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Welcome to the fourth edition! We hope that you are as excited to be here as we are. First, let's start with a quick tour of the book. You will notice some new things as well as familiar aspects from the previous editions. What has changed? In order to keep up with the times, we have altered the title slightly to Graber & Wilbur's Family Medicine Examination & Board Review. Okay, big deal. But wait; there's more. In addition, you will see a new and attractive layout. The whole book is in color, so you do not have to flip to the glossy pages in the middle of the book to see the color versions of photos and figures. For those of you who love your e-readers and tablets, there is now an online version of the book complete with explanations for the Final Examination questions. We added 50 more questions to the last chapter, “Final Examination.” Each chapter now ends with a list of quick clinical pearls, which amount to several evidence-based one-liners per chapter to help consolidate high-yield information. Of course, we have updated everything, so that you will have the most recent medical information. Last but not least, we have a new editor, Brigit Ray, who has brought a fresh perspective to the book.

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What has not changed? Our essential style remains the same. The book is divided into 29 chapters based on body system and elements of patient care, followed by the “Final Examination” (chapter 30). The thousands of questions in the book are woven into cases, which we hope you will find interesting, practical, and relevant. To test your acquisition of knowledge, each case ends with the learning objectives. To break the monotony of slogging through a study guide, you will find “Quick Quizzes” and “Helpful Tips” peppered throughout each chapter.

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A dozen years ago when we wrote the first edition, we made the decision to use the second person voice in order to engage the reader better and to give the book a conversational appeal. We have tried to keep the book from being boring. Yes, we are aware that this is a study aid. But why must studying be an exercise in tedium and endurance? It should be enjoyable, applicable to real life and provide a surprise every now and again. You will find (sometimes feeble) attempts at humor throughout the book. We have noticed that an occasional reader does not appreciate our sense of humor. Well, we're doctors, not writers for Saturday Night Live (but if Lorne Michaels is reading this—give Jason a call).

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We have been impressed with the level of engagement our readers possess. Over the years, we have received scores of emails from readers who have thanked us, corrected us, and sometimes chided us. No matter the intent of the message, the tone is almost universally positive—readers are invested in the book and want to offer helpful suggestions. Likewise, the comments posted online (not usually the place one goes for affirmation) have been mostly approving, constructive, and enthusiastic.

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The first edition was published amid a less-than-friendly environment, with declining interest in print media and several well-known board review books already on the market. Because our book carried a different tone, readers slowly gravitated to it, and its market share grew by word-of-mouth. As of 2015, the third edition was the best-selling board review book in print and made Amazon's top 10 list of general medicine books. To what do we attribute this success? Engaged and supportive readers play a huge role!

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In preparation for work on the fourth edition, we saved all of your emails and scoured the Internet for reader comments and reviews. We read and considered all that we could find—which amounted to several hundred readers' ideas. So, you, the reader, have helped shape this book. Keep those emails coming!

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With all of the board review books out there, why should you choose our text? There are two crucial differences between this book and other board review books on the market. First, we have written this book not only to help you pass the boards but also to broaden your knowledge of family medicine. The majority of questions contain a detailed explanation not only of why an answer is right but also why the other answers are wrong. In the rapidly changing world of medical knowledge, we have endeavored to provide you with the most relevant and up-to-date evidence. When the current evidence is controversial and we are not certain what the American Board of Family Medicine (ABFM) will do with it, we acknowledge the uncertainty and try to help you navigate the current evidence.

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We have tried to make this book as broad and as comprehensive as possible. In addition to its use as a board review book for family medicine, it can be employed as a general review for primary care physicians, physician assistants, and nurse practitioners. Students and residents studying for Step 3 of the licensing examination should find the book helpful as well. However, no board review book can possibly cover the entire scope of family medicine. Use these questions as a guide: what areas are your strengths and what do you need to study further? Each answer of the “Final Examination” is referenced in the book so you can go back and review any topic that you might have missed. For the online version, we realize it may be hard to switch back and forth through the book so we have included the answer explanations in a section for you.

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In this book, the use of eponymous medical terms such as Crohn disease and Wilson disease, reflects the current American Medical Association recommendations for these and similar terms where the possessive form is dropped. In addition, there is a general trend toward using fewer eponyms, such as Wegener, which has been dropped completely. We have made note of both new and old terms when we have deemed the old term more recognizable.

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We enjoyed writing this book and we hope that you enjoy using it. If you have suggestions or complaints (okay, maybe all of our jokes aren't politically correct or even funny), do not hesitate to write us at jason-wilbur@uiowa.edu or mark-graber@uiowa.edu. We take your comments seriously as we endeavor to make studying for the board examination more effective and more fun.

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We acknowledge and thank all our chapter authors who have brought their expertise to bear on this project. We also want to thank the good people at McGraw-Hill who have edited the book to keep errors to a minimum and created a handsome and readable layout.

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Jason thanks his loving and supportive family. After some initial threats, Deb has granted her patience and understanding to the project, and Jason simply owes her dinner every night … for a year. Jason thanks his boys, Ken and Ted, who offer a great distraction from work and find it entertaining that their dad is some form of an author. Finally, as with every edition, Jason must acknowledge that the book would never get finished without large amounts of coffee; so, he thanks everyone involved in the worldwide production of coffee, from the pickers on the Central American fincas to the local baristas.

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Mark would like to thank Jason and Brigit; this has been a collaborative effort, which has made it easier for all of us. Thanks to you for buying this book. Thanks also to his family: Hetty, Rachel, and Abe (as always). But not to the dogs, Nietzsche and Dante. They need to learn to stay either in or out of the house. No more of this back and forth. Music that has kept him awake: Faith No More, the Beach Boys (actually amazingly good … check out “The Sounds of Summer: The Very Best of the Beach Boys”), and the Kinks. Finally, thanks to his bicycle for keeping him sane … although some would argue this point.

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Brigit has been using the Family Medicine Board Review text to study for years and thanks Jason and Mark for including her as a new editor in this project! This was an honor for her and she enjoyed working on their team. Foremost, she would like to thank her fiance, Austin, and her family for being so patient when she has been cranky and sleep deprived juggling everything. It's not easy juggling a master's degree program with clinical duties, two busy schedules in the medical profession, and long distance relationships! In fact, she feels she is getting the hang of juggling so much that she may start to study how to actually do it!

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