ABIM Maintenance of Certification (MOC) internal medicine exam tips

This past spring, I took the American Board of Internal Medicine (ABIM) Maintenance of Certification (MOC) exam.

ABIM Maintenance of Certification (MOC) internal medicine exam tips 7 weeks later, I received my results.  Thankfully, I passed.

This was not entirely a surprise, as the pass rate for first-time test takers was 88%.  But it definitely requires some studying.  It’s not a gimmie.

Considering that I last took my board exam in 2002, when it was a 2-day pencil and paper affair, I wanted to check online to see if there were any test taking tips, or advice for studying.

Unfortunately, I found very little.  There was a small section on the ABIM website, titled Practical Advice, which wasn’t that helpful (sorry, ABIM).  And a few threads on Sermo, as well as on various physician message boards, but overall, I found online advice on how to approach the MOC exam to be lacking.

So, I want to use this post as a way to help future ABIM MOC internal medicine test takers.

For obvious reasons, I’m not going to comment on the test itself.  Instead, I’ll tell you how I prepared, and hopefully, other physicians can chime in below in the comments.

I understand that there are different ways of doing this.  I’ll tell you what worked for me.

I used the electronic version of the MKSAP 14 and MKSAP 15 questions, which together comprise over 2,000 questions.  I chose the digital version because I wanted to get used to reading and answering questions on a computer.  About 4-5 months before the test, I would do about 20-30 questions a day.  Not only answering them, but reading the MKSAP explanations, which is absolutely critical.  MKSAP 15 also provided to ability to randomize questions, which is a nice feature that replicates testing conditions.

I didn’t take a course, or spend any time reading a text or the MKSAP syllabus, but instead, just focused solely on question and answer. Last fall, the New York Times did a story on the psychology of studying, which commented on the learning power of testing:

In one of his own experiments, Dr. Roediger and Jeffrey Karpicke had college students study science passages from a reading comprehension test, in short study periods. When students studied the same material twice, in back-to-back sessions, they did very well on a test given immediately afterward, then began to forget the material.

But if they studied the passage just once and did a practice test in the second session, they did very well on one test two days later, and another given a week later.

“Testing has such bad connotation; people think of standardized testing or teaching to the test,” Dr. Roediger said. “Maybe we need to call it something else, but this is one of the most powerful learning tools we have.”

So with that in mind, I would repeat the MKSAP questions until I was able to score 90% and above.  This effort took about 3 to 4 times through the entire compendium of 2000+ questions.   About a 3 month process in total. Needless to say, I become quite comfortable reading and answering computer-based internal medicine board questions.

Two weeks before the exam, I twice read through the ACP’s Board Basics 2, which is a high-yield fact book written by fellows and chief residents who recently took the exam.

And that’s it.  My recipe for ABIM MOC board exam success.

In any case, I know doctors have many other approaches, including using the popular MedStudy series.

Please share some of your tips below.

As an aside, I wonder if the content of the MOC exam is slowly becoming impractical to internal medicine primary care physicians, like myself.  As hospitalists become more popular, fewer primary care physicians round on patients on the medical floor, or in the intensive care unit.  Yes, many of the questions were outpatient-based, but how long will it be before hospital-based questions become less relevant to an internal medicine primary care physician?  Already, there is a hospital focused MOC for hospitalists.  How long before we have a primary care focused MOC as well?

Note: This is an unsolicited, unpaid endorsement of the ACP’s MKSAP and Board Basics 2.  I highly recommend each without reservation.  Also, this is not a debate about the usefulness of maintenance of certification.  That is a separate discussion, so any comments pertaining to that here will not be allowed.

Kevin Pho is an internal medicine physician and on the Board of Contributors at USA Today.  He is founder and editor of KevinMD.com, also on FacebookTwitter, and LinkedIn.

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  • Dr Chris

    I just did the same thing-I did much of what DR Pho did. I thought the ACP MOC course was really helpful -on a couple of issues they pointed out what the answers were when the exam was written vs now. Board Basics 2 was key. Many of the questions were right out of MKSAP.
    As IM is the most “ADD” of specialities-we’re on our feet running from room to room- I set a timer on my computer, did MKSAP online, and gradually increased the time so that my behavior was shaped for prolonged computer concentration. It really helped. ( I passed)

  • Thomas Getchius

    Congratulations on passing the exam!

  • Jen.

    So good to know. I’m starting for recertification next year & have my MKSAP 15 in hand (both physically and electronically). Thanks for the insight!

  • Marnie Demeterio

    I pretty much did the same thing except that I carried around the MKSAP books. That made for interesting beach reading. I am questioning the value of this exam as it relates to clinical practice. If it had not been a requirement to be on the medical staff, I probably would not have taken it. I did several of the online exams, and looking up the answers pretty much gives you an additional review of the material. I was expecting questions on the more zebra-ish topics that came up on morning report during residency (Swyer James syndrome comes to mind) but I was pleasantly surprised to find mostly horses…

  • Max

    Thank you for the tips, Kevin. I did not quite know how to proceed with self-study and now I have a clear road map and will replicate your process with hopefully similar results.

  • Peter

    I failed the exam. I took 2 weeks off prior to the exam and put in 5 hours a day going through the MKSAP15 books. I thought that I had aced the exam so I had an unpleasant surprise. I am reevaluating my study plan and so your input is helpful.

    • Kevin

      Sorry to hear that Peter.

      I strongly recommend the digital version of MKSAP 15, versus the books, as doing the questions on a computer trains you for the actual testing environment.


  • Joel

    I actually failed the MOC exam in 2007. So demoralized, it took a long time for me to drag myself to start studying again. Eager to read journals, up to date on the practice component, and considered a solid internist by my peers – and yet it has been hard for me to face the exam again. True exam fear. I am hopeful that drills of questions will resolve this and I pass this year.

  • RPat1

    Nice to see my MOC prep mirrors your efforts. MKSAP15 CDROM is awesome!
    Now I just need to complete my practice improvement module and take the MOC exam in October!

  • http://pulse.yahoo.com/_V6FQUB5DJETV6WTCTLU42CRPQI Suriabala Kanu

    How would you say the focus of the initial certification exam and the MOC differ?  On the ABIM site the blueprints are identical but I wondered what you thought in general. I will be taking the MOC  in the Spring.

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