8 Tips for Taking the Internal Medicine Boards

Unless you like sitting in a dark room for 10 hours, you probably won’t find the boards to be a very enjoyable experience. However, if you’ve made it this far in your career, you are perfectly capable of passing (or re-passing) the internal medicine board exam. 

What you need is to combine the knowledge you’ve acquired with a solid test-taking strategy to be successful. Here are eight practical tips to help you put those two pieces together.

1. The key to all multiple choice questions is to get into the mind of the question writer. What competence is this clinical question, trying to test, try to picture the patient in a clinical setting so you can uncover the true decision point of the question, especially if the question is long.
   
2. The weakest point of a multiple choice question is the distractor: a wrong answer that is close enough to the real answer to fool test takers, but is still truthful. This is the most difficult part to write and is frequently added later, so it often contains an additional clause. If you can identify the distractor and understand the logic of this answer, it will often clue you into the correct choice.
3. No questions on the boards are unanswerable, which means that every question contains enough information for you to make the correct choice. Be on the lookout for details that really stick out, such as measurements, whether or not the patient is symptomatic, and highly specific physical signs, as these often hold the key to the correct answer.
4. The board wants you to avoid adding superfluous and unnecessary confusing details, so pay attention to things like race and ethnicity, occupation, HIV status, or geographic location, which will only be included if they are important to the answer. For example, specific ethnicities are associated with specific cardiology issues, so this should be an instant tip-off.
5. Question writers are looking for questions that approximately 50% of test takers will get wrong, so expect to be challenged. However, the board can exclude questions after the examination if the vast majority of candidates get the question right or wrong.
6. There must be a scientifically correct answer to every question, so the following will not be asked on the boards: the results of clinical trials less than one to two years old, practice guidelines less than one to two years old, controversial issues, device- or technique-specific questions.
7. You’ll certainly face some emergency situation questions and the ABIM is looking for a quick diagnosis and a definitive treatment. When answering, always choose the most serious diagnosis. Don’t be afraid to make a bold decision if that’s what you should do in clinical practice.
8. It is fine to guess in the multiple choice question section. You should answer every single question, even if you are unsure. However, be aware that more than one answer may be partially correct, so don’t automatically pick the first answer you think is correct. Read through all of the answers and pick the option that is most correct.

Bonus tips!

• Read over the initial certification and MOC exam blueprints. Make sure you understand the exam format and take any tutorials that are offered.
• For initial exam takers, don’t forget to prepare for the ECG coding portion of the exam. (MOC exams do not include ECG coding questions.) Feeling rusty on ECG interpretation? Our internal medicine board review products include a comprehensive lecture on the topic and ECG practice coding questions.
• For MOC exam takers, check out the detailed content outline for the internal medicine MOC exam. This lets you know the level of detail you need to consider for each topic. It also delineates low-frequency topics (noted with an LF); no more than 18% of questions will address topics with this designation.
• Use a Board Review product like our online Mayo Clinic Internal Medicine Board Review. 

Good luck!