How to Prepare for the ABIM Cardiology Boards

Last updated on February 25th, 2025

The American Board of Internal Medicine (ABIM) was initially founded in 1936 to answer a public call to establish more uniform standards for physicians. It is a physician-led, non-profit, independent evaluation organization driven by doctors to achieve high standards of care. It certifies 1 out of 4 physicians in the United States. There are more than 200,000 ABIM board-certified physicians across internal medicine and its 20 subspecialties. It is one of the 24 medical specialty boards that make up the American Board of Medical Specialties (ABMS).

In order to get certified through ABIM, after completion of predoctoral medical education, meeting the training requirements, and meeting the licensure requirements and procedural requirements, a cardiology fellow must first pass the ABIM cardiology boards.

ABIM Cardiology Boards: Acing the Exam

There are two formats in which ABIM administers exams.

First-time board certification, or the initial certification exam
10-year maintenance of certification (MOC or re-certification)

Initial certification exam format

ABIM administers a 1.5-day initial certification examination to the ones who have met the above requirements in the fall of every year.

Day 1 – Four two-hour sessions with 60 questions per one-hour session
Day 2 – Imaging studies component with EKG, echocardiogram, and coronary angiogram
- One 2-hour session, up to 35 EKGs
- One 2-hour and 15-minute session with up to 37 imaging cases (71% are echocardiograms and 29% are coronary angiograms)

Maintaining Certification: MOC exam format

The MOC assessment requirement consists of a one-day exam with four sessions of two hours each for a total of 60 questions per session.

According to the MOC exam blueprint, the continuing medical education, or MOC, cardiovascular disease certification exam covers:

Diagnosis: making a diagnosis or identifying an underlying condition
Testing: ordering tests for diagnosis, staging, or follow-up
Treatment/Care Decisions: recommending treatment or other patient care
Risk Assessment/Prognosis/Epidemiology: assessing risk, determining prognosis, and applying principles from epidemiologic studies
Pathophysiology/Basic Science: understanding the pathophysiology of disease and basic science knowledge applicable to patient care

How to Ace the Cardiovascular Disease Certification Exam

There are several board preparation materials available online including cardiovascular disease board review courses. The ACC/AHA guidelines are a must-read for the ABIM cardiology boards. One must emphasize Class I (the best evidence and consensus of all guidelines that should be done) and Class III (the best evidence or consensus that either shows that there is no benefit or there is harm to a particular management option). While the latest and greatest enamors many of us, it is important to know the basic bread and butter of cardiology, like advanced heart failure.

The goal of the ABIM certification exam is to have a performance assessment to evaluate whether a cardiologist is safe, effective, ethical and has the medical knowledge to evaluate cardiovascular disease patients.

Most of the questions up to 80% are based on actual patient management scenarios. The questions could be long and speed reading on a computer is certainly going to provide you with an edge. Physical examination is highly emphasized on the boards and learning basic murmurs, and signs of advanced heart failure and cardiovascular disease is crucial. Basic knowledge of EKGs, echocardiograms, and coronary angiograms is also tested.

One must learn how to code because it is one thing knowing the diagnosis but another thing to code it on a sheet. Frequently, first-time cardiovascular disease certification exam takers would find themselves not having enough time to go through all the EKGs. Therefore, it is important to go through this document at least once to understand the coding sheets for the day two exam. Doing more and more multiple-choice questions and having a mentor help guide you through the type of questions you could encounter on the board exams is also important.

How to study for the ABIM cardiology boards

It is important to understand that having a busy cardiology fellowship does not guarantee your passing of the certification exam. In fact, some of the busy cardiology fellowships where the fellows don’t get enough time for didactics and individual reading have poor exam results. It’s important to set aside time for studying, so you can lock in what you study. Many fellows fail because of day two of the board exam, where the EKGs, echocardiograms, and coronary angiograms are read.

6-12 months prior to exam

It is important to set a specific study schedule and start studying at least 10-12 months before the actual date so somewhere in the fall of the year prior to the exam, you should be at least collecting the materials that you will use to study such as clinical vignettes in cardiology, ACC SAP or MGH, or a cardiology board review.

It’s also important to review questions in each section of the board exam topics. If you have your previous in-training examinations and their results, check which sections you have been weak in. Next, start going through the American College of Cardiology/American Heart Association class I and class III guidelines (https://www.acc.org/Guidelines/). For physical examination, “Braunwald Heart Disease: A textbook of cardiovascular medicine,” is also an excellent resource.

If you have specific cardiovascular knowledge points you need to remember, either make a flash card (old style) or make digital flashcards on your phone or the web using Anki. Plan for at least 2-3 reviews of a primary source of reading such as ACCSAP or Current Diagnosis and Treatment Cardiology. In addition, prepare for at least 2 reviews of the question bank you will be using. Your initial exam prep should be completed by June of the year of your exam.

4 months prior to the exam

Start going through EKGs. Try to speed up your EKG reading ability. In the exam, you have around 3.5 minutes to go through each EKG. Consider subscribing to ECG Source or O’Keefe ECG.

It is always best to work through at least 2 question banks, including the comprehensive QBank at The Pass Machine.

2 months prior to the exam

You should go through EKG questions one more time, review wrong answers from question banks, and review at least 60-80 EKGs every day leading up to the board exam.

2 weeks prior to exam

Check online for ABIM sample cases. Go through incorrect practice questions, for the last time.

2 days prior to exam

Make sure if you are in a job, take at least 2-3 days off before the exam. This is the time to relax. You should check mentally check out!

You won’t be making much of a difference by reading now. Eat good food. Hydrate. Actually, eating carbs a day before the exam would help your brain to be ready (assuming you don’t have food restrictions).

You should sleep at least 6- 8 hours prior to the examination. Have a hearty breakfast and then go for the exam. Mindfulness prior to examinations has been shown to increase exam focus. If you practice it, it will help you through the exam.

What to expect on exam day

On the day of the test, you should expect to get to the testing center at least 15 minutes before your exam time. You will register at the front desk and you will be given a locker to lock your belongings. You should turn off your cell phone and put it in there. You are not allowed to take anything inside the room, including calculators, digital watches, phones, headphones, or anything that could be used to communicate outside.

Someone will take you to the computer and will give you headphones, a plastic sheet, and a marker that you can use to write. You can take bathroom breaks during the examination, however, it will take away your overall time from the exam.

I suggest you take a break for at least 10 minutes after each test block. Go to the restroom, wash your face, look at yourself in the mirror, and tell yourself that you got it! You may think you have made several mistakes or you could have done this better. Mentally train yourself that many of the tough questions, or not well-written questions, are for experimental purposes and may not be counted. Silence the negative inner voices, take long deep breaths, practice mindfulness, and come back ready to apply your knowledge.

For additional tips and tricks to help you beat exam day stress, visit The Pass Machine blog:

Internal Medicine Credits: Cardiology MOC

In an attempt to innovate the re-certification of cardiovascular medicine boards, the ABIM now offers 3 different MOC pathways.

The traditional re-certification examination will occur every 10 years. Test takers have access to UpToDate which is performed at a test center. This is offered twice a year.
Enrollment for the Longitudinal Knowledge Assessment (LKA®) opens 12/1 and remains open until 6/30. If you are due for an assessment in 2024 and the LKA is available in your discipline, you’ll be able to enroll beginning 12/1/23 by signing into the ABIM physician portal. As long as a physician is participating in LKA, the physician is reported as certified. To participate in LKA, an annual MOC fee has to be paid to ABIM.
In addition, 100 MOC points are required every 10 years. Every correct answer on LKA will earn 0.5 points. Over the course of 5 years, 600 questions are offered, and 500 questions should be opened to meet the LKA participation requirement. 30 questions are released each quarter so a total of 120 questions are released each year.
The collaborative maintenance pathway with the American College of Cardiology with access to ACCSAP. This is not a proctored examination and requires purchasing access to ACCSAP.

Cardiology Board Review Course

The Pass Machine Cardiology Board Review Course provides 1300+ multiple choice questions, 38+ hours of lectures by board-certified faculty, and 70.75 CME hours. This course is also backed by The Pass Machine’s Triple Trust Guarantee summary which includes a 100% money-back guarantee, an additional 10% reimbursement, and a free subscription renewal if you fail your ABIM cardiology boards.

Becoming Board Certified in Cardiology: Frequently Asked Questions

What study materials should I use to prepare for my cardiology board exam?

ACCSAP and The Pass Machine’s Cardiology Board Review Course are both good resources.

How do you prepare for the ABIM cardiology boards?

Make sure you set a study schedule and stick to it. Start prepping for the exam at least 6 months in advance and make sure you review practice exam questions and familiarize yourself with the ABIM cardiology exam blueprint. You can use this tool to help you plan your study schedule.

What happens if I fail my board exam?

If you fail your board exam, remember that this does not reflect your ability to take care of your patients, but rather reflects your ability to answer structured exam questions. You will need to study more and internalize the tips and tricks to taking the board exam.

What are the pass rates of the cardiovascular disease board exam?

The ABIM 2022 cardiovascular disease board passing rate for initial certification was 86% and for re-certification it was 89%. However, The Pass Machine board review course clients achieved a 94% pass rate.

*References

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Chen J, Rathore SS, Wang Y, Radford MJ, Krumholz HM. Physician board certification and the care and outcomes of elderly patients with acute myocardial infarction. J Gen Intern Med. 2006;21:238-44.

Curtis JP, Luebbert JJ, Wang Y, Rathore SS, Chen J, Heidenreich PA, Hammill SC, Lampert RI, Kromholz HM. Association of physician certification and outcomes among patients receiving an implantable cardioverter-defibrillator. JAMA. 2009;301(16):1661-70.