The Art of The Answer: Internal Medicine Board Exam Performance Boosters

Multiple choice examinations can be incredibly stressful and full of landmines for many test-takers. Several myths, tips, and tricks abound regarding strategies for choosing the right answer when you do not know the correct answer. You may be surprised that the tricks you learned in medical education or from your friends do not apply to Internal Medicine certification examinations because they are so strictly regulated and well-written. However, a few essential study strategies can increase your chances of getting the correct answer. These strategies are necessary for board certification exams graded as pass/fail because every point matters. Increasing your chances of choosing the correct answer might mean the difference between passing and failing the Internal Medicine examination.

These board exam tips explore effective time management, tame test anxiety, decipher tricky questions, and use elimination strategies to increase accuracy. These evidence-based tips will help you score higher on your American Board of Internal Medicine (ABIM) examination.

1. If two answers are opposites, one of them is the correct answer

Logically, both answer choices cannot be wrong if they cover all the possible scenarios. Eliminating the other answer choices can give you a 50/50 chance of getting the correct answer and will help you with exam mastery.

2. Answers with overgeneralizations are usually incorrect

Pay attention to words such as always, never, all, and must. Medicine is usually not absolute, and these overgeneralizations can alert you to a wrong answer when presented with a clinical reasoning challenge.

3. When answers contain numbers, eliminate the ones that appear too large or too big

Test writers often give a couple of answer choices that are too small, too big, or off by a decimal point, so check for math errors. They also might include a number that you would get if you only did the first step of the problem but should have done other steps. If you can eliminate these choices, you will have a better chance.

4. Use your gut feeling

If two answers seem correct, try to visualize both as right. Even if you don’t remember the correct answer, you probably have read about it at some point. You can use this to your advantage because feelings are stored easier than memories. For example, if you hate biostatistics, your brain will probably get a sense of the correct answer based on your anxiety over these types of questions instead of logic. Do not go back and overthink questions at the end of the board examination unless you need more time to think through the logic or perform a calculation. Your first instinct is usually your best, and you might talk yourself out of the correct answer if you don’t listen to your intuition.

5. Does the answer thoroughly address the question?

If it is only partially true, it is probably not the correct answer.

6. Beware of time-suckers

If a question takes up too much of your time, sometimes you are better off guessing and moving on. Try to eliminate questions that seem wrong, guess, mark it for review, and come back to it if you have time. Physicians often let their perfectionistic tendencies get in the way, but time management should be paramount.

7. Don’t read the answer choices first

Many people misread questions, and if you already have an answer choice in mind, it will distract you and encourage you to pay attention to the wrong information in the question stem. Ensure you understand the question entirely before moving on to the answer choices so you won’t be distracted. Some people get questions wrong because they didn’t read a question in its entirety or missed a small detail, such as a lab value. The distractors are there for people not paying attention to the details.

8. Don’t use the techniques you learned in medical education

Remember that the Internal Medicine boards employ professional editors. These editors often have extensive training in writing, and they usually have an MD or a PhD. They will ensure that the correct answer is no longer than the others, that the verb tense of the answers is not different from those in the question, and that the distractors do not contain mistakes. They are mindful of the tricks you used to outsmart your teachers when you didn’t know the answer. Assume that the ABIM examination is very well-written and that you won’t be able to pick out the correct answer without knowing something about the material. Don’t assume the most common answer is B or C. The test-makers will ensure that doesn’t happen.

9. Beware of similar answer choices.

When you are fatigued, similar answer choices can confuse you. If you are not paying close attention, these answer choices can trick you into choosing the wrong answer. Try to eliminate wrong choices first and then carefully consider the other options. Ask yourself how the test writers would have written the incorrect answer choice.

10. Practice stress management during the ABIM examination

When the brain is in fight or flight, it is challenging to access long-term memory. Learn breathing techniques, visualize receiving your score, and imagine it going well. Avoid other people before the examination if they tend to make you nervous. Use breathing techniques or paired muscle relaxation. These strategies can help with exam anxiety management.

11. Identify the unwritten step

Most ABIM exam questions contain two steps. For example, they may present a clinical reasoning challenge, from which you must determine the diagnosis. The question is not about the diagnosis but the treatment. Make sure you have the missing step correct before moving on to the answer choices. 1
Passing a multiple choice ABIM examination requires stress management techniques, elimination strategies, and an understanding of the nuances of the test format. If these study strategies are distilled to their essence, it is all about getting inside the test writer’s head. Most question writers have a specific agenda when they create the test questions, and thinking like a writer will help you to choose the correct answer. Imagine you are writing the question. What do you want the test taker to know about? What kind of knowledge are you testing? What kind of distractors would you include? Looking at the question from this point of view and thinking like a test writer instead of a test taker will empower you to do your best on the Internal Medicine certification examination. In the world of standardized tests, confidence is your best ally. Don’t second guess yourself; believe in your knowledge and abilities, and conquer the ABIM examination. 2

Sleight DA, Mavis BE. Study Skills and Academic Performance among Second-Year Medical Students in Problem-Based Learning. Med Educ Online. 2006;11(1):4599. doi:10.3402/meo.v11i.4599

Guerrasio J, Nogar C, Rustici M, Lay C, Corral J. Study Skills and Test Taking Strategies for Coaching Medical Learners Based on Identified Areas of Struggle. MedEdPORTAL J Teach Learn Resour. 2017;13:10593. doi:10.15766/mep_2374-8265.10593

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