The Ultimate Guide to the Internal Medicine ITE

One of the key milestones in becoming an internal medicine physician is the yearly In-Training Exam (ITE), a crucial assessment that evaluates your knowledge and helps gauge your progress. The internal medicine ITE experience can help you along your residency path, as you learn core clinical concepts and ultimately prepare for the ABIM certification exam. To make sure you’re ready for the exam, we’ll review some ITE basics, give you some preparation tips, and review test-taking strategies you can use to excel on exam day.

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What Is the Internal Medicine ITE?

The ITE is an annual exam which all U.S. residents take. It’s designed to assess your medical knowledge, clinical reasoning, and problem-solving abilities. The exam is typically taken in the fall of each year and covers a broad range of topics within internal medicine. 

Your score on the exam is used to gauge your knowledge, identify areas for improvement, and to see if you are on track to pass the American Internal Medicine Board (ABIM) exam after completing residency. Your program won’t explicitly report your score to fellowships and employers.

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Internal Medicine ITE Content

The ITE typically consists of multiple-choice questions that cover various subspecialties of internal medicine modeled after the ABIM certification exam, listed below:

Medical Content Category	Relative Percentage
Cardiovascular Disease	14%
Endocrinology, Diabetes, and Metabolism	9%
Gastroenterology	9%
Infectious Disease	9%
Pulmonary Disease	9%
Rheumatology and Orthopedics	9%
Hematology	6%
Medical Oncology	6%
Nephrology and Urology	6%
Neurology	4%
Psychiatry	4%
Dermatology	3%
Geriatric Syndromes	3%
Obstetrics and Gynecology	3%
Allergy and Immunology	2%
Ophthalmology	1%
Otolaryngology and Dental Medicine	1%
Miscellaneous	2%

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How to Prep for the Internal Medicine ITE

Now let’s take a look at some tips on how to prepare for the ITE. I recommend the following: 

1. Study consistently.

Per the ACP, “You are advised not to augment your study habits for the purposes of taking this exam.” This is because the purpose of the exam is to see how you are progressing with your current methods, and aggressively studying will inflate your score but not indicate how you’ll do on the ABIM. Instead, study consistently and often as you would even if the test were not coming up. Develop a study schedule that balances your clinical duties and study time.

2. Maintain your endurance. 

When you’re studying, keep yourself in a mode to learn but also keep in mind that the ITE and ABIM exams are long! The ITE can last up to 9 hours, with 7 hours for the exam itself and the rest for breaks. Try to learn as much as you can while on the job and continue your studying on weekends or evenings as needed to learn your field.

3. Set realistic goals.

Break your study goals into manageable chunks. Focus on a specific subspecialty each week to ensure comprehensive coverage, which is best done by studying for whatever rotation you’re on, so that what you see in books or questions can be applied to real patients.

4. Use high-yield resources. 

You’ll want access to reputable study resources in the forms of textbooks, review books, and online question banks. Some popular resources include Blueprint/Rosh Review Resident Qbank, MKSAP, and UpToDate.

Still looking for study resources to help you prepare for your upcoming ITE? We’ve got you covered. Check out your options for the Blueprint/Rosh Review Internal Medicine Resident Qbank with 2,000 ABIM-formatted questions, detailed explanations with important teaching pearls, engaging images, a One Step Further question for additional learning, and powerful analytics.

5. Practice with sample questions. 

Do practice questions regularly to familiarize yourself with the exam format and improve your test-taking skills. This will also help you identify weak areas that need further review. You can do this with the online practice test available from the ACP website.

In addition to the 2,000-question Blueprint/Rosh Review Internal Medicine Resident Qbank, the 300-question Blueprint/Rosh Review Mock IM ITE exam is a helpful resource that simulates the exam experience and can be purchased from the boost box on the Blueprint/Rosh Review dashboard.

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Test-Taking Tips for the Internal Medicine ITE

Finally, let’s discuss some tried-and-true approaches for taking the exam. Here’s four techniques that can improve your score: 

1. Read the question first. 

It’s rarely the case that you can pick the right answer from the question stem and without reading the vignette. However, it’s always good form to read the question first, so that you can know what to look for in the clinical scenario.

2. Use process of elimination. 

Remember to treat this as preparation for the ABIM. If you’re unsure of an answer, try to eliminate obviously incorrect options. This increases your chances of selecting the right answer.

3. Practice time management. 

Pace yourself throughout the exam to ensure you have sufficient time for each question. If you tend to run out of time, it may not be not worth going back to flagged questions. Due to the length of the exam, you’ll want to save your mental energy for the questions you’ll know towards the end. 

4. Use breaks wisely. 

Depending on your program’s set up, it can take some time to get in and out of the testing site. This can really eat into your break time (except for the break at the halfway point, which is an hour long.) If you can’t get back into the testing center before the next block starts, you may not be able to finish it. 

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Further Reading

The internal medicine ITE is a significant milestone in your journey toward becoming a proficient internal medicine physician. By following these exam preparation and test-taking tips, you can enhance your chances of success. Remember, diligent study, consistency, and effective time management are your allies in conquering the ITE and building a strong foundation for your medical career. Best of luck!

For more (free!) content to help you navigate internal medicine residency and beyond, check out these other posts on the blog:

• Internal Medicine Residency: Is Subspecialty Fellowship Right for Me?
• Internal Medicine Residency: Which Scholarly Pursuits Should I Consider?
• How to Increase Your ABIM Certification Exam Score

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