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Throughout the book, you will find that we give advice on what we think is likely to be on the examination. That's what you're paying for, right? However, the fourth edition marked the first time that we offered advice on studying for and taking the examination. We thought it worthwhile to keep this section for the fifth edition. We recommend you read this section prior to diving into the rest of the book.

While we acknowledge that some people are simply better test takers than others, there is good evidence to show that anyone can improve his or her scores. In fact, examination scores are directly proportional to time spent studying for the examination (although this association grows weaker for those who have high scores already). The point is, you don't have to be a genius who got a 36 on the ACT in order to rock the ABFM Certification/Recertification Examination. But you may need to put in the work.

Your first step in studying for the examination—after purchasing this book, of course—should be to develop a study plan. Plotting out time and dedicating that time to uninterrupted study is important. How much time do you have before the examination? How many hours per week can you devote to studying? When are you most productive in your studying—morning or night? What are the chances of a worldwide failure of coffee crops? Will a new Star Wars movie open before the examination? Thinking through these questions, get a calendar, mark the examination date, and plot out days and times that you will devote to studying. If you have taken the examination before and it didn't turn out so well, you may need to change your daily work schedule for 2 to 3 months before the examination to accommodate studying 10 to 15 hours per week. We endorse neither “cramming” for the examination nor “adding on” studying to an already full schedule. To get the most out of studying, you need to approach it like a daily devotion.

In order to maximize your return on your studying and to focus on deficiencies, try taking a pre-test. The best pre-test is the ABFM In-Training Examination (ITE) — keep reading for more on this. You can use your results on the pre-test to see what areas are your weakest. Studying weak areas is less fun but will net higher yield results than studying areas of relative strength. If your practice is narrow in scope (e.g., a hospitalist), you probably already have a sense of areas of strength and weakness. Make sure you address your weak areas with relatively more time on them.

Next, know what is on the examination. The percentage of examination content devoted to various systems is posted on the ABFM website, and we recommend you review it. The top systems tested are usually cardiovascular, respiratory, and musculoskeletal systems. If you are weak in any of these areas, be certain to focus your studying on them.

Now, what material should you use when studying? Some of our readers have been overly kind, suggesting in their reviews that this book is the only study tool needed for the board examination. While we would like to believe it, we cannot endorse this point of view.

To get a flavor for the questions on the examination, the best strategy is to go to the source. The ABFM posts its ITE for the last 3 years on its website ( A login is required, which board-certified family physicians should all have. The ITEs are perhaps the best source for assessing your knowledge—we strongly recommend you use them. Although we do not recommend relying on the ITEs as your only study aid (obviously; we're trying to sell books here!), you can use these as a way to measure your progress as you study. The critiques are available as well, so you can learn what the ABFM thinks you should know. The ABFM also has extensive information on what you should expect when you sit for the certifying/recertifying examination, including a tutorial that simulates the examination. If you are an anxious test-taker, be certain to check out the tutorial. While the ABFM has several useful tools, be aware that the Self-Assessment Modules are not representative of the types of questions you will find on the certifying/recertifying examination; however, the more recent Continuous Knowledge Self-Assessment activity, where the diplomate answers 25 questions per quarter, is a closer representation.

Another great source for questions is the American Academy of Family Physicians (AAFP) website. If you are a member of AAFP, you can access questions for free. They are categorized by body system and can be done in chunks of ten at a time worth 0.25 CME credits. This question bank offers another opportunity to test your knowledge and determine where you need to focus your studying.

Also, the AAFP markets a comprehensive board review self-study course, which will set you back over $1,000 if you are a member and more if you are not. Indeed, it covers everything you need to know for the examination. But so does this book! So, the choice is yours, but we doubt that you will need both our book and the AAFP board examination self-study package.

What about texts and primary sources? Well, while we would admire your perseverance in slogging through whole texts preparing for the examination, we do not recommend attempting to read cover-to-cover texts like Robert Rakel's Textbook of Family Medicine or reference material like UpToDate. Don't get us wrong. We like these sources and recommend them to you as references as you are studying, but you should not rely on them as your sole study material. Likewise, using primary sources, like medical journals, is impractical as a study foundation but useful to expand your knowledge when you don't understand something.

As far as board review courses: to each his or her own. If you are considering attending a course, the AAFP offers comprehensive courses multiple times per year in locations all across the country. For-profit entities provide additional options. If you learn best in a live lecture setting, these courses may be a good option for you, but you need not attend a course to get all that information (c'mon—you've got this book!).

There are some important basic things you need to know about the examination. As of the writing of this book, the examination is composed of 4 sections, each consisting of 80 multiple choice questions and 100 minutes in length. Sections 1, 3 and 4 have questions from a wide variety of family medicine topics. Section 2 consists of 40 questions from a chosen module and 40 questions pertaining to the general breadth of family medicine. It is best to choose modules with which you are more familiar. For example, if you practice primarily in an emergency department, you may want to choose Emergent/Urgent Care or Hospital Medicine rather than Maternity Care (unless you're looking for the additional challenge). We highly recommend to check out the ABFM website ( for exam information as this may change.

The examination consists entirely of four-item multiple-choice questions. You are not penalized for guessing. An unanswered question will always be wrong; whereas, a guessed question has a 25% chance of being right. If you have no idea, go ahead and guess. As a corollary to that rule, never exit the examination without first completing all the items. You cannot return to answer unmarked items.

Read every stem and option carefully. Although we doubt that the ABFM writes “trick questions,” they do use catch words/phrases, such as “except,” “most likely,” “first step,” and “least likely.” If you are not attending to the catch phrase, you are likely to answer the question wrong.

In the past, the ABFM recommended relying on evidence in place up to 2 years before the examination rather than the most recent medical evidence. Now, the ABFM recommends examinees rely on the most up-to-date evidence available. So, when you are looking at a question and thinking, “Well, the answer last year might have been ‘A’ but now the evidence points to ‘B’.” Choose “B.”

Successful test-takers do not use grand strategies to outsmart the question writers; instead they tend to employ a few simple rules when answering multiple-choice questions. These simple rules that follow amount to guidelines that cannot be blindly applied to the entire test, but are often true. No secret to many of you, perhaps, but here they are:

  • Go with your first thoughtful choice unless you have a solid reason to change it (e.g., you misread the question).

  • Look for catch words in the answers, such as “always” and “never.” These will often be incorrect.

  • Avoid answers with unfamiliar terms (e.g., obscure disease names or rarely performed procedures). These are often incorrect.

  • The most detailed answer is often the correct answer.

  • If two answers are similar, they are probably both wrong.

  • Stick with family medicine principles (e.g., answers with “more history” or “shared decision making” are more likely to be correct).

  • If you don't know, guess and move on. Do not waste time deliberating on a single question.

Finally, we part offering advice that we know busy doctors seldom follow: get plenty of rest. Seriously! Be prepared for the examination day by getting a good night's sleep. Don't stop taking care of your health prior to the examination, and that includes rest. Eat a good breakfast, bring a snack for your breaks, and plan to take yourself out for a nice lunch (but skip the martini—you've got an examination to finish). Just like a mountain climber, wear layers. Some of those test-taking centers are freezing; some are boiling. Stay positive, take a deep breath and keep moving through it. You will pass this thing! Good luck.

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