ABIM Rheumatology Boards: Studying/My Experience

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I took the rheum boards for the first time this week. Unlike the ABIM internal medicine boards - which I took immediately out of residency - I’ve been out of training for several years. I found very little discussion of the rheumatology boards here or elsewhere and thus I wanted to discuss the how I studied for the test, the test experience, etc.

I’m about four years out of training and I decided I wanted to finally knock this thing out and be done with it. Job changes, moves, life issues, etc had gotten in the way of me taking it up until this point. I started studying with about 3-4 months to go. The “holy trinity” of prep for this test is supposed to be Rheumatology Secrets, the ACR rheumatology image bank, and the ACR’s CARE questions. Across the 3-4 months, I managed 1.5 passes of Rheumatology Secrets and I completed two passes of the ACR image bank. I followed the “blueprint” recommended by this article in the Rheumatologist (How to Prepare for the ABIM Rheumatology Certification Exam - The Rheumatologist). I also read Rheum Pearls (Rheumatology Pearls), which was somewhat helpful and which supplied some correct answers on test day. I was extremely busy with work, so mustering even this level of studying was really chalIenging at times. I also worked through a lot of questions…and that’s where things got interesting.

In terms of study materials…I actually think the rheumatology community needs to step up and do a lot better with this, particularly when it comes to question banks. I know that the “holy trinity” of prep for this test is supposed to be Rheumatology Secrets, the ACR rheumatology image bank, and the ACR’s CARE questions. Rheumatology Secrets is very good, and the ACR image bank is OK (I got a few correct answers out of it on the day of the exam; however, very few images came straight from/were very similar to it as some have said in the past. Rheumatology Secrets was actually a better “image bank” than the image bank.) However, I actually feel the CARE questions are overrated and inadequate for a number of reasons, the biggest of which is that the ACR now releases these CARE questions annually only through their website - and they only let you access 2 (or perhaps 3, depending on your timing) years worth of these questions because they take the oldest set down off the website each year. Each of these CARE question sets is only 60 qs, and I don’t feel that 120-180 practice questions is anywhere near adequate to prep for this test (recall that the Uworld banks for USMLE, internal medicine boards, etc are >1000 qs). Furthermore, the CARE questions are really CME questions intended for practicing rheums to refresh their knowledge and learn about a few new developments each year…they are by no means comprehensive with regards to what you might see on the ABIM exam, their style is somewhat different than the ABIM questions, and I frankly just didn’t find them very helpful. (Nevertheless, in the past, rheumatology fellowships apparently got around the ACRs restrictions by secretly keeping illegal old copies of the CARE questions around that they released to their fellows. Well….my program didn’t do that for us, and none of my rheumatologist friends seemed to have old copies of CARE questions lying around either.) This meant I was on the hunt for more practice questions to prep with.

Unfortunately, most of the major test prep companies out there - Uworld, Kaplan, etc etc - don’t make question banks for the ABIM rheumatology exam. This was the first medical standardized test I’ve taken - including USMLEs, COMLEX, ABIM IM exam - where I wasn’t able to use a Uworld question bank to study. Ultimately, what I used for practice questions was the following:

- ACR CARE questions: I managed to get 3 years worth off the ACR website, for a grand total of 180 qs.

- Rheumatology Secrets questions: Rheumatology Secrets has a bank of 100 questions that you can access if you enter the code from your book into the Elsevier website. These were actually pretty well written and decent in terms of mimicking the ABIM style.

- Healio Rheum + Boards: A free bank of 180 questions developed by Dr Adam Brown of the Cleveland Clinic. Some of these qs were probably a bit too easy, and the style was off in some cases, but I thought his explanations were money and helped solidify a lot of concepts. I got 85% correct on the first pass.

This trio still amounted to less than 500 total questions. I really felt like I needed more practice questions, so I tried out the other two major banks available out there: Statpearls, and Board Vitals. Both of these initially seemed like junk - short, vague stems, sometimes multiple potentially correct answers, typos in the stems. Statpearls seemed slightly better than Board Vitals, so I kept using it, and actually as I used it more I felt like I was solidifying quite a bit of stuff.

When I took the actual test…guess what the questions were like? Mostly short, vague stems, typos and grammatical errors galore, seemingly multiple potentially correct answers. Statpearls was actually the closest to the real thing of any of the question banks, which was a real damn surprise indeed. I got a ton of questions correct purely from Statpearls.

The actual test? Oh lord, it was a friggin beast. Hard, vague. Ridiculously obscure questions. There was a lot of imaging, and the quality of the imaging was just atrocious (I don’t understand why they can’t come up with clear images to use for these tests? Why are half these images underexposed, blurry, and look like they were taken 50 years ago?) At times I felt like it was reasonable and fair, and at times I felt like I was failing the damn thing. I probably marked 20 qs per block. This was easily the worst I’ve felt coming out of any standardized test I’ve taken so far in my medical career, and I’m a good test taker who has done well on the USMLEs etc in the past. It was like someone took the vagueness and difficulty level of the ABIM IM exam and cranked it up a few notches. The only good thing is that as I’ve been looking up questions after the test, I found I’ve gotten most of them right. Hopefully everything will work out nicely, and I’ll pass this time around.

Edit: I’d like to point out that my exam was absolutely laden with typos, misspellings, grammatical and formatting errors, etc. This was the worst edited standardized test I have ever taken, even including some of the COMLEXes…which were themselves pretty bad in this regard. I think it is absolutely inexcusable to pay $1800 for a test where a significant portion of the questions look like someone typed them them out as fast as possible, 30 minutes before the test started…some of the misspellings and other errors were so bad that I actually think they actually influenced answer choices and made it harder to select correct answers. ABIM, you guys need to clean this up and do a lot better with this…

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I took the rheum boards for the first time this week. Unlike the ABIM internal medicine boards - which I took immediately out of residency - I’ve been out of training for several years. I found very little discussion of the rheumatology boards here or elsewhere and thus I wanted to discuss the how I studied for the test, the test experience, etc.

I’m about four years out of training and I decided I wanted to finally knock this thing out and be done with it. Job changes, moves, life issues, etc had gotten in the way of me taking it up until this point. I started studying with about 3-4 months to go. The “holy trinity” of prep for this test is supposed to be Rheumatology Secrets, the ACR rheumatology image bank, and the ACR’s CARE questions. Across the 3-4 months, I managed 1.5 passes of Rheumatology Secrets and I completed two passes of the ACR image bank. I followed the “blueprint” recommended by this article in the Rheumatologist (How to Prepare for the ABIM Rheumatology Certification Exam - The Rheumatologist). I also read Rheum Pearls (Rheumatology Pearls), which was somewhat helpful and which supplied some correct answers on test day. I was extremely busy with work, so mustering even this level of studying was really chalIenging at times. I also worked through a lot of questions…and that’s where things got interesting.

In terms of study materials…I actually think the rheumatology community needs to step up and do a lot better with this, particularly when it comes to question banks. I know that the “holy trinity” of prep for this test is supposed to be Rheumatology Secrets, the ACR rheumatology image bank, and the ACR’s CARE questions. Rheumatology Secrets is very good, and the ACR image bank is OK (I got a few correct answers out of it on the day of the exam; however, very few images came straight from/were very similar to it as some have said in the past. Rheumatology Secrets was actually a better “image bank” than the image bank.) However, I actually feel the CARE questions are overrated and inadequate for a number of reasons, the biggest of which is that the ACR now releases these CARE questions annually only through their website - and they only let you access 2 (or perhaps 3, depending on your timing) years worth of these questions because they take the oldest set down off the website each year. Each of these CARE question sets is only 60 qs, and I don’t feel that 120-180 practice questions is anywhere near adequate to prep for this test (recall that the Uworld banks for USMLE, internal medicine boards, etc are >1000 qs). Furthermore, the CARE questions are really CME questions intended for practicing rheums to refresh their knowledge and learn about a few new developments each year…they are by no means comprehensive with regards to what you might see on the ABIM exam, their style is somewhat different than the ABIM questions, and I frankly just didn’t find them very helpful. (Nevertheless, in the past, rheumatology fellowships apparently got around the ACRs restrictions by secretly keeping illegal old copies of the CARE questions around that they released to their fellows. Well….my program didn’t do that for us, and none of my rheumatologist friends seemed to have old copies of CARE questions lying around either.) This meant I was on the hunt for more practice questions to prep with.

Unfortunately, most of the major test prep companies out there - Uworld, Kaplan, etc etc - don’t make question banks for the ABIM rheumatology exam. This was the first medical standardized test I’ve taken - including USMLEs, COMLEX, ABIM IM exam - where I wasn’t able to use a Uworld question bank to study. Ultimately, what I used for practice questions was the following:

- ACR CARE questions: I managed to get 3 years worth off the ACR website, for a grand total of 180 qs.

- Rheumatology Secrets questions: Rheumatology Secrets has a bank of 100 questions that you can access if you enter the code from your book into the Elsevier website. These were actually pretty well written and decent in terms of mimicking the ABIM style.

- Healio Rheum + Boards: A free bank of 180 questions developed by Dr Adam Brown of the Cleveland Clinic. Some of these qs were probably a bit too easy, and the style was off in some cases, but I thought his explanations were money and helped solidify a lot of concepts. I got 85% correct on the first pass.

This trio still amounted to less than 500 total questions. I really felt like I needed more practice questions, so I tried out the other two major banks available out there: Statpearls, and Board Vitals. Both of these initially seemed like junk - short, vague stems, sometimes multiple potentially correct answers, typos in the stems. Statpearls seemed slightly better than Board Vitals, so I kept using it, and actually as I used it more I felt like I was solidifying quite a bit of stuff.

When I took the actual test…guess what the questions were like? Mostly short, vague stems, typos and grammatical errors galore, seemingly multiple potentially correct answers. Statpearls was actually the closest to the real thing of any of the question banks, which was a real damn surprise indeed. I got a ton of questions correct purely from Statpearls.

The actual test? Oh lord, it was a friggin beast. Hard, vague. Ridiculously obscure questions. There was a lot of imaging, and the quality of the imaging was just atrocious (I don’t understand why they can’t come up with clear images to use for these tests? Why are half these images underexposed, blurry, and look like they were taken 50 years ago?) At times I felt like it was reasonable and fair, and at times I felt like I was failing the damn thing. I probably marked 20 qs per block. This was easily the worst I’ve felt coming out of any standardized test I’ve taken so far in my medical career, and I’m a good test taker who has done well on the USMLEs etc in the past. It was like someone took the vagueness and difficulty level of the ABIM IM exam and cranked it up a few notches. The only good thing is that as I’ve been looking up questions after the test, I found I’ve gotten most of them right. Hopefully everything will work out nicely, and I’ll pass this time around.

Edit: I’d like to point out that my exam was absolutely laden with typos, misspellings, grammatical and formatting errors, etc. This was the worst edited standardized test I have ever taken, even including some of the COMLEXes…which were themselves pretty bad in this regard. I think it is absolutely inexcusable to pay $1800 for a test where a significant portion of the questions look like someone typed them them out as fast as possible, 30 minutes before the test started…some of the misspellings and other errors were so bad that I actually think they actually influenced answer choices and made it harder to select correct answers. ABIM, you guys need to clean this up and do a lot better with this

So I passed pretty comfortably with a score in the 430s. Done with ABIM for a while, thank god.
 
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So I passed pretty comfortably with a score in the 430s. Done with ABIM for a while, thank god.
Don’t you get to start your quarterly quiz questions like next month? Or am I mistaken (please tell me I am mistaken)
 
So I passed pretty comfortably with a score in the 430s. Done with ABIM for a while, thank god.
Congratulations! That is a great performance. What do you think was the most helpful for your exam? Unfortunately, I failed the exam. I just took 369 (pass 374).
 
Don’t you get to start your quarterly quiz questions like next month? Or am I mistaken (please tell me I am mistaken)
I’m not doing that quarterly nonsense lmao. I prefer to keep my brain ABIM free for 10 year intervals.
 
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Congratulations! That is a great performance. What do you think was the most helpful for your exam? Unfortunately, I failed the exam. I just took 369 (pass 374).
Personally, what I would do is review Rheumatology Secrets and then just crank out questions. I’d work through the question banks listed above, especially Statpearls. I got a ton of questions right from Statpearls explanations, and it is very comprehensive. You might start doing Statpearls and have a wtf moment - a lot of the questions look poorly written, wacky answers, etc - but I think it’s actually by design, because that’s how the rheumatology boards really are. There were a few near repeats from Statpearls, and many questions that drew heavily from Statpearls explanations. That’s a lot more than can be said for the CARE questions (almost useless IMO). Healio Rheum + Boards was really useful too, as were the Rheumatology Secrets questions.
 
Personally, what I would do is review Rheumatology Secrets and then just crank out questions. I’d work through the question banks listed above, especially Statpearls. I got a ton of questions right from Statpearls explanations, and it is very comprehensive. You might start doing Statpearls and have a wtf moment - a lot of the questions look poorly written, wacky answers, etc - but I think it’s actually by design, because that’s how the rheumatology boards really are. There were a few near repeats from Statpearls, and many questions that drew heavily from Statpearls explanations. That’s a lot more than can be said for the CARE questions (almost useless IMO). Healio Rheum + Boards was really useful too, as were the Rheumatology Secrets questions.
Stat pearls would be something subscription right ?
 
So I passed pretty comfortably with a score in the 430s. Done with ABIM for a while, thank god
So I passed pretty comfortably with a score in the 430s. Done with ABIM for a while, thank god.
Would you mind sharing some of the topics or question that you found challenging to attempt or high yield for preparation. thak you
 
To be brief, RA and SLE were extremely high yield (look at the ABIM blueprint and it mimics that pretty closely). Just as the blueprint suggests, RA and ANA associated diseases make up a very significant portion of the questions.

My other suggestion is this: read rheumatology secrets, but don’t get too bogged down in the chapters about more obscure stuff that is less relevant to adult rheumatology. For instance, I only minimally reviewed the peds stuff, and I didn’t spend a huge amount of time obsessing over topics like bone tumors, etc etc. Focus on the big inflammatory stuff that you may see in an adult rheumatology clinic: RA, spondyloarthropathy, ANA associated diseases, vasculitis, crystalline arthritis. (This is also what the ABIM blueprint recommends.) Know your pharmacology and drug mechanisms.
 
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I took the rheum boards for the first time this week. Unlike the ABIM internal medicine boards - which I took immediately out of residency - I’ve been out of training for several years. I found very little discussion of the rheumatology boards here or elsewhere and thus I wanted to discuss the how I studied for the test, the test experience, etc.

I’m about four years out of training and I decided I wanted to finally knock this thing out and be done with it. Job changes, moves, life issues, etc had gotten in the way of me taking it up until this point. I started studying with about 3-4 months to go. The “holy trinity” of prep for this test is supposed to be Rheumatology Secrets, the ACR rheumatology image bank, and the ACR’s CARE questions. Across the 3-4 months, I managed 1.5 passes of Rheumatology Secrets and I completed two passes of the ACR image bank. I followed the “blueprint” recommended by this article in the Rheumatologist (How to Prepare for the ABIM Rheumatology Certification Exam - The Rheumatologist). I also read Rheum Pearls (Rheumatology Pearls), which was somewhat helpful and which supplied some correct answers on test day. I was extremely busy with work, so mustering even this level of studying was really chalIenging at times. I also worked through a lot of questions…and that’s where things got interesting.

In terms of study materials…I actually think the rheumatology community needs to step up and do a lot better with this, particularly when it comes to question banks. I know that the “holy trinity” of prep for this test is supposed to be Rheumatology Secrets, the ACR rheumatology image bank, and the ACR’s CARE questions. Rheumatology Secrets is very good, and the ACR image bank is OK (I got a few correct answers out of it on the day of the exam; however, very few images came straight from/were very similar to it as some have said in the past. Rheumatology Secrets was actually a better “image bank” than the image bank.) However, I actually feel the CARE questions are overrated and inadequate for a number of reasons, the biggest of which is that the ACR now releases these CARE questions annually only through their website - and they only let you access 2 (or perhaps 3, depending on your timing) years worth of these questions because they take the oldest set down off the website each year. Each of these CARE question sets is only 60 qs, and I don’t feel that 120-180 practice questions is anywhere near adequate to prep for this test (recall that the Uworld banks for USMLE, internal medicine boards, etc are >1000 qs). Furthermore, the CARE questions are really CME questions intended for practicing rheums to refresh their knowledge and learn about a few new developments each year…they are by no means comprehensive with regards to what you might see on the ABIM exam, their style is somewhat different than the ABIM questions, and I frankly just didn’t find them very helpful. (Nevertheless, in the past, rheumatology fellowships apparently got around the ACRs restrictions by secretly keeping illegal old copies of the CARE questions around that they released to their fellows. Well….my program didn’t do that for us, and none of my rheumatologist friends seemed to have old copies of CARE questions lying around either.) This meant I was on the hunt for more practice questions to prep with.

Unfortunately, most of the major test prep companies out there - Uworld, Kaplan, etc etc - don’t make question banks for the ABIM rheumatology exam. This was the first medical standardized test I’ve taken - including USMLEs, COMLEX, ABIM IM exam - where I wasn’t able to use a Uworld question bank to study. Ultimately, what I used for practice questions was the following:

- ACR CARE questions: I managed to get 3 years worth off the ACR website, for a grand total of 180 qs.

- Rheumatology Secrets questions: Rheumatology Secrets has a bank of 100 questions that you can access if you enter the code from your book into the Elsevier website. These were actually pretty well written and decent in terms of mimicking the ABIM style.

- Healio Rheum + Boards: A free bank of 180 questions developed by Dr Adam Brown of the Cleveland Clinic. Some of these qs were probably a bit too easy, and the style was off in some cases, but I thought his explanations were money and helped solidify a lot of concepts. I got 85% correct on the first pass.

This trio still amounted to less than 500 total questions. I really felt like I needed more practice questions, so I tried out the other two major banks available out there: Statpearls, and Board Vitals. Both of these initially seemed like junk - short, vague stems, sometimes multiple potentially correct answers, typos in the stems. Statpearls seemed slightly better than Board Vitals, so I kept using it, and actually as I used it more I felt like I was solidifying quite a bit of stuff.

When I took the actual test…guess what the questions were like? Mostly short, vague stems, typos and grammatical errors galore, seemingly multiple potentially correct answers. Statpearls was actually the closest to the real thing of any of the question banks, which was a real damn surprise indeed. I got a ton of questions correct purely from Statpearls.

The actual test? Oh lord, it was a friggin beast. Hard, vague. Ridiculously obscure questions. There was a lot of imaging, and the quality of the imaging was just atrocious (I don’t understand why they can’t come up with clear images to use for these tests? Why are half these images underexposed, blurry, and look like they were taken 50 years ago?) At times I felt like it was reasonable and fair, and at times I felt like I was failing the damn thing. I probably marked 20 qs per block. This was easily the worst I’ve felt coming out of any standardized test I’ve taken so far in my medical career, and I’m a good test taker who has done well on the USMLEs etc in the past. It was like someone took the vagueness and difficulty level of the ABIM IM exam and cranked it up a few notches. The only good thing is that as I’ve been looking up questions after the test, I found I’ve gotten most of them right. Hopefully everything will work out nicely, and I’ll pass this time around.

Edit: I’d like to point out that my exam was absolutely laden with typos, misspellings, grammatical and formatting errors, etc. This was the worst edited standardized test I have ever taken, even including some of the COMLEXes…which were themselves pretty bad in this regard. I think it is absolutely inexcusable to pay $1800 for a test where a significant portion of the questions look like someone typed them them out as fast as possible, 30 minutes before the test started…some of the misspellings and other errors were so bad that I actually think they actually influenced answer choices and made it harder to select correct answers. ABIM, you guys need to clean this up and do a lot better with this…
I totally get this.
I just took it too. A ton of mistakes and everything else you said.
Reading "Secrets" does nothing for me. Its too much scatter-brain writing.

In my opinion, it is impossible to do well on any of the medical board exams just from "passive reading". Rheumatology just has too-much passive reading to make it efficient studying (ie. Hochberg, Kelly).
It's a puzzle after all, and you need to figure out exactly what each question is wanting you to know. Some of the questions are straight forward (you either know it or not), and the others and multi-step thinking. A lot of ACR guideline based questions. Not so many images in my opinion (but I might have forgotten most of them). But a lot of xrays.
Some pediatric rheum. A lot of neuro-rheum related diseases.

Honestly, I dont think I would have passed if my (previous) senior fellow didn't share with me the "RheumZoom" ANKI flashcards.
This website has been floating around.
Find it here:

I think realizing the need for study sources, a previous (very smart) fellow made cards for all the up-to-date ACR guidelines for everything (I think up to 2022) as well as important points/Qbank from "Secrets", plus all the CARE questions from 2010 (I think) onward to 2022. The deck has relevant images too like histology, xrays, photos, etc.

This was huge for me. A very much needed (and efficient) study source for rheumatology fellows that I think will become a staple to prepare for the boards given the lack of other resources.
 
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I totally get this.
I just took it too. A ton of mistakes and everything else you said.
In my opinion, it is impossible to do well on any of the medical board exams just from "passive reading". Rheumatology just has too-much passive reading to make it efficient studying (ie. Hochberg, Kelly).
It's a puzzle after all, and you need to figure out exactly what each question is wanting you to know. Some of the questions are straight forward (you either know it or not), and the others and multi-step thinking. A lot of ACR guideline based questions. Not so many images in my opinion. But a lot of xrays.
Some pediatric rheum.

Honestly, I dont think I would have passed if my (previous) senior fellow didn't share with me the "RheumZoom" ANKI flashcards. A previous (very smart) fellow made all the up-to-date ACR guidelines for everything (I think up to 2022) as well as important points from "Secrets", plus all the CARE questions from 2010 (I think) onward to 2022. The deck has relevant images too like histology, xrays, photos, etc.
Find it here:

This was huge for me. A very much needed study source for rheumatology fellows that I think will become a staple to prepare for the boards given the lack of other resources.
Forgot to mention, its a donation page. You choose how much to pay.
 
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