ABIM statement

The IM board exam consists of single-best-answer questions only. This type of question consists of a brief statement, case history, graph, or picture followed by a question and list of possible options. You must choose the one answer that is better than the others; note that other options may be partially correct. Familiarizing yourself with the question format in advance may help you work more effectively.

Most ABIM exam questions use a clinical stem (patient-based case scenario) format that assesses the higher-order cognitive abilities required for clinical decision-making. A small number of questions address specific knowledge points without the use of a clinical stem.

The question breakdown

Any board question is divided into four parts:

• The intro: The first line of the question.
• The Body: the part between the intro and the last line of the question.
• The finale: the last line of the question.
• The multiple choice answers. 

   

The four-step process of reading any question is as follows: 

1. Read the finale and the multiple-choice answers.
2. Read the intro.
3. Read the body.
4. Read the finale and the multiple-choice answers again. 

The Intro

The intro of the question provides the epidemiology data of that question and gives the first clue about the clinical problem we are being asked about. Board questions don’t go against disease epidemiology.

For instance, clinical problems can be:

• Gender-predominant: a question about lupus will never have a male patient in the question! Because lupus is a female-predominant disease. The same applies to most autoimmune diseases.

• Race-predominant: a question about sickle cell disease will describe a black patient, and a question about Thalassemia will describe a patient of Mediterranean origin.

• Age-predominant: a question about cholangiocarcinoma or pancreatic cancer will likely describe an elderly patient (70 plus). On the other hand, a question about congenital heart disease will always be about a young patient.

• Risk factor predominant: For instance, A question about PAD will always have a patient with a strong smoking history. 

The body

• Most of the clinical clues are embedded within the body.
• The information in a question must be consistent and supportive, without any contradictions. For example, a question describing hypothyroidism will not describe weight loss or diarrhea, a patient who has cardiac tamponade will never have normal vital signs in the question, a patient with empyema will never have a normal WBC,…etc.
  

The Finale

You must understand what they are asking about, your answer will likely be incorrect if you misread or misunderstand the finale of a question.

Answers:

• I pick the correct answer by eliminating the wrong answers. For instance, if I have answers A, B, C, and D and the correct answer is D. I would eliminate A, B, and C instead of directly picking D.
• The question will always have clues and info to eliminate the less correct answers! For example, we may suspect the correct answer is C or D. We take C & D and screen them against the question looking for anything that will favor one over another! The correct answer is the one that is compatible with the info provided in the question. Pay attention to abnormal labs, imaging, or physical findings. See if the age and gender help make one option less likely.  

Guessing

• Guessing is not a random process! Decide, ahead of the exam day, when to use guessing and which option to pick have you decided to guess.
• I, personally, use guessing in questions I am clueless about or have no time left to read!

Remember to

• Avoid the delusion that a question can’t be straightforward. A lot of questions are simple and they are not trying to trick you!
• A correct statement doesn’t necessarily mean a correct answer. 
• When you see two options that are opposite to each other, one of them is likely the correct answer!
• The board will not and shall not test you about any controversial issues. They only follow the approved guidelines or what’s agreed upon between medical societies.
• To master the question reading technique we need to practice, practice, and practice.