Everything to Know About the FMCLA in 2025

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The Family Medicine Certification Longitudinal Assessment (FMCLA) is a new way for family physicians to fulfill their continuous certification requirements, the ongoing continuing medical education and assessment program family medicine physicians participate in to maintain their board certification.

The FMCLA offers an alternative to the traditional recertification exam family medicine doctors had to take every 10 years, and allows physicians to demonstrate their knowledge over time in a longitudinal, low pressure environment. Whether you’re new to the FMCLA or considering it as an option, here’s everything you need to know about the exam format, scoring, prep, and more.

What is the FMCLA?

The FMCLA is a longitudinal exam offered by the American Board of Family Medicine (ABFM) as part of the recertification process for family physicians. Instead of sitting for a single, comprehensive 300 question multiple-choice exam every ten years to recertify, the FMCLA breaks the assessment into manageable, quarterly sets of 25 multiple-choice questions over a three to four year period.

This approach allows you to answer questions at your convenience, and receive immediate feedback on your performance, all while maintaining your board certification throughout the cycle. This offers flexibility and align with busy physicians’ schedules, focusing on relevant clinical scenarios you may encounter in daily practice.

The FMCLA is available to family medicine physicians who are currently board-certified by the ABFM and due for their recertification examination. To participate, you must be within your certification cycle window, typically starting two to three years before your certification expires.

To register, log into your ABFM physician portfolio and select the option to enroll in FMCLA. You can register in the fall prior to the year your recertification is due. For example, if you have to take your exam in 2026, you can apply for the FMCLA in the fall of 2025.

In this scenario, you’d start getting quarterly questions in January 2025. If you miss the registration window, you’ll need to wait for the next year’s enrollment period or opt for the traditional exam. There is no additional cost for the longitudinal assessment.

What is the FMCLA format?

Quarterly Questions

You’ll receive a total of 25 questions every three months, spanning over a three to four year period (until you complete 300 questions total and achieve a passing score).

Find a breakdown of the question structure in this graphic from the ABFM:

Image Credit: ABFM

We’ll cover more on how this works in the next section about exam scoring!

Time per Question

You must answer each question within five minutes, but you can work at your own pace within each quarterly period. You can answer questions on any device, including a desktop, laptop, tablet, or smartphone. However, for the best experience, we recommend using a computer, especially for questions with multimedia or images.

Of note, the ABFM provides reasonable accommodations in accordance with the Americans with Disabilities Act (ADA), so if you had ADA accommodations before, you’ll still get them for the FMCLA.

How is the FMCLA scored?

The complete assessment includes answering 300 questions over a maximum period of four years (100 questions per year) but you can miss one year’s worth of questions if needed. If you complete 300 questions in total and achieve a passing score within the four-year window, you’ll meet the exam requirement to maintain your board certification.

You must answer 75 of the 100 questions you receive in the first year and complete a brief survey to provide feedback, following completion of each quarter. After all 300 questions are scored, your raw score will be transformed into a scaled score, which accounts for the difficulty of the questions you received.

This ensures that no one is unfairly advantaged or disadvantaged by receiving a relatively easy or difficult set of questions. Your final scaled score and a detailed report will be delivered in the quarter following your completion of 300 questions. To continue your certification, you must meet the minimum passing standard, which is set at the same standardized “grade” as the one-day certification exam.

Throughout the FMCLA cycle, you’ll receive periodic reports summarizing your performance, including areas where you excel and those where you need additional improvement. These reports help you tailor your preparation for future questions and ensure you’re on track to meet the passing standard.

How do I prepare for the FMCLA?

Preparing for the FMCLA is less intensive than preparing for the traditional certification exam, with a focus on the content relevant to family medicine clinical practice. The exam focuses on full-spectrum family medicine, covering areas such as women’s health, pediatrics, primary care and disease prevention, emergency care, and geriatrics. You can find the full breakdown of the FMCLA content blueprint here.

Considering the FMCLA in 2025? We’ve got you covered!

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Here are a few tips to prepare:

1. Stay up-to-date with current clinical guidelines.

Since the questions are evidence-based, it’s important to stay up-to-date on current clinical guidelines. Focus on common conditions seen in family medicine such as hypertension, diabetes, asthma, depression, and preventive care.

2. Leverage the open-book format.

Take advantage of the open-book format by familiarizing yourself with reliable resources such as the United States Preventive Services Task Force (USPSTF) and AAFP (American Academy of Family Physicians) guidelines, as well as your personal notes. Practice searching for answers quickly to manage time efficiently during the assessment. You can also use your Blueprint/Rosh Review FMCLA Qbank to quickly search for question topics during the exam.

3. Develop a consistent routine.

Although the FMCLA allows flexibility in answering questions, it’s helpful to dedicate regular study time to maintain momentum and reinforce your knowledge. Review recent journal articles (those from AAFP are especially helpful), attend CME courses, and use board review resources like the Blueprint/Rosh Review FMCLA Qbank or ABFM knowledge assessment questions.

4. Collaborate with peers.

Consider participating in study groups with colleagues, as discussing clinical scenarios can enhance learning and highlight different approaches to problem-solving.

5. Track your performance.

Pay attention to the feedback provided after each question. Use this to identify areas of weakness and focus your studies accordingly. Adjust your preparation based on the subjects where you score lower to improve your overall performance.

6. Stay consistent.

Because the FMCLA is a long-term assessment, consistency is key. Try to stay on top of the quarterly questions, and take time to review explanations and references after completing each set.

Should I take the FMCLA or the traditional recertification exam?

For family physicians, the FMCLA offers a convenient, low-stakes alternative to the traditional 10-year certification exam. However, it’s not the only option. If you prefer to complete your assessment in one sitting and not worry about answering questions every quarter, the traditional exam may be a better fit.

Ultimately, the choice between FMCLA and the traditional exam depends on your learning style and preferences. The FMCLA is new and provides an opportunity to spread the workload over several years, receive continuous feedback, and remain certified throughout the process. On the other hand, the traditional exam allows you to complete the assessment in one go and remain certified for 10 years.

You may withdraw your longitudinal assessment application and switch to the one-day exam on, or before, the final deadline to submit your online application. This can be done through your MyABFM portfolio. Your fee will simply be transferred from one application to the other.

A Few Expert Opinions…

Personally, I remember taking the one-day board certification and believe me, moving forward, I will choose the FMCLA for my own recertification.

A few colleagues who have been in practice much longer than I have also offered to weigh in:

“It offers me the flexibility I need as a full-time physician balancing patient care and family life. The option to take assessments in manageable increments allows me to fit it into my schedule more easily, compared to a single high-stakes exam that I have to take an entire day for, not to mention the stresses leading up to test day.”

“As an educator, I appreciate how the FMCLA emphasizes continuous learning. The structure encourages me to review current guidelines and evidence-based practices regularly. It makes the certification process feel less intimidating and more like an integrated part of lifelong learning.”

“The longitudinal format of the FMCLA has been a gamechanger for me. Working in a rural setting, time is always a challenge, and traveling for a proctored exam was less than ideal. Being able to take the assessment from my home and on my own time made maintaining my certification less anxiety-inducing, and the fact I didn’t need to travel and book a hotel for a test was nice.”

“I see the benefits of the FMCLA, but personally find the format overwhelming. I struggle with keeping up with the regular assessments while managing my busy practice. I prefer to focus my efforts on one exam and then get it over with.”

“I understand the continuous learning aspect of the FMCLA, but I feel like the frequent deadlines add to the burden of practice management and patient care. The need to balance everything can be difficult, and at times, I wonder if it’s more time-consuming than the traditional recertification exam, since the quarterly assessment is always in the back of my mind.”

Final Thoughts

The Family Medicine Certification Longitudinal Assessment (FMCLA) offers a modern, flexible, and continuous approach to maintaining board certification for family physicians. By spreading out assessments over four years and integrating learning into daily practice, the FMCLA reduces the stress associated with traditional high-stakes medical exams while promoting ongoing learning.

Understanding the eligibility criteria, exam format, scoring system, and effective preparation strategies is essential for successfully navigating the FMCLA pathway. Embracing this innovative assessment model not only ensures compliance with ABFM certification requirements, it also fosters a culture of lifelong learning and excellence in family medicine practice.

For more detailed information and updates, always refer to the official ABFM website. Best of luck on your recertification journey from Blueprint/Rosh Review!

Looking for more (free!) content to help you succeed as a practicing physician? Check out these other articles on the blog:

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By Mike Ren, MD

Mike is a driven tutor and supportive advisor. He received his MD from Baylor College of Medicine and then stayed for residency. He has recently taken a faculty position at Baylor because of his love for teaching. Mike’s philosophy is to elevate his students to their full potential with excellent exam scores and successful interviews at top-tier programs. He holds the belief that you learn best from those close to you in training. Dr. Ren is passionate about his role as a mentor and has taught for much of his life–as an SAT tutor in high school, then as an MCAT instructor for the Princeton Review. At Baylor, he has held review courses for the FM shelf and board exams as Chief Resident. For years, Dr. Ren has worked closely with the Office of Student Affairs and has experience as an admissions advisor. He has mentored numerous students entering medical and residency and keeps in touch with many of them today as they embark on their road to aspiring physicians. His supportiveness and approachability put his students at ease and provide a safe learning environment where questions and conversation flow. For exam prep, Mike will help you develop critical reasoning skills, and as an advisor, he will hone your interview skills with insider knowledge to commonly asked admissions questions.