I’ve always wondered who actually writes the questions that end up on the ABIM exam. In my mind, I imagine a Voldemort-like character leading a group of equally dark souls, laughing every time they come up with a particularly difficult question that is sure to trip up some poor exam fool. Most likely, and this, too, is pure speculation, there is a group of senior internal medicine academics, fellows, or even ACP teachers (you know, FACP and the lauded MACPs listed on resumes) trying to motto of a way to objectively evaluate future partners. But I still like the characterization of Voldemort more.
On that fateful August day, exam day, I felt like Harry Potter about to do battle with the forces of evil. After the alarm went off on my iPhone at 6am, I jumped out of bed, adrenaline coursing through my veins.
The night before, reluctantly, I put away the books and the questions. Instead, I watched clips of Game of Thrones on YouTube. Between clips, I prepared everything that, on a normal work day, would have been done in a mad rush 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 sandwich with mayonnaise, crackers, a can of orange soda, and two bottles of water. I am certainly a hypocrite, since I normally advocate a low sodium, low sugar diet. But today I wanted and deserved all my comfort foods.
On the way to the test site, I blasted through my motivational playlist: movie theme songs by Eminem, Jay-Z, and Rocky. I finally got to the site at 7:30 am. The employees were inside, but they wouldn’t let us in. The only people waiting outside were, by the expression on their faces and the books they were leafing through, also the ABIM examinees. I asked a woman with MKSAP cardiology, “Are you ready for the test?” She did not answer. She must have thought 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 picture taken, and I put my backpack in a storage locker. An employee said we would be videotaped at all times. I felt like I was being booked for 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 pen and a pink laminated sheet where I could scribble some notes. A pair of noise-canceling headphones dangled from the edge of the cubicle.
I clicked “start” and began reviewing the questions.
Unlike previous tests we’ve 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 an hour for breaks that you can use at your discretion. For each question, I read the question statement and answers before going back and reading the paragraphs of 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 even though I could narrow down the correct answer 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 weighted equally and there is no penalty for a wrong answer, the right thing to do when you get stuck is to make an educated 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 he knew the answer to a short question, it was like an oasis in the desert. True to form, the questions also covered the whole of internal medicine. My test, for example, was especially heavy on rheumatology concepts.
However, other people I spoke with 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 a completely different set of questions. According to ABIM, some of the questions are also experimental and don’t count towards the final score (hope I was wrong). I wish I could find out the exact methodology of the exam, but I’m afraid the ABIM’s punishment would be severe.
If I finished a section early, I’d leave the clock ticking to take a bathroom break so I wouldn’t eat on my hour-long break time, which I used for a long 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 out and then rested my eyes for 15 minutes hoping to recharge my brain.
By the middle of block 3, I was in a flow state. The clock and other distractions faded, and I concentrated 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 should 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 guess. 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 of celebrations.
