Prepping for the ABIM Exam: an Internist’s Candid Perspective (Part II)

For full disclosure, I am a decidedly average test taker. My test-taking career peaked on my SATs in high school, and my percentile ranks on subsequent standardized tests have gone down in inverse relation with my ascent in the medical hierarchy. By the time I got to residency, I was, much to the chagrin of my residency program director, satisfied with being an Average Joe.


My program director was an old school guy you’d picture from one of those stuffy prestigious places like Hopkins or MGH. Every hospital has somebody like him on their internal medicine staff. He’s got a mad-scientist shock of white hair, Benjamin Franklin bifocals, a serious demeanor, and quotes the New England Journal of Medicine as easily as a priest quotes the Bible. At our hospital, he was renowned for his diagnostic acumen and warm bedside manner—not surprisingly, the rest of the physicians at the hospital send their families to him.


Most unfortunately, he was also my clinic attending, which meant that once or twice a week, I spent an afternoon with him getting pimped and learning all of the physical exam skills I neglected to pick up in med school.


Well, you can imagine how the conversation went after he reviewed my in-service training results as an intern. That year, I scored a 26th percentile on general internal medicine—the same subject my program director/clinic attending spent 6 to 12 hours every week personally grilling me on. This was definitely not an auspicious beginning to a career in medicine.


But there’s a silver lining to this tale of woe. You see, with experience, energy, and a healthy dose of fear, my scores on the in-training exam rose with each year of training (much to the program director’s relief). It was still nothing my mom would brag about, but internal medicine residency coupled with a month of furious studying allowed me to ultimately pass the ABIM test with my head held high and my dignity intact.


I tell you this not to talk about myself, but to relay to you that, with some dedicated effort, you, too, can pass the ABIM exam.


As is usually the case, I went on an Amazon book-buying binge in early July, 6 weeks before my exam date in mid-August. However, this was money that could’ve been spent on more useful things—like a suite of nifty Apple products—because ultimately, even with a month of prep time, I only had time to do questions out of MKSAP 15 and review concepts from Boards Basics 2, an ABIM “Board Review Digest” published by the American College of Physicians that’s akin to First Aid.


Even after the rigors of internal medicine training, the prospect of reviewing all the organ systems in one month is a daunting task. After all, according to the ACP, we should be experts in cardiology, dermatology, gastroenterology and hepatology, hematology and oncology, general internal medicine, neurology, infectious disease, rheumatology, nephrology, pulmonary and critical care medicine, and endocrinology and metabolism. Indeed, I don’t think I can even speak the preceding sentence without losing my breath.


I started with dermatology, the shortest and therefore (in my mind) easiest section. I tackled cardiology second, given that it was one of my weaker subjects, and from there systematically proceeded through the rest of the question books one by one….


You can find Part III of Dr.Feng’s prepping for the ABIM board exam and other posts by Dr.Feng on the Knowmedge Blog. You can find also additional topics and questions directly from the Knowmedge Internal Medicine ABIM Board Exam Review Questions QVault.



Charles Feng is an internal medicine physician at Kaiser Permanente. He will be starting an allergy / immunology fellowship at UC Davis in the summer.

1 Comment
May 15, 2013

Charles, fantastic post. I really enjoyed reading both parts. If I may, add a few more pearls to help others with passing their board exams:

1. Always read the question and answers first, before reading the vignette. This will make you a more efficient test taker and not waste as much time going back and forth between passage and answers. You will be able to throw some answers out right away with this strategy.

2. Know what the big 5 topics are on your specialties boards. In other words get your bang for your buck. Pick the largest subsections and spend the most time on those. In IM the BIG 5 are: General Internal Medicine, Cardiology, Pulmonary/Critical Care, Gastroenterology, and Infectious Disease. Ideally you want to get through all the sections, but to be efficient why not study the sections that will have the most questions.

3. Take a disease process and be able to answer these four questions: Best initial test, most accurate test, best initial therapy, and best next step in managment. Based on the Fischer Method if you could answer these four questions about every disease process you will be prepared for 80% of the questions you will get asked.

4. Pick a Book and Stick with it. I 100% agree with you. I used Med study for studying and MKSAP 15 for my questions. You can also do a board review course if you want, but the bottom line is don’t go buy 15 books when really you will focus on 1 or 2 of them. I think a good review book and a good question bank is exactly what everyone needs.

5. Focus on most commons. If a disease process is the most common or second most common cause of something, or increasing in prevelance, odds are you will get asked about this on your exam. i.e. number on killer in the world cardiovascular disease….number two killer in the world infectious disease… wonder these are 2 of the top 5 on the IM boards.

Enough ranting by me, but hopefully these 5 things will be found useful and Charles thank you again for the great posts.


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