Jan. 21, 2025
Kiersten Kelly, M.D, F.M.O.B.
I remember feeling confused on how to approach the In-Training Exams during residency. Was I supposed to study or not study? I was told, vaguely, that there was no passing score, but if I did poorly there would be consequences, including to my ability to moonlight as a senior resident.
There was no set percentage of correct questions that corresponded to the minimum passing score (which I learned did exist), so I found it difficult to assess my progress in practice questions against the test. I found the ambiguity of the scoring frustrating, especially after studying for Step exams, where I knew exactly what the minimum passing score was and my UWorld question banks continually assessed my progress toward meeting that goal.
After finishing residency and taking three ITEs along with the final board exam, here is what I can tell you definitively:
During my intern year, I did not study for the ITE. I was three months into residency and had spent most of that time on inpatient rotations, during COVID no less.
After my first ITE, I learned that both the ITE and ABFM board exams are graded on a curve from 200 to 800 with a minimum passing score of 380,. For the ITE, there were 200 questions. I answered 105 correctly, 90 incorrectly and five were thrown out. Excluding the discarded questions, I answered 53% correctly and received a score of 310, which was below the PGY1 average of 369 and below the minimum passing score of 380.
I met with my advisor and started an individualized academic improvement plan, which largely consisted of my own self-directed study toward improving my score. One thing I found helpful was understanding the breakdown of the ITE and board exam. The largest proportion of questions were dedicated to the cardiovascular, respiratory and musculoskeletal systems, with each representing 12 to 13% of the exam. I focused my efforts on those systems and other systems on my score report that showed low performance. Between my PGY1 and PGY2 exams, I largely used free Anki decks with old ITE questions to study in my spare time.
For my PGY2 ITE, I scored 440, which was higher than the average PGY2 score of 397 and higher than the minimum passing score of 380. The average PGY2 score of 397 corresponded to 65.6% correct.
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During my PGY2 year, I served as one of the resident members of the editorial board for the AFP journal. One of the most important things I gained from the experience was learning how to more effectively use the journal for both patient care and my own continued education. Between PGY2 and PGY3 exams, I did not tailor my studying to the ITE and board exams; rather I started routinely using the AFP journal website in my clinical practice and answered questions at the beginning of the journals if I had any down time. During my PGY3 ITE, I answered 66% correct for a score of 450, which was higher than the PGY3 mean of 427.
Prior to my board exam in spring of PGY3 year, I focused on areas that were weaker on my ITEs. I found the AAFP Family Medicine Board Review helpful because I could review lectures on subject-specific topics. I also continued with free questions on the AAFP website. I scored a passing score of 480 on my board exam!
All this to say, sure there is no true “passing score” on the ITE; rather, it is supposed to show your progress through residency and predict your subsequent success on the board exam. However, you can shoot for 65% correct on your question banks, ITE and board exam, and you will likely pass.
When I was on my inpatient pediatrics rotation in residency, the attending physician counseled parents that they were some of the most vulnerable targets for advertising. Parents of a sick child would do anything or buy any product that would ensure their child would be healthy or recover sooner. Most of these products wouldn’t help at all. In a similar fashion, medical trainees are a particularly susceptible population. There are so many question banks (UWorld, Firecracker, Amboss, Rosh Review and Anki, to name a few) that have promised us if we pay for their product, we will pass our board exams and spend less time studying than if we use something else. These products have targeted our most valuable commodity: time, which is something that we never seem to have enough of during medical training.
As a third-year resident, I fell victim to advertising and purchased one of these question banks, which I would not do again. It was not a bad product, but I found many other resources that were free and more tailored to family medicine residents and the board exam.
For instance, the American Board of Family Medicine has a free app called Continuous Knowledge Self-Assessment that provides 25 questions per quarter made by the organization that writes the board exam. These questions also count towards CME after residency.
There also are Anki decks of past ITE questions that are free to download. The AAFP website has thousands of free questions available to medical trainees (and the AFP journal is free to student members). You might have used UWorld for every exam up to this point and feel uncomfortable forgoing it this time. You might ask, “Will I pass if I only use the free resources?” To which I would answer, yes.
Your studying has come from countless hours with patients in the hospital and clinic settings. Your experience will help you on this exam. In the months or years prior to your board exam, I recommend using the AFP journal as a resource in your patient care. If you have a question about the most recent guidelines for COPD management after failing the first inhaler or workup for PCOS, before you ask your attending, take two minutes to read the abstract on the topic in the AFP journal. This small practice will make you a better physician to your patients and will help you pass your exams. The difference between the number of questions correct during my PGY1 ITE with a score of 310 and my PGY3 ITE with a score of 450 was a measly 27 questions, or 13%.
The board exam is the last mile in the marathon of medical training; you can do this, and you have already come so far.
Disclaimer
The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. All comments are moderated and will be removed if they violate our Terms of Use.
