ABIM Certification

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American Board of Internal Medicine (ABIM)


The Internal Medicine Certification Exam (IMCE) was first given in 1936 and administered by the newly created American Board of Internal Medicine (ABIM). A number of specialty examinations soon followed. The first exams were handwritten; the IMCE converted to computer-based testing in 2006.[1] In the first four years, over 2,000 candidates achieved certification. As of calendar year 2013, over 262,000 internists were certified.[2]

The ABIM is a non-profit organization whose sole mission is to evaluate and certify internal medicine physicians using evidence-based, professionally developed criteria that set a standard for knowledge and clinical competency in the field. Consumers can be assured that their board-certified internist, whether generalist or specialist, is held to a high standard of care in his or her area of practice and maintains current knowledge through the certification maintenance process. [3]

Function of the Test

ABIM Study Guide

The IMCE was developed to test physicians practicing in internal medicine in the areas of basic medical knowledge and clinical diagnostic and treatment skills against a standard of competence developed by the ABIM Board of Directors. The exam is designed to measure a candidate’s abilities to manage a wide range of conditions as would be encountered in a typical clinical internal medicine practice.[4]

To be eligible to sit for the IMCE, a physician must hold a current, unrestricted US or Canadian medical license and have completed their residency training in internal medicine in an accredited US or Canadian training program within 7 years of applying to take the exam. Candidates whose training was completed more than 7 years prior to application must complete a year of retraining before being considered eligible.[5]

While certification is not required for licensing or practice of internal medicine, many hospitals require staff physicians to be board-certified to assure that their knowledge and skills are continually assessed and keep pace with advancements in their specialty.[6]

Candidates who pass the exam are certified as diplomats of ABIM.[7]

Test Administration

ABIM Flashcards

The exam is offered over a six-day period in August of every year. Registration should be completed between December 1st and February 15th in the period prior to the requested schedule date. There is an additional 2-week late registration window in which applications will be accepted.[8] The cost to take the exam is $1,365 during the standard registration period. A late fee of $400 is assessed for late registrants. Applicants who are not approved to take the exam will be refunded 85% of the fee. Partial refunds are also in effect for those who register and later cancel a scheduled exam. .[9]

Once a conformation notice is received from ABIM, candidates may contact the testing vendor Pearson VUE directly to schedule their exam. This should be done as soon as possible to insure availability on the candidate’s preferred exam date.[10]

Accommodations are available for candidates who have physical, learning, or psychological disabilities as defined by the Americans with Disabilities Act (ADA). Written requests with supporting documentation should be submitted to the “Special Examinations Coordinator” at the address given on the ABIM Web site in advance of the exam registration deadline.[11] Accommodations for nursing mothers are also available if requested at least 30 days in advance of the exam date.[12]

Any candidate who does not pass their initial exam may reapply for admission to the following year’s exam. Candidates who are not successful over three consecutive years must wait a year before reapplying to take the exam for the fourth time.[13]

Test Format

Sections of the ABIM Test
ABIM Pt 1 Test Subject Areas Percent
Cardiovascular Disease 14%
Gastroenterology 9%
Pulmonary Disease 10%
Infectious Disease 9%
Rheumatology/Orthopedics 8%
Endocrinology, Diabetes and Metabolism 8%
Medical Oncology 7%
Hematology 6%
Nephrology/Urology 6%
Allergy/Immunology 3%
Psychiatry 4%
Neurology 4%
Dermatology 3%
Obstetrics/Gynecology 2%
Ophthalmology 2%
Otorhinolaryngology 2%
Miscellaneous 3%
Total 100%

Test Structure

The ABIM Exam is made up of seventeen exam topics: Cardiovascular Disease; Gastroenterology; Pulmonary Disease; Infectious Disease; Rheumatology/Orthopedics; Endocrinology, Diabetes and Metabolism; Medical Oncology; Hematology; Nephrology/Urology; Allergy/Immunology; Psychiatry; Neurology; Dermatology; Obstetrics/Gynecology; Opthalmology; Otorhinolaryngology; and Miscellaneous. There are a total of 240 questions broken up into sections made up of around 70 questions each. Total testing time takes around ten hours.[14]

Test Environment

Test takers are expected to arrive half an hour early to the testing appointment. Arriving late may mean not being admitted into the test. For exam security, two forms of personal identification is required during admission, one of whic must be a government issued photo ID containing a signature.. Personal items, such as electronics, watches, study materials, bags, and snacks are not allowed into the testing room. [15]

Test Content

  • Sample ABIM Questions
  1. Your Emergency Room patient is a 68-year-old man, who awoke with palpitations, chest pain, dyspnea and dizziness. He complains his heart is “pounding” but denies any history of heart disease or hypertension. His blood pressure is 85/60 mm/Hg, and his pulse is rapid and irregular. Crackles are audible at his lung bases. His routine lab work is normal, including a troponin level. His EKG shows atrial fibrillation with a ventricular response of 130/minute. Choose the most appropriate treatment:
    A. Intravenous digoxin
    B. Intravenous beta-blocker
    C. Immediate cardioversion
    D. Delayed cardioversion after anticoagulation
  2. A 70-year-old man presents with brisk, maroon-color bleeding from his rectum. He has no history of bowel disease or previous gastrointestinal bleeding. He reports mild left lower quadrant pain for the past few days. His blood pressure is 140/70 mm/Hg, and his hemoglobin is 12 gm/dL. Identify the most likely source of his bleeding and your initial diagnostic step:
    A. Diverticular source diagnosed by barium enema
    B. Diverticular source diagnosed by colonoscopy
    C. Acute colitis diagnosed by colonoscopy
    D. Cancer of the ascending colon diagnosed by colonoscopy
  3. The polysaccharide pneumococcal vaccine:
    A. Stimulates a B-cell response but not a T-cell response
    B. Is active against fewer serotypes than the conjugate vaccine
    C. Requires only one injection if the patient is older than 65
    D. Is equally effective in immune-compromised patients
  4. You discover a thyroid nodule in a 40-year-old woman during a routine exam. She has no family or personal history of thyroid disease. She denies symptoms of hyperthyroidism or hypothyroidism. There is no fixation of the nodule, cervical lymphadenopathy, or voice abnormalities. Choose the appropriate initial test for this patient:
    A. Cervical ultrasound
    B. Fine-needle aspiration biopsy
    C. Anti-thyroid antibody titers
    D. TSH
  5. Your patient is a 55-year-old man, who takes low-dose Aspirin and clopidogrel after his angioplasty for coronary artery syndrome. One month after angioplasty, he developed fever, headaches, and confusion. On the way to his doctor’s office, he had a seizure. He was taken to the Emergency Room, where he regained consciousness, but remains groggy. His temperature is 102o F. The laboratory reports his results as: Hemoglobin 9 gm/dL; WBC 14,000/µL; platelets 40,000/µL; LDH 1,400 u/L; creatinine 3.0 mg/dL. His blood smear exam shows numerous schistocytes, red cell fragments, and low platelets. Choose the most effective immediate treatment:
    A. Emergency splenectomy
    B. Intravenous corticosteroids
    C. Transfusion with fresh frozen plasma
    D. Plasma exchange with fresh frozen plasma
  6. Your patient is a 30-year-old man with psoriasis vulgaris. He has erythematous, scaly plaques on his elbows, knees, scalp, and buttocks. He was treated with topical corticosteroids alone and in combination with a coal tar preparation. They were helpful in the past, but not currently, and now new lesions are appearing. He has no signs of arthritis. Select the next logical therapy:
    A. Methotrexate
    B. Narrow band UV B light (NB-UVB)
    C. Etanercept (Enbrel)
    D. Psoralen + UVA (PUVA)

More free ABIM practice test questions.


The IMCE consists of multiple choice questions in “single best answer” format. Unanswered questions are scored as incorrect, and candidates are thus advised to attempt to answer all questions on the exam. Because of the ever-evolving nature of medical knowledge, answers should be selected in the context of a candidate’s most current medical knowledge. Any questions that may be affected by very recent changes to medical knowledge will be reviewed and adjusted by ABIM so that a candidate’s overall score will not be impacted by potentially obsolete information.[16] Exam forms are constructed from an available pool of questions, and multiple forms are used for each exam administration. Forms are leveled to insure that all forms in a given administration are generally equivalent in difficulty and other variables such that individual candidates will not be unduly advantaged or disadvantaged by using any given form. Passing standards are set by the test committee for each test administration.[17] Over 7,000 physicians sit for the initial certification exam each year, and on average over 85% pass their first attempt.[18]

Answers to Sample Questions

1;C 2;B 3;A 4;D 5;D 6;B


  1. ^ Exam Administration History January 13, 2015
  2. ^ Number of Candidates Certified Annually by the American Board of Internal Medicine January 13, 2015
  3. ^ About the American Board of Internal Medicine January 13, 2015
  4. ^ Internal Medicine Certification Examination Blueprint January 13, 2015
  5. ^ General Policies and Requirements January 13, 2015
  6. ^ A Trusted Credential January 13, 2015
  7. ^ Taking the Internal Medicine Exam January 13, 2015
  8. ^ Taking the Internal Medicine Exam January 13, 2015
  9. ^ Cost January 13, 2015
  10. ^ Schedule an Exam January 13, 2015
  11. ^ Request an Accommodation January 13, 2015
  12. ^ Test Accommodations for Nursing Mothers January 13, 2015
  13. ^ General Policies and Requirements January 13, 2015
  14. ^ ABIM Bluepring 2 April 2015
  15. ^ ABIM Administration 2 April 2015
  16. ^ Taking the Internal Medicine Exam January 13, 2015
  17. ^ How Exams are Developed January 13, 2015
  18. ^ First-Time Taker Pass Rates – Initial Certification January 13, 2015