A lot of people have been writing about failing the ABIM. I am one of those people who failed, studied, and passed the test this year. I wanted to share my experience in the hopes that this helps those who failed the exam. The first time, I took the test, I scored in the bottom decile. The second time around, I got the seventh decile. I was proud of this improvement. I worked as a full-time hospitalist during that year and was still able to accomplish this. So here are my tips and pointers.
1. Take your own pulse. Immediately after the test I was devastated. I questioned by own abilities and wondered how this might affect my career. This thinking is self-defeating and unhelpful. This test does NOT measure your abilities as a physician or your worth as a person. It is important to realize that the best doctors are hard-working, detail-oriented and compassionate towards their patients. The ability to recall the SAAG cutoffs rarely will affect life and death. However, your commitment to patient care and work ethic might. Also, it is very unlikely that this will affect your career. My group requires certification for partnership, but failing the test doesn't get you fired! Most groups have some policy in place (e.g., pass within three years of joining, etc). Right now, people can search and see that you're not certified, but once you pass the test, there will be no way for people to know about this. Your career will move on.
2. But do take an honest self-assessment. While this test is not a measure of physician excellence, it does measure SOMETHING. As others have pointed out, it is a relatively small number of questions that differentiates passing and non-passing scores. A small increase in medical knowledge can make the difference. In most cases, I think the test reveals that there was not enough learning and reviewing during residency. A brief cram session is inadequate if the basic knowledge is not there. In my case, I also had to face the fact that I was probably suffering from burnout and depression. While I don't think all shortcomings should be attributed to depression (a common habit in medicine programs), it is important to evaluate yourself for any symptoms of depression.
3. Realize that the ABIM is very different from the USMLE. Word recognition won't work! In the USMLE, questions can often be answered on recognition alone. If you recognize the condition, you can often answer the question easily. By contrast, the ABIM is testing confusing points or how to narrow a broad differential diagnosis. Knowing what they're testing can help you figure out the right answer.
4. Consider a review class. I took the Chicago ACP class. While expensive, it was very helpful preparation and review. They are good at showing you what points are tested. They can help you pick up easy points (e.g., derm pictures, peripheral smears, etc). Also, miserly loves company.
5. You need to use MKSAP. Some writers have recommended questions, questions, questions. I agree ... up to a point. If you failed the ABIM, there is a clear knowledge deficit (I'm not trying to offend; I'm just being honest). There is some information you need to know. I read each subject textbook twice and reviewed Board Basics multiple times. Highlight your underlines and underline your highlights.
6. Questions, Questions, Questions! I recommend using the computer version or MKSAP questions and creating multi-subject tests. Keep doing them until all questions are easy (>90% correct). When this is done, do some Med Study questions. Med Study tends to focus on tricky or easily-missed subjects. I recommend them in the weeks before the test to pick up some easy questions.
7. You need a plan. This will vary from person to person, but you need a plan. In my case, I work as a 7-on-7-off hospitalist. Studying during rounding weeks was almost impossible. So I focused on my off-days. I made sure that I spent a solid 2 hours every off day reading and doing questions. I have a family, so in my case, this meant going to a cafe so I could focus exclusively on my studying without distractions. Make sure you have time off from work in the weeks running into the test. I had a little under three weeks off, which seemed about right.
8. Don't forget to take care of yourself. When my studying was complete, I made sure to spend time with my family. I watched a little TV. I went to the gym. You can't let this take over your life.
9. Attitude matters. Don't be bitter or angry. If you can accept that this test has at least some meaning, then your studying will be much more enjoyable. If your belief is that the test is BS and the ABIM screwed you over, you will be miserable studying. And most likely, you'll fail the test again. If, however, you can accept that this information may be relevant and there is something for you to learn, the process will be much better. Tell yourself, "I may see this someday and this information may actually help my patient."
I hope this helps. Good luck to all of you
