ABIM Exam Overview

The American Board of Internal Medicine (ABIM) is a non-profit organization established in 1936 to certify and recertify physicians of internal medicine and its subspecialties in a standardized format and process through the utilization of self-evaluation modules and secure examinations. The ABIM administers board examinations to members of the American College of Physicians. Their mission is to set standards for clinical competency, improve the quality of care delivered, and encourage continuing medical education for post-graduate practitioners of internal medicine. Beginning in 1990, ABIM granted certificates that were valid for 10 years. For physicians to maintain their certification status, they must participate in the Maintenance of Certification (MOC) program, which entails a self-evaluation component and a secure examination (shorter than the initial exam). The majority of the internal medicine community agrees that this process fosters a continued knowledge in up-to-date medical practices, procedures, and treatment regimens.[1]

Examination Content

The purpose of the Internal Medicine Boards is to certify physicians who have demonstrated the competent level of knowledge, skill, and professionalism to maintain a high standard of health care delivery in the United States. To earn their admitting privileges, Internal Medicine physicians are required by most hospitals to attain an initial certification followed by recertification every ten years to satisfy the certification requirements of health care plans that classify physicians as "preferred" or "in network."

The exam takes place over the course of one day and covers a broad range of topics. The majority of the exam (approximately 75%) is based in an outpatient or emergency department setting; the remaining cases occur in an inpatient setting (ie, intensive care unit, nursing home, etc). Most of the exam will test the examinees' knowledge of traditional internal medicine and its subspecialties, with particular focus given to cardiology, pulmonology, and gastroenterology. However, the American Board of Internal Medicine (ABIM) also expects that test takers be well-rounded and prepared to identify and treat patients in departments such as allergy/immunology, dermatology, psychiatry, ophthalmology, nutrition, women's health, and ethics.

Most of the questions require that examinees integrate information from a variety of sources and use appropriate clinical judgment to attain the correct answers. A few of the questions may involve audio/visual aids. Examinees can also expect to see both long- and short-question stems and should be able to manage their testing time effectively.

Examination Dates

The ABIM Initial Certification examination is offered only once per year and is administered on a predetermined test date. The ABIM recertification exam is offered twice per year, also on predetermined test dates. Examination dates and registration deadlines may change throughout the year. A list of current examination dates as well as other important registration deadlines for each of the tests can be found on the official ABIM website.

Cost of Examination

Taking this exam is costly. Utilizing the UWorld IM Qbank will help you maximize your chances of passing on the first try, sparing you the expense of re-examination fees. The cost of the examination for initial certification and recertification, refund policies on fees, as well as other discount-related information can be found on the official ABIM website.

Test Length and Format

The Initial Certification and Maintenance of Certification examinations are comprised of four sessions of up to sixty multiple choice questions each. Two hours are allotted for each session. Also included in the examination time is one hundred minutes worth of break time that can be divided between three predetermined break points (between each session). A candidate can expect to spend approximately ten hours taking the test on examination day.

The entire exam is made up of multiple choice questions with only one single best answer option. Some of the questions may require interpretation of radiographs, electrocardiograms, clinical photographs, photomicrographs, etc. There may also be questions that contain audio/video-related content meant for interpretation (eg, heart sounds, lung sounds, and clinical videos). Many of the questions will contain patient laboratory results; a list of normal laboratory values will also be provided.

Results/Scoring

Results of the examination are released within three months of the last examination date. Scoring is based on a pass/fail decision on the entire examination. The minimum passing score is based on a predetermined absolute standard. Scores are not based on the cumulative performance of any group of examinees; all scores reflect the independent performance of the candidate. Examinees are encouraged to answer all questions, as any unanswered question is scored as incorrect.

In the event that candidates are unsuccessful on the initial attempt at the Internal Medicine Examination, they may reapply as long as all licensure, professional standing, and procedural requirements are met.

IMPORTANT: Starting in 2011, if a candidate fails the initial certification examination for three consecutive years, the candidate must "sit out" one full examination year and will not be eligible to retake the exam during the following annual exam administration. (This new policy does not apply to recertification examinees). If the above requirements are met, there are no restrictions on the total number of opportunities for re-examination.

Eligibility Criteria - Initial Certification

To be considered eligible to take the initial certification exam, candidates must meet all of the following criteria:

  1. Completion of predoctoral medical education
    • Graduates of medical schools in the United States or Canada must have attended an institution that (at the time of graduation) is/was accredited by one of the following:
      • The Liaison Committee on Medical Education (LCME)
      • The Committee for Accreditation of Canadian Medical Schools
      • The American Osteopathic Association
    • Graduates of international medical schools must have one of these:
      • A current Educational Commission for Foreign Medical Graduates (ECFMG) certificate
      • Equivalent credentials from the Medical Council of Canada
      • Document of training from a US-sponsored Fifth Pathway program
  2. Completion of Graduate Medical Education (GME)
    • Thirty-six months of graduate medical education must have been completed by August 31st of the year of examination and must be accredited by one of the following:
      • The Accreditation for Graduate Medical Education (ACGME)
      • The Royal College of Physicians and Surgeons of Canada
      • The Professional Corporation of Physicians of Quebec
    • GME must include 12 months of accredited internal medicine curriculum at each of the levels of R1, R2, and R3.
      • There is no credit recognized for repeated training at the same level or for administration duties as a chief medical resident.
      • Training as a subspecialty fellow is not credited as fulfillment of the internal medicine training requirements.
  3. Content of Training
    • The stipulated 36 months of full-time internal medicine residency education must include:
      • A minimum of 30 months of general medicine, subspecialty internal medicine, and emergency medicine training which may include:
        • Four of the 30 months of education in primary care areas such as neurology, dermatology, office gynecology, and office orthopedics
        • Up to three months of other electives approved by the internal medicine program director
        • A maximum of three months vacation leave
      • Twenty-four of the 36 months of residency education in areas in which the resident provided or supervised direct patient care in inpatient or ambulatory settings
      • A minimum of 6 months of direct patient care on internal medicine rotations during the R1 year
  4. Clinical Competence Requirements
    • The American Board of Internal Medicine stipulates that certification candidates in internal medicine be competent in:
      • Patient care and procedural skills
      • Practice-based learning and improvement
      • Interpersonal and communication skills
      • Professionalism
      • Systems-based practice
    • Residents must receive a minimum of satisfactory ratings in overall clinical competence and moral and ethical behavior in each aspect of clinical competence throughout the final training year.

Importance of Maintaining Certification

Research suggests that clinical skills and up-to-date medical knowledge diminish over time, even in the most experienced practicing physicians.

  • While this may seem counterintuitive, evidence shows that the number of years a physician has practiced is inversely proportional to the quality of care provided.[2] As a result, physicians need a structured set of criteria and self-assessment tools to evaluate the clinical knowledge and current treatment plans/guidelines that will deliver the highest quality patient care.

Technology is changing continuously.

  • Advances in technology lead to rapid changes in all aspects of health care delivery. As such, physicians have an obligation to update their skills, knowledge base, and outlook to maintain a high standard of quality in day-to-day clinical practice.[3]

Physicians certified by the ABIM, on average, deliver a higher quality of health care.[4]

  • Patients of certified physicians had a lower mortality rate for acute myocardial infarction than those of non-certified physicians.[5]
  • A decline in the quality of health care given to hypertensive patients has been correlated with the time elapsed since a physician's most recent board certification.[6]
  • Certified physicians provided preventive care services to Medicare patients more often than those who were not certified.[7]

Employers and health plans require it, and patients prefer it.

  • One-half of physicians report that their employer requires maintenance of certification.[8]
    • However, only one-third of these physicians recertified for the sole purpose of employer requirement. Most recertify for positive professional reasons rather than monetary benefits or professional advancement.[8]
    • In many cases, physicians who did not recertify chose other fields.
  • Many health insurance plans require physician board certification in order for the physician to be considered "preferred" or "in network."
  • Surveys suggest that patients prefer a board-certified physician to a non-board-certified physician; they also expect physicians to continue to build on and update their knowledge base and current practices periodically.[9,13]

Everybody is doing it.

  • More than 75% of practicing internal medicine physicians recertify.[8]

Residency In-training Examination as a Predictor of Performance on the ABIM Certification Exam

  • A resident's performance on in-training examinations administered during residency is strongly predictive of the performance on the American Board of Internal Medicine Certification exam.[10,11]
  • Residents who performed well in the in-training examination will appear more knowledgeable and well-rounded than their peers and provide better patient care during residency.
  • Poor attending evaluations and low USMLE scores can jeopardize residency contract renewal.

Factors that negatively impact ABIM Board performance[12]

  • Low scores on initial certification exam.
  • Physicians who are in solo practice rather than group practice.
  • Lower pass rate of foreign medical graduates often due to limited US clinical experience.
  • Older physicians who have not taken a certification examination in a number of years.
References

1. Dale, David C. "Recertification in Internal Medicine- the American Experience." Annals of the Academy of Medicine, Singapore. 2007, 36/(11):894-7

2. Choudry, N.K., R.H. Fletcher, and S.B. Soumerai. "Systematic Review: The Relationship Between Clinical Experience and Quality of Health Care." Annals of Internal Medicine, 2005. 142(4): p. 260-W-30.

3. Holmboe ES, Lynn L, Duffy DF. "Improving the quality of care via maintenance of certification and the Web: an early status report." Perspectives in biology and medicine, 2008. 51(1):71-83

4. Reid RO. "Associations between physician characteristics and quality of care." Arch Intern Med. 2010;170(16):1442-9.

5. Norcini JJ, Kimball HR, and Lipner RS. "Certification and specialization: do they matter in the outcome of acute myocardial infarction?" Acad Med. 2000;75(12):1193-98.

6. Turchin A, Shubina M, Chodos AH, Einbinder JS, Pendergrass ML. "Effect of board certification on antihypertensive treatment intensification in patients with diabetes mellitus." Circulation 117(5):623-8. (Feb 5, 2008)

7. Pham HH, Schrag D, Hargraves JL, Bach PB. "Delivery of preventative services to older adults by primary care physicians." JAMA. 2005;294(4):473-81.

8. Lipner Rebecca S; Bylsma Wayne H; Arnold Gerald K; Fortna Gregory S; Tooker John; Cassel Christine K. "Who is maintaining certification in internal medicine--and why? A national survey 10 years after initial certification." Annals of Internal Medicine, 2006. 144(1):29-36.

9. Freed GL, Dunham KM, Clark SJ, Davis MM. "Perspectives and preferences among the general public regarding physician selection and board certification." J Pediatr. 2010; 156(5):841-5.

10. Grossman RS, Fincher RM, Layne RD, Seelig CB, Berkowitz LR, and Levine MA. "Validity of the in-training examination for predicting American Board of Internal Medicine certifying examination scores." Journal of General Internal Medicine, 1992. 7(1):63-7.

11. Rollins LK, Martindale JR, Edmond M, Manser T, and Scheld WM. "Predicting Pass Rates on the American Board of Internal Medicine Certifying Examination." Journal of General Internal Medicine, 1998. 13(6):414-6.

12. Lipner Rebecca, Song Hao, Biester Thomas, Rhodes Robert. "Factors that influence general internists' and surgeons' performance on maintenance of certification exams." Academic Medicine : Journal of the Association of American Medical Colleges, 2011. 86(1):53-8.

13. Brennan TA, Horwitz RI, Duffy FD, Cassek CK, Goode LD, Lipner RS. "The role of physician specialty board certification status in the quality movement." JAMA. 2004; 292(9):1038-43.