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There is a lot less mystery surrounding the American Podiatric Medical Licensing Exam (APMLE) part 1 than upperclassmen and your classmates might have you believe. If you know what the exam is and how to properly prepare for it then you should find the majority of the questions quite easy and leave your testing center with high confidence that you passed. This post will likely be very long so I will try to break it into sections so that you can scroll through and just find the information you're looking for.
MY BACKGROUND
I am within the top 10% of my class but I assure you that the methods I used should work for any student of any rank. I only had zero idea on about 5 questions on the entire exam, had good confidence in another 20-30, and was completely confident in the remainder. You should maybe also know that I have taken two board exams written by the American Board for Certification in Orthotics, Prosthetics & Pedorthics which apparently has used some of the same statisticians as the National Board of Podiatric Medical Examiners (NBPME). I am not 100% sure how those statisticians were involved in the process of making either exam but I am sure that all three of those exams (two from ABC and one from NBPME) were similar in structure and difficulty, I prepared for them in a similar manner, and I found them similarly straightforward. Compared to those ABC exams the APMLE did not stand out to me as the terrible exam that everyone says it is. In my opinion, 99% of people dislike the exam because they didn't correctly prepare for it.
QUESTION MAKING PROCESS
The most important thing to know about the question making process is that every potential question is submitted by a professor from a podiatry school. That means that every topic being tested should be taught by at least one podiatry school (the school from which the question was submitted) but that doesn't mean that every topic being tested was taught at your podiatry school. New questions are reviewed by committees of subject matter experts and edited for clarity or for other reasons. The questions that make it through will be put on future exams as pilot questions to see how they perform statistically. NBPME does also look at how top APMLE performers do on pilot questions and take that into special consideration.
CONTENT OF THE EXAM (WHAT NBPME WANTS)
This exam is made to test the minimally competency podiatrist, not the minimally competency student, and with that in mind the examiners really do not care one bit what you've learned in school. NBPME says directly on their website that the content of the examination derives directly from the periodic practice analysis studies conducted by NBPME. It focuses on competencies necessary to protect the public. It does not derive from a study of the curricula of podiatric programs. This has implications for the types of questions that NBPME solicits from question writers, the actual makeup of your exam on test day, and how the exam is scored—which I will touch on later. Every 5 years NBPME conducts their practice analysis and updates their exam specifications (% breakdown of each major category) accordingly. NBPMEs practice analyses aren't released to the public that I'm aware of but from other practice analyses that I've seen they generally ask practitioners what kinds of tasks they perform on a daily basis, how much time they spend on these various tasks, and how important or complex each of these tasks actually is. This is good information to have if you plan on making an exam for a minimally competent podiatrist. Back to my experience with ABC, they also use their practice analyses to help write their board exams, so this idea isn't unique to podiatry. The 2018 exam that we just took had been updated with new practice analysis information to the current specifications (25% lower extremity anatomy, 13% general anatomy, 13% physiology, 13% microbiology and immunology, 13% pathology, 13% pharmacology, and 10% biochemistry). The 2023 exam should be the next one to update. The only really useful information to pull from here is (1) this exam is not a direct extension of what your school teaches you, so be prepared to teach yourself a good amount of material on your own and (2) the test specifications can help guide your studying. This second tip is less useful now than in past years since most content categories are now worth 13%, but you should still be very aware that lower extremity anatomy is worth twice as much as any other category and that biochemistry is worth the least. So for example if you have one month to study you may want to start by mastering lower extremity anatomy, the the other subjects, then biochemistry last. You may hit a subject like pharmacology that takes you longer than expected and then you run out of time and don't make it through everything you wanted to. If you're going to run out of time on a subject it should be on the subject that is tested the least.
CONTENT OF THE EXAM (WHAT NBPME GETS)
Now it's maybe useful to know what NBPME wants on their exam, but what will really help you prepare is knowing the questions that the professors are actually submitting. I believe we can make two basic assumptions about what professors will submit: (1) professors will submit questions based on topics that they teach at their school and (2) professors will submit questions that they believe are important. If you had a list of questions/topics that matched those two criteria then you would essentially have the question bank in your hands. If only such a list existed. Oh...wait...it does exist. https://www.aacpm.org/wp-content/uploads/2018-AACPM-Curricular-Guide-pdf.pdf AACPM has gone through the trouble of gathering dozens of PhDs, DPMs, MDs, DOs, and more from all nine schools, combining their curricula into one long list of topics (i.e., assumption one) and then ranking those topics on a 0-4 scale based on how important they are for us to know (i.e., assumption two). In other words, this curriculum guide is our hypothetical test bank. One of the reasons this guide was originally created and is regularly updated is to help us prepare for boards. Now I know that this guide looks daunting at first, and the few upperclassmen at my school who were aware of the guide dismissed it purely because it is a lot of information. But I promise you that this is the exact information that you want, and keep in mind that the APMLE part 1 only covers the preclinical learning objectives, which is maybe a little under 2/3 of the document. I compared the curriculum guide to the old (2005 and 2008) NBPME practice exams, which were made from actual board questions that were no longer in use. I found that approximately 75% of the old board questions were ranked 3.5 or higher on the curriculum guide and that approximately 95% of the old board questions were ranked 3.0 or higher on the curriculum guide. Hypothetically then if you only studied the topics ranked 3.5 and higher from the curriculum guide you could expect to get about a 75% if you took those old exams and if you expanded that to every topic ranked 3.0 and higher from the curriculum guide you could expect to get about a 95% if you took those old exams. This validates the idea those two assumptions I made earlier and does make a case for the curriculum guide essentially being the test bank. But it goes further. Speaking with Denise Freeman, Chair of the AACPM curriculum guide committee, I found out that it is now "highly recommended" to faculty that they use objectives ranked 3.0 or higher to write new questions—though it is not mandated that they do so. So now more recently I looked at the current online APMLE practice test hosted by Prometric and compared that to the most recent edition of the curriculum guide. This time I found that 98% of the questions on the new online practice tests (which again were actual APMLE questions used in the past) were ranked 3.0 or higher on the curriculum guide and that 75% were ranked 4.0. Comparing that to the older practice tests made of older questions, the newer practice test made of newer questions is becoming more similar to the curriculum guide. And with professors now being encouraged to actually submit questions from the curriculum guide future versions of the APMLE should only become more and more similar to future versions of the curriculum guide. So the important thing to take from all of this is that the curriculum guide should absolutely guide your studying and that it is really only necessary to study the higher ranked (i.e., higher yield) topics on the guide. For me that meant studying everything ranked 3.0+ for lower extremity anatomy, 3.5+ for most other subjects, and only 4.0 for biochemistry. Now, the curriculum guide is only a line item list of topics so you'll have to pull the information from other resources (e.g., class notes, boards study books) but at least now you should know what is important and what is not. Do not trust ANY "high yield" boards preparation books made for the USMLE to tell you what you need to know for the APMLE when you have access to a full list of exactly what you need to know.
SCORING THE EXAM
Like most licensing and certifying exams, the questions are standardized by a modified Angoff standard-setting method. That's written right in the test bulletins as well as the Audit Panel Report available on the APMLE website. So if someone is trying to explain to you the scoring of the exam, and they can't explain the modified Angoff method, then I wouldn't take their advice. The percentage that you need to pass will be unique to your exam. That allows a sort of standardization for difficulty, where someone with an easier exam will require a higher percentage to pass and someone with a more difficult exam will require a lower percentage to pass. The percentage needed to pass on your exam is scaled to a 75. That 75 is the scaled score, which is not a percentage, which is where most people get lost. On a difficult exam a scaled score of 75 might only require answering 60% correct, on an easier exam a scaled score of 75 might require answering 80% correct—now that they're using LOFT the passing percentages shouldn't be quite so drastically different between exams, I'm just trying to make a point. So let's say you have the harder exam and it's scaled so that you need 60% to get the 75 scaled score and pass. Anything from 0-59% is scaled to be 55-74. So the lowest scaled score you could possibly get is a 55, which would be 0% correct. The current bulletin reads "Failing candidates will receive a report with a failing scale score (between 55 and 74)." That's what that means. They don't say how high the scaled score goes but it really doesn't matter since its minimal competency, if you reach or exceed the cut score you simply get a "pass" result. The only reason the exam is scaled is for easy comparison between different years, since the question bank is different year to year. So how is the cut score, the percentage you need, determined? I'm going to simplify the heck out of it, but you can look up the nitty gritty details if you want. Basically, a group of podiatrists looks over each question and determines the odds that a "minimally competent" podiatrist would answer that question correctly. They'll assign each question a percentage like a hard question might be 20% and an easy one might be 80%. Now let's say you have a test with 5 questions rated 20% (hard), 40% (medium), 60% (medium), 80% (easy), and 100% (easy). You can basically average those out to get your cut score of 60%. So on this specific test, a 60% is equivalent to a scaled score of 75 which would be a passing score. Now on the actual exam each question is actually weighted the exact same. So on our imaginary test you would need 60% to pass and that could be done in a number of ways including by (1) correctly answering the two easy questions and one medium difficulty question or (2) correctly answering the one hard question and two medium difficulty questions. This is an important concept to understand when studying because no matter how many easy, medium, or hard questions a particular exam is made of, you can see that the easy and medium questions will pretty much always get you to the cut score—I keep saying easy, medium, and hard because that's a simplified way of how LOFT (the algorithm they now use to make the exam) will assign you questions, giving everybody about the same number of easy, medium, and hard questions. Hypothetically it should always be more worth your time to learn the very basic and fundamental facts of a subject before getting bogged down in the more specific and difficult details, since they've pretty much designed the exam to not expect you to answer the difficult questions correctly anyway. Also, there are about 50ish pilot questions on each exam that do not count towards the cut core and will not match the exam specifications. So if it feels like a huge part of your exam was biochemistry or histology or it seemed skewed in any other way, that is probably why. Just have faith that the questions that are graded will match the specifications that you prepared for.
RESOURCES
Just because somebody else used a resource and passed the exam does not mean it was a good resource. Most people use First Aid and most people pass, but correlation is not causation. Ask those people how many questions they got that were straight out of First Aid and their answer is generally underwhelming. I would say that there is no single good resource. You should now know what you need to study based on the curriculum guide and you will have to use multiple resources to cover that all, as no single resource will. If you learn well from videos use Sketchy—I did not use Sketchy. If First Aid works well for you, then go for it—I did not use First Aid. Whatever resource you find works for you, just keep in mind that the curriculum guide should be guiding your studying. If you read any book front to back, no matter how "high yield" that book says it is, you are wasting your time reading some things that you do not need to read. So to be honest, the resources are not very important at all, knowing what to study is. Also, I would highly recommend board vitals or any similar question bank. Definitely also go over the APMLE practice tests. You will not get a huge amount of repeats from these question banks on your actual exam (though you might get some repeats), but they do cover roughly the same breadth of material and if you're the type of person who takes longer on tests you may need to practice pacing by timing yourself on practice tests. Do not use USMLE question banks, they are more difficult than anything you will see on test day and will only discourage you.
HOW TO PREPARE
Taking all of this information together:
-Time, time, and more time. Make sure you give yourself enough time. Slowly start at the beginning of the semester, ramp it up throughout the semester, and within the month before you should eat, sleep, and breathe boards. Asking our upperclassmen who failed and then passed on the retake what the largest factor was, the answer was quite simply time.
-Let the test specifications (% breakdown) guide your overall study plan.
-Let the curriculum guide guide your detailed study plan, pulling information from the resources of your choice—I personally copy-pasted information from various resources into a long study guide, but you do you. Again, the specific resource is not super important. Many people do not like First Aid but feel like they need to use it because most other people use it. IT IS NOT NECESSARY TO USE FIRST AID.
-Focus on the basics, do not get bogged down in the details. In fact, master the basics before you even look at the details. You will pass the exam based purely on the simpler questions. It is waaaay more important to just cover the full breadth of what the curriculum guide tells you to, even relatively superficially, than to study in any real detail at all. Speaking to a lot of my classmates a lot of the questions they missed they said were technically easy, they simply didn't know to review that material before hand—but you have the curriculum guide, so you will know. Also, as you're studying, don't go into any more depth than you think a minimally competent podiatrist would know. For lower extremity anatomy that might be a lot of depth, for histology of the trachea, maybe not so much.
FINAL THOUGHTS
If you know what the exam is and you know how to prepare for it you should pass without any issue. Good luck errrrbody.
MY BACKGROUND
I am within the top 10% of my class but I assure you that the methods I used should work for any student of any rank. I only had zero idea on about 5 questions on the entire exam, had good confidence in another 20-30, and was completely confident in the remainder. You should maybe also know that I have taken two board exams written by the American Board for Certification in Orthotics, Prosthetics & Pedorthics which apparently has used some of the same statisticians as the National Board of Podiatric Medical Examiners (NBPME). I am not 100% sure how those statisticians were involved in the process of making either exam but I am sure that all three of those exams (two from ABC and one from NBPME) were similar in structure and difficulty, I prepared for them in a similar manner, and I found them similarly straightforward. Compared to those ABC exams the APMLE did not stand out to me as the terrible exam that everyone says it is. In my opinion, 99% of people dislike the exam because they didn't correctly prepare for it.
QUESTION MAKING PROCESS
The most important thing to know about the question making process is that every potential question is submitted by a professor from a podiatry school. That means that every topic being tested should be taught by at least one podiatry school (the school from which the question was submitted) but that doesn't mean that every topic being tested was taught at your podiatry school. New questions are reviewed by committees of subject matter experts and edited for clarity or for other reasons. The questions that make it through will be put on future exams as pilot questions to see how they perform statistically. NBPME does also look at how top APMLE performers do on pilot questions and take that into special consideration.
CONTENT OF THE EXAM (WHAT NBPME WANTS)
This exam is made to test the minimally competency podiatrist, not the minimally competency student, and with that in mind the examiners really do not care one bit what you've learned in school. NBPME says directly on their website that the content of the examination derives directly from the periodic practice analysis studies conducted by NBPME. It focuses on competencies necessary to protect the public. It does not derive from a study of the curricula of podiatric programs. This has implications for the types of questions that NBPME solicits from question writers, the actual makeup of your exam on test day, and how the exam is scored—which I will touch on later. Every 5 years NBPME conducts their practice analysis and updates their exam specifications (% breakdown of each major category) accordingly. NBPMEs practice analyses aren't released to the public that I'm aware of but from other practice analyses that I've seen they generally ask practitioners what kinds of tasks they perform on a daily basis, how much time they spend on these various tasks, and how important or complex each of these tasks actually is. This is good information to have if you plan on making an exam for a minimally competent podiatrist. Back to my experience with ABC, they also use their practice analyses to help write their board exams, so this idea isn't unique to podiatry. The 2018 exam that we just took had been updated with new practice analysis information to the current specifications (25% lower extremity anatomy, 13% general anatomy, 13% physiology, 13% microbiology and immunology, 13% pathology, 13% pharmacology, and 10% biochemistry). The 2023 exam should be the next one to update. The only really useful information to pull from here is (1) this exam is not a direct extension of what your school teaches you, so be prepared to teach yourself a good amount of material on your own and (2) the test specifications can help guide your studying. This second tip is less useful now than in past years since most content categories are now worth 13%, but you should still be very aware that lower extremity anatomy is worth twice as much as any other category and that biochemistry is worth the least. So for example if you have one month to study you may want to start by mastering lower extremity anatomy, the the other subjects, then biochemistry last. You may hit a subject like pharmacology that takes you longer than expected and then you run out of time and don't make it through everything you wanted to. If you're going to run out of time on a subject it should be on the subject that is tested the least.
CONTENT OF THE EXAM (WHAT NBPME GETS)
Now it's maybe useful to know what NBPME wants on their exam, but what will really help you prepare is knowing the questions that the professors are actually submitting. I believe we can make two basic assumptions about what professors will submit: (1) professors will submit questions based on topics that they teach at their school and (2) professors will submit questions that they believe are important. If you had a list of questions/topics that matched those two criteria then you would essentially have the question bank in your hands. If only such a list existed. Oh...wait...it does exist. https://www.aacpm.org/wp-content/uploads/2018-AACPM-Curricular-Guide-pdf.pdf AACPM has gone through the trouble of gathering dozens of PhDs, DPMs, MDs, DOs, and more from all nine schools, combining their curricula into one long list of topics (i.e., assumption one) and then ranking those topics on a 0-4 scale based on how important they are for us to know (i.e., assumption two). In other words, this curriculum guide is our hypothetical test bank. One of the reasons this guide was originally created and is regularly updated is to help us prepare for boards. Now I know that this guide looks daunting at first, and the few upperclassmen at my school who were aware of the guide dismissed it purely because it is a lot of information. But I promise you that this is the exact information that you want, and keep in mind that the APMLE part 1 only covers the preclinical learning objectives, which is maybe a little under 2/3 of the document. I compared the curriculum guide to the old (2005 and 2008) NBPME practice exams, which were made from actual board questions that were no longer in use. I found that approximately 75% of the old board questions were ranked 3.5 or higher on the curriculum guide and that approximately 95% of the old board questions were ranked 3.0 or higher on the curriculum guide. Hypothetically then if you only studied the topics ranked 3.5 and higher from the curriculum guide you could expect to get about a 75% if you took those old exams and if you expanded that to every topic ranked 3.0 and higher from the curriculum guide you could expect to get about a 95% if you took those old exams. This validates the idea those two assumptions I made earlier and does make a case for the curriculum guide essentially being the test bank. But it goes further. Speaking with Denise Freeman, Chair of the AACPM curriculum guide committee, I found out that it is now "highly recommended" to faculty that they use objectives ranked 3.0 or higher to write new questions—though it is not mandated that they do so. So now more recently I looked at the current online APMLE practice test hosted by Prometric and compared that to the most recent edition of the curriculum guide. This time I found that 98% of the questions on the new online practice tests (which again were actual APMLE questions used in the past) were ranked 3.0 or higher on the curriculum guide and that 75% were ranked 4.0. Comparing that to the older practice tests made of older questions, the newer practice test made of newer questions is becoming more similar to the curriculum guide. And with professors now being encouraged to actually submit questions from the curriculum guide future versions of the APMLE should only become more and more similar to future versions of the curriculum guide. So the important thing to take from all of this is that the curriculum guide should absolutely guide your studying and that it is really only necessary to study the higher ranked (i.e., higher yield) topics on the guide. For me that meant studying everything ranked 3.0+ for lower extremity anatomy, 3.5+ for most other subjects, and only 4.0 for biochemistry. Now, the curriculum guide is only a line item list of topics so you'll have to pull the information from other resources (e.g., class notes, boards study books) but at least now you should know what is important and what is not. Do not trust ANY "high yield" boards preparation books made for the USMLE to tell you what you need to know for the APMLE when you have access to a full list of exactly what you need to know.
SCORING THE EXAM
Like most licensing and certifying exams, the questions are standardized by a modified Angoff standard-setting method. That's written right in the test bulletins as well as the Audit Panel Report available on the APMLE website. So if someone is trying to explain to you the scoring of the exam, and they can't explain the modified Angoff method, then I wouldn't take their advice. The percentage that you need to pass will be unique to your exam. That allows a sort of standardization for difficulty, where someone with an easier exam will require a higher percentage to pass and someone with a more difficult exam will require a lower percentage to pass. The percentage needed to pass on your exam is scaled to a 75. That 75 is the scaled score, which is not a percentage, which is where most people get lost. On a difficult exam a scaled score of 75 might only require answering 60% correct, on an easier exam a scaled score of 75 might require answering 80% correct—now that they're using LOFT the passing percentages shouldn't be quite so drastically different between exams, I'm just trying to make a point. So let's say you have the harder exam and it's scaled so that you need 60% to get the 75 scaled score and pass. Anything from 0-59% is scaled to be 55-74. So the lowest scaled score you could possibly get is a 55, which would be 0% correct. The current bulletin reads "Failing candidates will receive a report with a failing scale score (between 55 and 74)." That's what that means. They don't say how high the scaled score goes but it really doesn't matter since its minimal competency, if you reach or exceed the cut score you simply get a "pass" result. The only reason the exam is scaled is for easy comparison between different years, since the question bank is different year to year. So how is the cut score, the percentage you need, determined? I'm going to simplify the heck out of it, but you can look up the nitty gritty details if you want. Basically, a group of podiatrists looks over each question and determines the odds that a "minimally competent" podiatrist would answer that question correctly. They'll assign each question a percentage like a hard question might be 20% and an easy one might be 80%. Now let's say you have a test with 5 questions rated 20% (hard), 40% (medium), 60% (medium), 80% (easy), and 100% (easy). You can basically average those out to get your cut score of 60%. So on this specific test, a 60% is equivalent to a scaled score of 75 which would be a passing score. Now on the actual exam each question is actually weighted the exact same. So on our imaginary test you would need 60% to pass and that could be done in a number of ways including by (1) correctly answering the two easy questions and one medium difficulty question or (2) correctly answering the one hard question and two medium difficulty questions. This is an important concept to understand when studying because no matter how many easy, medium, or hard questions a particular exam is made of, you can see that the easy and medium questions will pretty much always get you to the cut score—I keep saying easy, medium, and hard because that's a simplified way of how LOFT (the algorithm they now use to make the exam) will assign you questions, giving everybody about the same number of easy, medium, and hard questions. Hypothetically it should always be more worth your time to learn the very basic and fundamental facts of a subject before getting bogged down in the more specific and difficult details, since they've pretty much designed the exam to not expect you to answer the difficult questions correctly anyway. Also, there are about 50ish pilot questions on each exam that do not count towards the cut core and will not match the exam specifications. So if it feels like a huge part of your exam was biochemistry or histology or it seemed skewed in any other way, that is probably why. Just have faith that the questions that are graded will match the specifications that you prepared for.
RESOURCES
Just because somebody else used a resource and passed the exam does not mean it was a good resource. Most people use First Aid and most people pass, but correlation is not causation. Ask those people how many questions they got that were straight out of First Aid and their answer is generally underwhelming. I would say that there is no single good resource. You should now know what you need to study based on the curriculum guide and you will have to use multiple resources to cover that all, as no single resource will. If you learn well from videos use Sketchy—I did not use Sketchy. If First Aid works well for you, then go for it—I did not use First Aid. Whatever resource you find works for you, just keep in mind that the curriculum guide should be guiding your studying. If you read any book front to back, no matter how "high yield" that book says it is, you are wasting your time reading some things that you do not need to read. So to be honest, the resources are not very important at all, knowing what to study is. Also, I would highly recommend board vitals or any similar question bank. Definitely also go over the APMLE practice tests. You will not get a huge amount of repeats from these question banks on your actual exam (though you might get some repeats), but they do cover roughly the same breadth of material and if you're the type of person who takes longer on tests you may need to practice pacing by timing yourself on practice tests. Do not use USMLE question banks, they are more difficult than anything you will see on test day and will only discourage you.
HOW TO PREPARE
Taking all of this information together:
-Time, time, and more time. Make sure you give yourself enough time. Slowly start at the beginning of the semester, ramp it up throughout the semester, and within the month before you should eat, sleep, and breathe boards. Asking our upperclassmen who failed and then passed on the retake what the largest factor was, the answer was quite simply time.
-Let the test specifications (% breakdown) guide your overall study plan.
-Let the curriculum guide guide your detailed study plan, pulling information from the resources of your choice—I personally copy-pasted information from various resources into a long study guide, but you do you. Again, the specific resource is not super important. Many people do not like First Aid but feel like they need to use it because most other people use it. IT IS NOT NECESSARY TO USE FIRST AID.
-Focus on the basics, do not get bogged down in the details. In fact, master the basics before you even look at the details. You will pass the exam based purely on the simpler questions. It is waaaay more important to just cover the full breadth of what the curriculum guide tells you to, even relatively superficially, than to study in any real detail at all. Speaking to a lot of my classmates a lot of the questions they missed they said were technically easy, they simply didn't know to review that material before hand—but you have the curriculum guide, so you will know. Also, as you're studying, don't go into any more depth than you think a minimally competent podiatrist would know. For lower extremity anatomy that might be a lot of depth, for histology of the trachea, maybe not so much.
FINAL THOUGHTS
If you know what the exam is and you know how to prepare for it you should pass without any issue. Good luck errrrbody.
