How to Prepare for the ABIM Interventional Cardiology Board Examination

2016-2017 Fellow Talk Bloggers       

The American Board of Internal Medicine (ABIM) interventional cardiology board exam—as you probably already know—is the final official certification for those who have committed themselves to the long road of becoming an interventional cardiologist.  Before I took the test last month, I often heard my senior colleagues say things like: “Oh, that’s the easiest test you’ll ever take” and “I didn’t even study because it’s a piece of cake!” But now that I’m on the other side of this exam, I’d like to share some hopefully more helpful advice.  

1.  Review the exam blueprint: Know the test’s content and carefully review the ABIM exam blueprint, which outlines specific areas of focus and specifies the percentage of questions from each area of the field. Understanding this blueprint helped me to focus on high yield content such as platelet and vascular biology as well as pharmacology.

2.  Know your guidelines: Due to variations in practice patterns, if you walk into this test thinking that you’ll pass just because you “do this stuff everyday” or “can cross any lesion,” you will be unpleasantly surprised with the test-taking experience. The exam is significantly geared towards understanding societal guidelines and distinguishing among class I, IIa, IIb, and III recommendations.  For example, you may have performed aspiration thrombectomy in every STEMI during your interventional year, but this exam expects you to know that aspiration thrombectomy in STEMI only has a class IIa, not class I, recommendation.  Similarly, you may be accustomed to routinely using IVUS to size coronary vessels, but there are no class I recommendations for this. Mostly, don’t walk into the exam assuming anything, and know that exam questions will task you with knowledge of the guidelines and not what you might do in reality. A note about changing guidelines: the boards can’t immediately incorporate the most up-to-date recommendations so if you confront a question that has two right answers, the best approach is to answer the question in the way you would treat the patient in the present day. Some specific guidelines I found helpful to review were:

• 2011 PCI Guidelines (focus on periprocedural anticoagulation, antiplatelet therapies, adjunctive devices, and vein graft intervention recommendations)
• 2011 CABG Guidelines Executive Summary
• 2013 STEMI Guidelines
• 2014 NSTEMI Guidelines Executive Summary
• 2014 Valvular Heart Disease Guidelines Executive Summary (focus on the flow diagrams for the management of stenotic and regurgitant aortic and mitral valve disease)

3.  Study from reliable materials: There are many review resources and question books for the interventional cardiology boards, but remember that a question is only as good as the source it comes from. The vast majority of study questions are not peer-reviewed, and it can be frustrating to get a question wrong when you disagree with the answer key. For me, the most reliable sources of information, with the best representation of board-relevant subject matter, can be found in the American College of Cardiology (ACC) CathSAP series and the ACC interventional cardiology online Maintenance of Certification (MOC) modules.

4.  Attend live courses: Both the ACC and the Mayo Clinic host annual reviews for the interventional cardiology boards that I would highly encourage attending if you can fit one or both in your schedule.  Live courses can be hard to attend as an interventional fellow given call responsibilities and the need to minimize time away from the lab, so these courses are often taped and posted online after the fact. The ACC course, for example, is free for fellows with institutional logins to access on-demand. The information from the review videos that I watched complemented the reading material in the ACC CathSAP series very well, and I certainly would have missed out on vital information had I only done one and not both.

5.  Give yourself enough study time: Everyone is different when it comes to the amount of time they need to study, but I think 4-6 weeks of periodic evening/weekend studying or 3 weeks of dedicated intense studying should be sufficient for this exam. Ideally, reviewing practice questions and watching review videos throughout your interventional fellowship would prepare you for test day, but the rigors of interventional fellowship can make it challenging to maintain that level of discipline and devote enough time over the course of your fellowship year to do so.

6.  Be practical about test day: Call the testing site prior to the exam to ensure you are on their schedule for the exam date, and be familiar with the directions to the testing center. Also, be sure to bring two government-issued photo IDs, and make sure you are well rested. The exam can take anywhere from 6-10 hours depending on how fast you finish a section or how many breaks you choose to take. If you typically like to take breaks between sessions, then continue that habit and don’t change up your usual practice patterns on test day.