Internal Medicine

Certification Examination Blueprint What Does the Examination Cover? The exam is designed to evaluate the extent of the candidates knowledge and clinical judgment in the areas in which an internist should demonstrate a high level of competence. Expertise in the broad domain of internal medicine, and the diagnosis and treatment of both common and rare conditions that have important consequences for patient, will be assessed. Exam content is consistent with a pre-established blueprint or table of specifications. The blueprint is developed by the Board of Directors and is reviewed and revised annually to ensure that it is current. In addition, practicing internists, internal medicine trainees, and training program directors are surveyed periodically to provide feedback on the blueprinting process. The blueprint is used as a guide in developing the exam. The majority of questions (over 75 percent) are based on patient presentations. The setting of the encounters reflect current medical practice, so most take place in an outpatient or emergency department setting (roughly 75 percent); the remainder occur in inpatient settings, ranging from the intensive care unit to the nursing home. Questions requiring simple recall of medical facts are in the minority; the majority of items require integration of information from several sources, prioritization of alternatives, and/or utilization of clinical judgment in reaching a correct conclusion. Some questions require interpretation of pictorial material such as electrocardiograms, radiographs, and photomicrographs (e.g., blood films, Gram stains, urine sediments). The content areas covered and their relative proportions on the exam are: Medical-Content Category Cardiovascular Disease Gastroenterology Pulmonary Disease Infectious Disease Rheumatology/Orthopedics Endocrinology, Diabetes and Metabolism Medical Oncology Hematology Nephrology/Urology Allergy/Immunology Psychiatry Neurology Dermatology Obstetrics/Gynecology Ophthalmology Otorhinolaryngology Miscellaneous Total Relative Percentage 14% 9% 10% 9% 8% 8% 7% 6% 6% 3% 4% 4% 3% 2% 2% 2% 3% 100%

Cross-Content Category Critical Care Medicine Geriatric Medicine Prevention Women's Health Clinical Epidemiology Ethics Nutrition Palliative/End-of-Life Care Adolescent Medicine Occupational Medicine Patient Safety Substance Abuse Content Outline of the Certification Examination

Relative Percentage 10% 10% 6% 6% 3% 3% 3% 3% 2% 2% 2% 2%

This content outline describes a typical Internal Medicine Certification Examination; actual content on a specific examination may vary. Note that some questions may be classified in more than one MedicalContent or Cross-Content category. Question content distributions are not listed for categories with relatively few questions (5% of the examination blueprint or less). Medical Category (Relative Percentage) Adolescent Medicine (2%) Allergy/Immunology (3%) Cardiovascular Disease (14%) Hypertension Pericardial disease Ischemic heart disease Arrhythmias Congenital heart disease Valvular heart disease Myocardial disease Cardiac tumors Endocarditis and other cardiovascular infections Vascular disease Noncardiogenic syncope Preoperative consultation Miscellaneous cardiovascular disease Number of Questions 47 68 3032 as follows 24 14 811 25 01 25 14 01 01 02 01 23 13

Medical Category (Relative Percentage) Critical Care Medicine (10%) Critical care Allergy Critical care Cardiology Critical care Dermatology Critical care Endocrinology Critical care Gastroenterology Critical care Hematology Critical care Infectious disease Critical care Nephrology/Urology Critical care Neurology Critical care Obstetrics/Gynecology Critical care Oncology Critical care Psychiatry Critical care Pulmonary Critical care Rheumatology/Orthopedics Ethical considerations in the ICU patient Other critical care topics Miscellaneous critical care Dermatology (3%) Endocrinology, Diabetes and Metabolism (8%) Adrenal disorders Thyroid disorders Hypertension Lipid disorders Ovarian disorders/Female reproductive health Testes/Male reproductive health Diabetes mellitus Disorders of calcium metabolism and bone Hypothalamic disorders Anterior pituitary disorders Posterior pituitary and water metabolism Endocrine tumors and endocrine manifestations of tumors Hypoglycemia not due to insulinoma Polyglandular disorders Nutritional disorders Womens health endocrine issues Miscellaneous endocrine disorders End-of-Life/Palliative Care (3%)

Number of Questions 1418 as follows 01 26 01 13 02 02 14 01 01 01 01 01 47 01 01 01 01 68 1719 as follows 02 24 01 23 01 12 58 15 01 01 01 01 01 01 01 01 01 2-6

Medical Category(Relative Percentage) Epidemiology (3%) Ethics (3%) Gastroenterology (9%) Diseases of the mouth and salivary glands Esophageal disease Stomach or duodenum Small intestinal disease Colonic and anorectal disease Pancreatic disease Biliary tract disease Liver disease Gastrointestinal complications of HIV infection Undiagnosed gastrointestinal hemorrhage Miscellaneous gastroenterology Geriatric Medicine (10%) Cardiovascular disease in the elderly Dermatology in the elderly Endocrinology in the elderly End-of-life/Palliative care in the elderly Ethics in the elderly Gastroenterology in the elderly Hematology in the elderly Infectious disease in the elderly Nephrology/Urology in the elderly Neurology in the elderly Nutrition in the elderly Oncology in the elderly Ophthalmology in the elderly Psychiatry in the elderly Pulmonary disease in the elderly Rheumatology/Orthopedics in the elderly Principles of the geriatric assessment Rehabilitation and the elderly Other primary geriatric topics Miscellaneous geriatrics

Number of Questions 59 37 1921 as follows 01 25 02 25 26 13 02 38 01 01 01 1423 as follows 14 01 02 01 01 02 01 01 02 36 01 01 01 01 01 57 01 01 01 01

Medical Category (Relative Percentage) Hematology (6%) Hypoproliferative anemias Hemolytic anemias Hemoglobinopathies and thalassemias Leukocyte disorders Platelet disorders Coagulation factor disorders and thrombotic disorders Porphyrias Myeloproliferative disorders Myelodysplastic syndrome Hematologic malignancies Transfusion medicine (principles and complications) Hematologic complications of HIV infection Bone marrow transplantation Miscellaneous hematology disorders Infectious Disease (9%) Skin and soft tissue infections CNS infections Upper respiratory tract infections Eye infections Lower respiratory tract infections Endocarditis and other cardiovascular infections Hepatic infections Enteric infections AIDS and HIV infection Sexually transmitted diseases and infections of reproductive organs Urinary tract infections Infectious arthritis Osteomyelitis Bacteremia/sepsis syndrome Rheumatic fever Procedure- and device-associated infections Nosocomial infections Immunization Prevention of infectious disease Specific causative organisms Miscellaneous infectious disease disorders Miscellaneous (3%)

Number of Questions 1215 as follows 15 23 13 01 12 13 01 02 01 03 01 01 01 01 1921 as follows 03 13 02 01 15 02 02 14 24 02 01 12 01 02 01 12 01 01 01 05 01 58

Medical Category (Relative Percentage) Nephrology/Urology (6%) Acute renal failure Chronic kidney disease Tubulointerstitial disease Glomerular disorders Hypertension Urinary tract infections Nephrolithiasis Other kidney disorders Urologic cancer Prostate disorders Other urology Urinary incontinence Water and electrolyte balance Miscellaneous bladder and kidney disorders Neurology (4%) Nutrition (3%) Obstetrics/Gynecology/Womens Health (6%) Cardiovascular disease in women Dermatology in women Endocrinology in women End-of-life/Palliative care in women Ethical issues relating to women Gastroenterology in women Hematology in women Infectious disease in women Nephrology/Urology in women Neurology in women Nutrition in women Oncology in women Ophthalmology in women Psychiatry in women Prevention in women Pulmonary disease in women Rheumatology/Orthopedics in women Miscellaneous obstetrics/gynecology/womenshealth Occupation/Environmental Medicine (2%)

Number of Questions 1214 as follows 14 13 12 13 01 01 02 01 01 02 01 01 24 01 810 46 1015 as follows 13 01 03 01 01 02 01 02 01 01 01 23 01 02 01 01 13 01 26

Medical Category (Relative Percentage) Medical Oncology (7%) Lung cancer Breast cancer Neoplasms of the head and neck Gastrointestinal or hepatic cancer Urologic cancer Cardiac tumors Gynecologic cancer Bone tumors CNS tumors Skin cancer Hematologic malignancies Soft tissue cancer Assorted endocrine tumors and endocrine manifestations of tumors Oncologic complications of HIV infection Cancer prevention and screening Oncologic emergencies Adverse effects of cancer chemotherapy Management of malignant pain Carcinoma of unknown primary Miscellaneous oncology Ophthalmology (2%) Otolaryngology/Dental Medicine (2%) Patient Safety (2%) Prevention (6%) Prevention of infectious disease Cancer prevention and screening Diet and prevention Exercise and prevention Smoking cessation Prevention of violence and injury Substance abuse Prevention of cardiovascular disease Other prevention Psychiatry (4%)

Number of Questions 1416 as follows 12 24 01 34 02 01 01 01 01 01 25 01 01 01 02 01 02 01 01 02 35 35 46 610 as follows 23 12 03 01 01 01 01 01 02 810

Medical Category (Relative Percentage) Pulmonary Disease (10%) Obstructive airway diseases Occupational and environmental lung disease Restrictive lung disease Interstitial lung disease Pulmonary vascular disease Pleural disease Lower respiratory tract infections Bronchiectasis Congenital lung disease Adult respiratory distress syndrome Lung cancer Sleep medicine Management of ventilators Pulmonary complications of HIV infection Miscellaneous pulmonary disorders Rheumatology/Orthopedics (8%) Crystal-induced arthropathy Localized joint syndromes Spondyloarthropathies Rheumatoid arthritis Systemic lupus erythematosus Systemic sclerosis Vasculitis Other primary rheumatic disorders Infectious arthritis Metabolic and other bone disease Osteoarthritis Sports injuries/trauma Miscellaneous rheumatology/orthopedics Substance Abuse (2%)

Number of Questions 2123 as follows 48 13 01 04 24 14 14 01 01 01 02 01 03 01 14 1719 as follows 02 16 02 02 01 12 15 25 01 01 23 01 13 25