I Failed My ABIM Board Exam: Now What?

January 8, 2024
If you sat for the American Board of Internal Medicine (ABIM) certification exam and received a failing score, the experience can be discouraging and challenging to process. 
Still, it’s important to remember that setbacks are inevitable parts of everyone’s medical career—you’re not alone! In fact, according to ABIM, 13% of first-time test-takers failed the exam in 2022. While this may seem like a small minority, it’s still quite a few people when you consider how many take the exam (9,868 in 2022)! 
That said, it can be confusing trying to understand what it means and what to do next. This article will take you through the next steps. Here are a few things you can do that’ll help you crush the ABIM exam next time around.

1. Process what happened.

The crucial first step is to process what happened. You understandably may feel confusion, anxiety, disappointment, or even insecurity about what failing the ABIM exam means.

You’re encouraged to seek out assistance if you need it. This can come from friends or family you know and trust or from trained professionals who can provide counseling and support. 

This phase can take some time and shouldn’t be rushed. You have to prioritize your mental health in order to retake and pass the exam on your next attempt.

2. Understand what this means for your situation.

Immediately after receiving your results, you may panic about what this means for your ability to practice. Don’t worry—there are protocols in place for this outcome and you’re still able to become a board-certified physician. 

First, even if you didn’t pass the exam and become certified, you’re still categorized as board-eligible. This means that you’ve completed all requirements to practice internal medicine and are only awaiting a passing score on the ABIM for certification. 

It varies location to location, but many practices will allow you to provide care even if you’re board-eligible but not board-certified. Furthermore, you can keep the board-eligible distinction for up to seven years before your eligibility expires, so you’ll have plenty of time to attain certification.

So, take a deep breath. If you failed your ABIM exam, this does not spell the end of your career!

3. Plan to retake the ABIM exam.

The ABIM Certification Exam is offered during an annual two-week period, so you should plan on retaking the exam the following year. Of note, having failed the ABIM exam on your most recent attempt has no influence on your next attempt. 

You can take the exam annually for up to three years, but if you have not passed after your third attempt, you’ll have to wait one year before registering again. For example, if you fail the exam in 2023, 2024, and 2025, you wouldn’t be able to register for the exam again until 2027. 

It goes without saying you should prioritize taking the exam as few times as possible.

4. Reflect on how you felt on exam day.

The next step is to review your performance and think about what happened. Consider your exam day experience by asking the following questions: 

Did you run out of time, or leave questions blank?

Did you think the exam was hard? Were the questions easy or challenging?

How were you feeling during the test? Were you tired or anxious?

Finding answers to those questions can help you explore the outcome and why it happened. Regardless of how well you may have prepared, fatigue, decreased stamina, or nervousness may have affected your performance. 

You may instinctively assume that you just need to study more before you take the exam again. However, it may be more important to optimize your physical and mental well-being leading up to and during the test to be successful next time.

5. Review your score report and identify any areas of weakness.

You should also spend time reviewing and understanding the score report that accompanies your exam results. 

The first thing you’ll see is your actual score and a histogram of how you performed relative to other examinees and the passing threshold. This can help you understand how far you were from where you needed to be. Still, it’s important to remember that your professional skills are defined by so much more than this number. 

The ABIM report will also reveal how you performed in different subjects and even provide granular detail of the specific content areas where you need improvement. You inevitably will have some variability across the different disciplines tested, but if there are clear outlying sections where your performance was lower, this can help guide your future study plan.

6. Create a study plan so you pass the ABIM exam on your next attempt!

It may feel like the next time you can take the exam is far off in the future, but it will come sooner than you think. Therefore, make a personalized study plan for how you’ll approach your next attempt starting now. 

There are many guides for designing a study schedule available online—see an example below for how to create a study schedule from Adam Rosh, MD:

Additionally, you’ll find a detailed study plan for preparing for your ABIM certification exam in this post, How to Study for the ABIM Certification Exam in 2024!

Think of your study plan as a recipe for success. By being efficient with your time and effort, you can turn your goal of becoming a board-certified physician into a reality on your next attempt!

To create a good study plan, I recommend doing the following: 

Choose your resources. 

Decide which resources worked, which didn’t, and choose which to prioritize. 

When it comes to selecting study resources, deciding what you’ll use can be overwhelming, especially in the face of so many options. I personally recommend making use of question banks like the Medical Knowledge Self-Assessment Program (MKSAP) published by the American College of Physicians. 

If you finish those questions and are interested in other banks, consider the Rosh Review ABIM question bank. This large bank of 3,000 questions comes with detailed explanations, One Step Further questions to reinforce material, Rapid Review cards for spaced repetition, and formatting nearly identical to that on the ABIM certification exam.

For more information about how to use Rosh Review in tandem with MKSAP, check out this other blog post on How to Use Rosh Review with MKSAP for ABIM Board Review!

Develop a realistic plan. 

Consider other commitments in your life and set realistic goals for how much studying you will get done each week and month. 

You undoubtedly will have work and life commitments the year before you retake the test. Make sure you’re building flexibility into your plan for both planned and unplanned circumstances when you’ll have to take time away from studying. 

Furthermore, make sure you prioritize a healthy work-life balance. If you sacrifice taking care of yourself while you study, your efficiency will decline and you ultimately may end up being less productive.

Avoiding procrastination. 

While you need to make time for yourself, don’t put off studying completely. A little bit of work every day or week over many weeks and months is a far more effective way to learn and reinforce large volumes of material than trying to cram information in over a short period of time. 

Again, it may seem like the next time you’ll take the exam is far off in the future, but the time will go quickly. Be proactive and start preparing as soon as possible to optimize your chance for success on test day.

Further Reading 

Learning that you failed your ABIM exam is undoubtedly disappointing, but this won’t define the kind of physician you can and will become with the right amount of effort. Think about what happened on your last attempt, use that experience to learn and grow, and make the right plan so you succeed next time.

Remember that setbacks like this are part of everyone’s professional path in medicine, and resilience is the key to becoming a successful and capable physician!

Looking for more (free!) tips for your upcoming exam? Check out these other posts on the Rosh Review blog:

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 choiceno credit card required! Gain access to board-style practice questions, detailed explanations, beautiful medical images, and more.

By Michael Stephens, MD

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