handy to expedite the process.