Everything to Know About the ABIM Longitudinal Knowledge Assessment (LKA)

March 3, 2023
The American Board of Internal Medicine offers multiple options to complete the assessment component of your Maintenance of Certification (MOC). This includes the traditional MOC exam every 10 years and a new longitudinal knowledge assessment (LKA) that has taken the place of the retired Knowledge Check-In. 
Read on to learn more about the new ABIM LKA and what it means for meeting your MOC assessment requirement.

Highlights of the ABIM LKA

 If you’re unfamiliar with the ABIM LKA, here are a few features to keep in mind:

  • Provides convenience in meeting the MOC assessment requirement by allowing you to answer questions at home
  • Breaks a large exam into smaller pieces over a five-year timeframe throughout which you remain certified
  • Provides real-time feedback and explanations so you can learn as you progress through the assessment
  • Focuses on content relevant to standard clinical practice

But these are just a handful of the LKA’s most notable characteristics. Let’s dig a bit deeper into what the exam is and how it’s administered.

What is the ABIM LKA and how can I register?

The LKA opened for physicians practicing most specialties in 2022 and represents sets of quarterly questions you can do longitudinally over a five-year period. Enrollment spans from December 1 of the prior year to June 30, but the first set of questions is released on or shortly after January 1 and then every three months after that. 

You cannot leave more than 100 questions unopened, and questions you will have missed by enrolling later in the cycle (e.g., in June) will count towards this total. Therefore, if you plan to enroll in the ABIM LKA, you should do so early in the year when you are required to do an assessment.

If you are currently within an enrollment period and would like to join the next LKA five-year cycle, access your ABIM Physician Portal to sign up. The following outlines the current 2024 schedule of when questions are released:


An important note is you must enroll before the second quarter ends (e.g., 6/30/24) if you plan to participate in 2024. Otherwise, you will have to wait until 2025 to begin.

Once you’re enrolled in the LKA, you remain certified throughout the five-year cycle even though you will not have completed an assessment until the end of that cycle. However, if you decide midway through the LKA is not for you, you always have the option to unenroll and opt for the standard MOC exam.

What is the structure of the LKA?

Each quarter, 30 new questions are released. All the questions are standard multiple choice with a single best answer just like most board exams you may have taken in the past. You will have four minutes to answer each question, though you do not have to use all that time.

In addition, you receive an annual allowance of 30 minutes that you can apply to certain questions if you need additional time. In other words, you have a bank of extra time you can use for some questions, and it renews each year back to the full half hour.

A notable feature of the LKA is that you receive immediate feedback after submitting an answer. This includes what the correct answer is, an explanation about why that answer is correct, and references for further review.

In addition, after you complete five quarters of the LKA, you will receive summative reports of your performance relative to the passing threshold. These reports also include details about areas in which you are scoring well and areas on which you may want to focus before the next set of questions.

Of note, you may be asked to complete so-called pre-test questions each quarter. These questions are not scored but rather are used in the development of new questions. Unlike for the standard questions, you may not receive feedback about your performance on pre-test questions. 

You also will be asked to complete a post-question survey after each question intended to assess how important and relevant that question is to clinical practice.

How is the LKA scored? What happens at the end of the cycle?

As discussed, every quarter over the five-year cycle, you will receive 30 questions, so in total, you will be able to answer up to 600 questions. Because each question you answer correctly is worth 0.2 MOC points towards the 100 total points that you will need for the cycle, your target should be to answer at least 500 of the 600 questions correctly.

Remember you cannot access and answer any questions after the quarter is over, and you’re not allowed to leave more than 100 questions unopened over the entire five-year cycle.

At the end of the five-year cycle, your performance each quarter is summarized in one pass/fail decision. If you pass, you have two next steps:

  1. You can enroll in a new five-year cycle of the LKA. You will continue to remain certified during the timeframe you’re answering questions, just like during your previous cycle. Essentially, nothing changes, and you continue doing the LKA.
  2. You can transition from the LKA to the standard 10-year MOC exam the following year. As previously explained, you will take this test in one sitting, and if you pass, you will meet this MOC assessment requirement for a 10-year period.

If you do not pass the LKA, you will be required to pursue the second option above and have a one-year grace period during which you remain certified to take and pass the traditional exam.

Do accommodations exist for the LKA?

Testing accommodations are available for test-takers who need them. The deadline to submit documentation for accommodations is the end of the month prior to the enrollment deadline of the next quarter. In accordance with Title III, you should expect to have access to any necessary aids or services. 

If you need additional time for testing, this will be added to the 30-minute bank you can use to have more time on certain questions. Keep in mind that if you were approved for accommodations on the MOC exam, it’s not guaranteed these will automatically roll over to the LKA. So it’s important to reach out to the ABIM in advance to arrange this.

What do I need to take the LKA?

The interface can be accessed from any device including a laptop or desktop computer, tablet, or smartphone, although test-takers are advised to answer questions on a computer. Questions may include multimedia components best viewed on a device with a large screen. 

Beyond that, just make sure your device and operating system are updated and you have a reliable internet connection.

What can I do to prepare for the LKA?

Even though it’s spaced over many years, the LKA is still an important assessment. The material on the LKA is drawn from the same content outline used for the traditional MOC, so you will not have to change how or what you would otherwise study. 

The questions are intended to reflect standard clinical practice, so depending on the context in which you practice, you may need more or less preparation. For some, their day-to-day experience may be enough, while others may need to dedicate time to study.

If you want to review content before diving into the LKA, a great resource to consider is the Rosh Review Maintenance of Certification Qbank. It includes 2000 updated questions based on the ABIM MOC Blueprint categories. The high-yield questions are formatted to match what you will see on the LKA or the MOC, and the explanations are informative and well-written.

Choosing a path for MOC

If you’re still unsure which route for meeting your MOC requirements makes sense for you, rest assured that either option is perfectly reasonable. By taking the traditional MOC exam and meeting the assessment requirement for a 10-year period, you wouldn’t have to worry about keeping track of questions every few months. 

However, the LKA is a great way to break up the requirement into smaller pieces you can work through on a longitudinal basis. Having multiple options to meet MOC requirements can feel confusing, but the advantage is it allows you to customize your experience and choose the path that’s right for you.

Rosh Review is a board review company providing Qbanks that boost your confidence for your boards and beyond. Get started with a Rosh Review free trial to the Qbank of your choice (no credit card required!) and gain access to board-style practice questions, detailed explanations, beautiful medical images, and more.

Disclaimer: Rosh Review is neither endorsed by nor affiliated with ABIM.

By Michael Stephens, MD

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