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

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 Facebook, Twitter, and LinkedIn.