ABIM Exam Prep: An Candid Internist’s Perspective (Part III)

I’ve always wondered who actually writes the ending questions on the ABIM exam. In my mind, I picture a Voldemort-like character leading a group of equally dark souls, laughing every time they come up with a particularly difficult question that’s sure to trip up some poor exam chump. Most likely, and this is also pure speculation, there is a group of high-level internal medicine academic physicians, fellows, or even ACP masters (you know, FACPs and the lauded MACPs listed on résumés) who are trying to motto of a way to objectively evaluate future companions. But I still like Voldemort’s characterization better.

On that fateful day in August, the day of the exam, I felt like Harry Potter about to fight the forces of evil. After the alarm on my iPhone went off at 6am, I jumped out of bed, adrenaline coursing through my veins.

The night before, I reluctantly put away the books and the questions. Instead, I watched Game of Thrones clips on YouTube. Between clips, I prepared everything that, on a normal work day, would have been done in a mad dash in the morning. I packed my backpack with pens, a notepad, a watch, a hoodie, and snacks that included chips and chocolate chip cookies. My mom thought she was back in high school.

Lunch, which I also made the night before, consisted of a ham and cheese sandwich, a salami and mayonnaise sandwich, crackers, a can of orange soda, and two bottles of water. I am certainly a hypocrite, since I normally advocate a diet low in sodium and sugar. But today I wanted and deserved all my comfort foods.

On the way to the testing site, I blew up my motivational playlist: movie themes from Eminem, Jay-Z, and Rocky. I finally reached the site at 7:30 am. The employees were inside, but they wouldn’t let us in. The only people waiting outside were, from the looks on their faces and the books they were flipping through, also the ABIM examinees. I asked a woman with cardiology MKSAP: “Are you ready for the test?” She did not answer. She must have thought that she was flirting with her. Whatever. She wasn’t that pretty anyway.

After lounging outside for another half hour, the employees let us through the door. I was fingerprinted and had my photo taken, and I put my backpack in a storage locker. An employee said that we would be videotaped at all times. I felt that I was being registered for the prison, but as I understand it, this is necessary to ensure the integrity of the test. Later, some non-ABIM examinees were late. They complained that their 3 hour tests were exhausting. I had no sympathy for them.

When I sat in my cubicle, there was a black marker and a pink laminated sheet where I could scribble some notes. A pair of noise-cancelling headphones dangled from the edge of the cubicle.

I clicked “get started” and started going through the questions.

Unlike previous tests we have taken, the ABIM test consists of “only” 240 questions. They are divided into four blocks of 60 questions each, with two hours for each section. This gives a total testing time of 8 hours, including one hour for breaks that you can use at your discretion. For each question, I read the question statement and the answers before going back and reading the paragraphs of the text. This helped me put each question in context.

I had the most difficulty with the first block of questions. I was pressed for time and had marked at least 10 questions with little red flags, because although I could narrow the correct answer down to two options, I often couldn’t decide between the two. Worse yet, I let my ego get in the way and spent ten minutes agonizing over a question about eosinophilic esophagitis.

If you do the math, you have two minutes to answer each question. Since all questions are equally weighted and there is no penalty for an incorrect answer, the right thing to do when you get stuck is to make an informed guess and move on. You should return to the question only if you have extra time at the end.

Fortunately the other 3 sections were much more manageable. The questions ranged from several paragraphs to a single sentence. If I knew the answer to a short question, it was like an oasis in the desert. True to form, the questions also covered the entirety of internal medicine. My test, for example, was especially heavy on rheumatology concepts.

However, other people I spoke to felt that block 2 or block 4 was the most difficult, or that their exams emphasized gastroenterology or nephrology. Therefore, each test taker probably has a different order of questions, or more likely an entirely different set of questions. According to ABIM, some of the questions are also experimental and don’t count towards the final score (I hope I’m wrong). I wish I could find out the exact methodology of the exam, but I’m afraid ABIM’s punishment would be severe.

If I finished a section early, I would leave the clock running for a bathroom break, so I wouldn’t eat in my hour-long break time, which I used for an extended lunch. After completing blocks 1 and 2, I decided it was time for lunch. Since it was a hot summer day in California, I ate outside and then rested my eyes for 15 minutes in the hope that I could recharge my brain.

By the middle of block 3, I was in a state of flux. The clock and other distractions faded away, and I focused on answering the questions as if I were Michael Jordan preparing to take the game-winning shot. At the same time, my number of bathroom breaks increased; there needs to be a study linking stress to increased urination.

Finally, I sped through the last 10 questions of block 4 and left the test site feeling good. I knew I got some questions wrong and wished I had studied certain sections in more depth, but this was not the time to be guessing. I felt good enough to know that I had passed the test: at the end of the day, that was all that mattered.

The night was a time for celebrations.