I was a re-taker this year (turns out I missed by a tiny margin last year using only MKSAP for a couple of weeks in a semi-serious fashion). I went into a deep depression and questioned my career choice every time I went to work last year. I was the kind of resident that skipped meals and conferences all the time to be with patients and their family and I stayed up with them all night to stabilize them when they were really sick. This made the failing score last year even harder to accept--especially when I (albeit inappropriately) started to think of some of my peers who were barely clinically competent with general medicine and openly cared little about patients and would hide when patients were sick or leave for conferences etc. at the drop of a hat....yet still passed the ABIM certifying exam, likely because they just memorized the random things tested. The ABIM exam (and probably) the ABIM seems to care little about how diligent you are and how hard you work to remain clinically competent, and the exam is the gold standard. Like others have said, just respect it and accept that it tests 'something'--even if you do not agree or understand what that something might be.
MKSAP IMHO is not enough unless you are very good at gaming exams or are very lucky with the version of the test you get. The questions are just too different from anything you've ever taken - not like the inservice, not like the NBME or Step exams, not like med school exams. I'll let you know how I do (I took it last week on the first available date), but sad to say that I felt no different from last year. I was supposed to study with someone on this board, but he dropped the ball (you know who you are
), so I flew solo.
I was more focused this year. I also was working a lot more as a hospitalist, and studying actually did improve my patient care when diagnoses were unclear. This was satisfying. I studied slowly from November 1 last year until June, and then ramped it up on June 1 a lot until the test last week. I read all of the Medstudy books, and transferred them to > 24 hours of audio which I listened to every single day running, gardening, and when I was in the car. I got sick of listening to my own voice. I then watched the Medstudy videos. I also used the Medstudy flash cards a little. I made my own notes on things I was perpetually tripped up on (different and odd presentations of RTAs, different guidelines and side effects of meds for rheum conditions, rare heme conditions, chemo regimens etc.) I did maybe 30-40% of MKSAP 15 over but did not use it as my focus and it's crap preparation IMHO. I did all of the latest medstudy board review questions, I did around 85% of Harrison's IM Board Review Questions (they were hard), and 85% of USMLEWORLD questions (they were really hard!). I also read First Aid for IM boards, and made my own notes in the margin. I did very well on the general medicine section last year, and so decided to focus on the four subjects that got me in trouble on my first attempt...I read them over, and over, and over, and listened to the MKSAP lectures and Medstudy lectures over until I was nauseated.
Oh yes...almost forgot...I also purchased iMedicine Review for my hand-held device. Save your money as it's a piece of junk. They seem to have plagiarized the EXACT format of another commercially-available IM prep course, and are getting fat from the proceeds. It is RIDDLED with typos and mistakes making me question the quality control. Don't buy it.
Overall, it was just as hard this year, and many of the question stems in my opinion are random, tricky, and seem to withhold vital info. that would be freely available in real life to make the diagnosis obvious. Lastly, I finished each section around 20-30 minutes early last year and am sure that it why I lost the few vital points that might have tipped me into the passing range with the others. This year, I slowed WAY down, and read very carefully. Give it the respect is deserves. The biggest different this year were my preparation, and my attitude toward the exam. Studying any more than I did would make not one bit of different, in my opinion...
Good luck to you all. I love internal medicine, and gave it my best this year. I wish all of you the best of success.