How to Study for the ABIM Certification Exam in 2025

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The American Board of Internal Medicine (ABIM) Certification Exam is offered once per year over a two-week period of time. The assessment evaluates the ability of test takers to diagnose and manage both common and rare conditions under the broad umbrella of internal medicine.

As you begin to prepare for the exam, it’s important to have an organized approach to master the material tested. Read on to learn more about the test, how to make a study schedule, and other relevant tips so you will be ready by exam day.

The Structure of the ABIM Certification Exam

A great starting point for understanding the test is the Internal Medicine Certification Exam blueprint which provides a content outline of what the exam covers. The test consists of 240 multiple-choice questions with a single best answer, but 35 of those are experimental and not counted in your score. The questions are spread across 4 blocks lasting up to 2 hours each, though you don’t need to use all of the time if you finish early. You also will have a total of 100 minutes of break built into the day, which you can use in between the different sections.

The structure of the exam is summarized in this table:

Section			Time Allotted (min)
Tutorial (optional)			30
Instructions and pledge of honesty			10
Session 1 (maximum 60 questions)			120
Session 2 (maximum 60 questions)			120
Session 3 (maximum 60 questions)			120
Session 4 (maximum 60 questions)			120
Survey (optional)			10

Additionally, the following outline of exam topics provides a breakdown of the different diagnoses you will need to know. The disciplines with the most questions are cardiovascular medicine followed by endocrinology, gastroenterology, infectious diseases, pulmonary medicine, and rheumatology and orthopedics.

The full breakdown from the content outline is as follows:

Medical Content Category	% of Exam
Allergy and immunology	2
Cardiovascular disease	14
Dermatology	3
Endocrinology, diabetes, and metabolism	9
Gastroenterology	9
Hematology	6
Infectious disease	9
Miscellaneous	2
Nephrology and urology	6
Neurology	4
Allergy and Immunology	3
Medical oncology	6
Ophthalmology	1
Otolaryngology and dental medicine	1
Psychiatry	4
Pulmonary disease	9
Rheumatology and orthopedics	9
Geriatric syndromes	3

A few other important points:

You have a total of about 10 hours to complete the exam and any pre-exam/post-exam content, but if you complete sections early, you do not need to use all of the time allotted.

Within the different disciplines listed above, you should also expect questions related to clinical epidemiology, ethics, patient safety, and various other topics.

Some questions on the exam may come with media like a patient photograph, an electrocardiogram, radiographic images, or audio recordings of physical examination findings.

There’s no penalty for answering incorrectly, so you should make an educated guess on every question. You should try to manage your time to avoid rushing, but if you’re running out of time, at least make sure every question has an answer.

When to Start Studying and Creating a Study Schedule for the ABIM Certification Exam

It’s important to give yourself plenty of time to prepare. In particular, because of the breadth of the ABIM Certification Exam, you should not count on trying to cram in the days leading up to the test. The key to retention is spaced repetition, so you should afford yourself adequate time to review and re-review material until you have solidified your mastery of the information.

Finding the Right Resources

Practice questions should be a centerpiece of your study plan for the ABIM Certification Exam. Working through questions is an inherently active form of learning, and it prepares you for the exam day environment since your test will consist of single best-answer, multiple-choice questions. To that end, the first step in constructing your approach to studying is to pick quality question banks.

If you’re looking for an Internal Medicine Certification Exam Qbank to help you prepare, check out this additional post “How to Select the Best Internal Medicine Board Review Qbank” for more information on making your decision, or “Top 12 Questions About Internal Medicine Qbanks & Exams” to compare your options.

While MKSAP by the American College of Physicians is one option, Blueprint/Rosh Review offers a well-structured Internal Medicine Certification Exam Qbank that addresses the wide scope of the test. Questions are formatted similarly to the ABIM Certification Exam questions and include detailed explanations. Some unique advantages of the Blueprint/Rosh Review question bank include its size (3,000 questions), teaching illustrations included with each question, One Step Further questions with additional teaching pearls, and Rapid Reviews that summarize high-yield information in one place.

Other supplemental resources include flashcards or textbooks. Ultimately, these options are secondary to the question banks, so you should ensure that the majority of your study time is spent working through practice questions. Furthermore, it’s better to prioritize a few high-yield resources rather than trying to integrate too many things. The bottom line is simply to be realistic.

Important ABIM Certification Exam Study Tips

How Long Should You Study?

The ABIM Certification Exam can feel daunting, but remember that you’ve already learned quite a bit of the material on the exam from your experiences throughout residency alone. To that end, how long you should study is a personal decision and can vary widely depending on what you already know. At a minimum, you should set aside about ten hours per week for several weeks to months depending on the amount of content you feel you need to work through.

As your exam date approaches, consider taking a practice exam, such as the 240-question Blueprint/Rosh Review Mock Certification Exam. This exam can be purchased from the boost box located on the Blueprint/Rosh Review dashboard.

Remember to Take Care of Yourself!

Perhaps the most important tip of all is to prioritize your mental health anytime you’re preparing for an exam like this. Make sure you budget time in your plan to sleep, eat a balanced diet, exercise, and see family and friends. Spending too much time studying at the expense of caring for yourself will be counterproductive in the long run and lead to less retention.

Especially on the day before the exam, avoid excessive cramming and focus on a light review of high-yield material. It’s far more important to relax, gather all the check-in materials you’ll need for your exam, and go to bed early. Staying up late studying will only lead to fatigue on exam day and ultimately work against you.

Final Thoughts on the ABIM Certification Exam

While the exam does cover a substantial amount of content, remember that you can do this! Think about how much time you will need versus how much you can commit to studying and utilize high-yield resources. The recipe for success really is working through high-yield question banks, supplementing with textbooks and flashcard resources as needed, and most of all taking care of yourself. Put it all together, and you will do great on exam day!

Rosh Review is a board review company providing Qbanks that boost your confidence for your boards and beyond. Get started with a Rosh Review free trial to the Qbank of your choice, no credit card required! Gain access to board-style practice questions, detailed explanations, beautiful medical images, and more.

By Michael Stephens, MD

Originally from the Kentucky suburbs of Cincinnati, OH, Mike finished his undergraduate degree at a small Kentucky liberal arts school called Thomas More University. From there, he attended medical school at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, PA, where he was involved in the Medical Student Government, Dermatology Interest Group, and University City community clinic. He completed a preliminary internship in Internal Medicine at Brigham and Women's Hospital in Boston, MA and is currently a dermatology resident in the Harvard combined program. Outside of medicine, Mike enjoys hiking, playing tennis, and just generally being outside. Though the Patriots and Eagles might have Super Bowl wins behind them, he will always be a Bengals fan at heart.