The Ultimate Guide to the Internal Medicine ITE

October 27, 2023
One of the key milestones in becoming an internal medicine physician is the yearly In-Service Training Exam (ITE), a crucial assessment that evaluates your knowledge and helps gauge your progress. Preparing effectively for the internal medicine ITE can make all the difference in your performance, which impacts how your faculty evaluates you, potential letters of recommendation, and so on. To make sure you’re ready for the exam, we’ll review some ITE basics, give you some preparation tips, and review test-taking strategies you can use to excel on exam day.

What Is the Internal Medicine ITE?

The ITE is an annual exam which all U.S. residents take. It’s designed to assess your medical knowledge, clinical reasoning, and problem-solving abilities. The exam is typically taken in the fall of each year and covers a broad range of topics within internal medicine. 

Your score on the exam is used to compare you to other IM residents in your year across the country, and to see if you are on track to pass the American Internal Medicine Board (ABIM) exam after completing residency. Your program won’t explicitly report your score to fellowships and employers, but a good score may be used as part of a recommendation for a fellowship or academic position. Conversely, a poor score allows you to identify areas for improvement before the eventual ABIM exam.

The ITE matters to different people for different reasons. If you do poorly, your program leadership will want to work with you to address your areas of weakness. A low score may affect your candidacy for a chief residency and have a negative impact on letters of recommendation. Conversely, if you do really well, the opposite is true and you can look like a rockstar to your leadership, although no one else will know your score.

If you earn an average score (i.e., 40th-70th percentiles), it doesn’t mean much to anyone. This actually can be the best scenario, since you’re expected to improve each year to show that you’re working on your weaknesses. A perfect ITE score trio would be something like going from the 60th, to the 70th, to the 80th percentile. Doing worse between years may cause concern for your program leadership, since it can appear like you are not keeping up with your studies.

If you’re ever in doubt about how to prepare, remember that studying hard year round is always a safe option and will keep you in the clear!

Internal Medicine ITE Content

The ITE typically consists of multiple-choice questions that cover various subspecialties of internal medicine, listed below:

Medical Content CategoryRelative Percentage
Cardiovascular Disease14%
Endocrinology, Diabetes, and Metabolism9%
Infectious Disease9%
Pulmonary Disease9%
Rheumatology and Orthopedics9%
Medical Oncology6%
Nephrology and Urology6%
Geriatric Syndromes3%
Obstetrics and Gynecology3%
Allergy and Immunology2%
Otolaryngology and Dental Medicine1%
Source: American College of Physicians (ACP)

How to Prep for the Internal Medicine ITE

Now let’s take a look at some tips on how to prepare for the ITE. I recommend the following: 

1. Study consistently.

Per the ACP, “You are advised not to augment your study habits for the purposes of taking this exam.” This is because the purpose of the exam is to see how you are progressing with your current methods, and aggressively studying will inflate your score but not indicate how you’ll do on the ABIM. Instead, study consistently and often as you would even if the test were not coming up. Develop a study schedule that balances your clinical duties and study time.

2. Maintain your endurance. 

When you’re studying, keep yourself in a mode to learn but also keep in mind that the ITE and ABIM exams are long! The ITE can last up to 9 hours, with 7 hours for the exam itself and the rest for breaks. Try to learn as much as you can while on the job and continue your studying on weekends or evenings as needed to learn your field.

3. Set realistic goals.

Break your study goals into manageable chunks. Focus on a specific subspecialty each week to ensure comprehensive coverage, which is best done by studying for whatever rotation you’re on, so that what you see in books or questions can be applied to real patients.

4. Use high-yield resources. 

You’ll want access to reputable study resources in the forms of textbooks, review books, and online question banks. Some popular resources include Rosh Review ITE Qbanks, MKSAP, and UpToDate.

Still looking for study resources to help you prepare for your upcoming ITE? We’ve got you covered. Check out your options for the Rosh Review Internal Medicine ITE Qbank with 2,000 ABIM-formatted questions, detailed explanations, images, and powerful analytics.

5. Practice with sample questions. 

Do practice questions regularly to familiarize yourself with the exam format and improve your test-taking skills. This will also help you identify weak areas that need further review. You can do this with the online practice test available from the ACP website.

Test-Taking Tips for the Internal Medicine ITE

Finally, let’s discuss some tried-and-true approaches for taking the exam. Here’s four techniques that can improve your score: 

1. Read the question first. 

It’s rarely the case that you can pick the right answer from the question stem and without reading the vignette. However, it’s always good form to read the question first, so that you can know what to look for in the clinical scenario.

2. Use process of elimination. 

Remember to treat this as preparation for the ABIM. If you’re unsure of an answer, try to eliminate obviously incorrect options. This increases your chances of selecting the right answer.

3. Practice time management. 

Pace yourself throughout the exam to ensure you have sufficient time for each question. For the ITE, it’s probably not worth going back to flagged questions. Due to the length of the exam, you’ll want to save your mental energy for the questions you’ll know towards the end. 

4. Use breaks wisely. 

Depending on your program’s set up, it can take some time to get in and out of the testing site. This can really eat into your break time (except for the break at the halfway point, which is an hour long.) If you can’t get back into the testing center before the next block starts, you may not be able to finish it. 

Further Reading

The internal medicine ITE is a significant milestone in your journey toward becoming a proficient internal medicine physician. By following these exam preparation and test-taking tips, you can enhance your chances of success. Remember, diligent study, consistency, and effective time management are your allies in conquering the ITE and building a strong foundation for your medical career. Best of luck!

For more (free!) content to help you navigate internal medicine residency and beyond, 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 Dr. Navin Prasad

Comments (0)