Prepping For The Internal Medicine Boards: Which Question Bank Is Right For Me?

It has been a long three years, but my internal medicine residency is nearing its conclusion. Before starting my career as an independent physician, I must overcome one last obstacle along this character-building, knowledge-expanding journey – the Internal Medicine Certification Exam.  However, as I prepare for boards, I have had a hard time figuring out which study aid is best and what features I should be looking out for.  As such, I thought I would share with you my personal review of three of the most popular internal medicine board examination question banks.

This review is certainly not all-inclusive, but rather highlights the main features of the most popular question banks being used by internal medicine residents prepping for the big exam. To simplify this analysis, and focus particularly on high yield differences, I centered on three specific characteristics: (1) overall workflow and ease of use (2) specific content and (3) features that make each program unique.

It is worthwhile highlighting the similarities among these programs prior to delving into the differences. Keep in mind that the commonalities and differences discussed here on out are applicable only to the three programs I reviewed (MKSAP, Knowledge+, UWorld), and may not apply to other question banks.
MKSAP, Knowledge+, and UWorld each have a dashboard separating questions into various topics. Questions are categorized by corresponding subspecialty/system (e.g cardiovascular, rheumatological). From there, the user selects specific content for a quiz. Quizzes can be created reviewing a single system or all subspecialties can be reviewed at once using shuffle mode. The next step is picking a learning mode. Education/tutor mode is best for study sessions as each submitted answer is immediately followed by detailed explanations. Conversely, quiz mode resembles the actual board exam in that correct answers and their explanations are not revealed until a full block of questions has been completed.

All platforms also provide practice exams for the learner to assess their overall preparedness. The programs make available in-depth analysis and graphical representations of individual progress; however, only MKSAP and UWorld offer direct comparison to peers. Importantly in this digital age, all reviewed programs have mobile applications for on-the-go studying.

But enough of the similarities, time to highlight what makes each program different.

NEJM Knowledge+
Knowledge+ is a platform developed by the New England Journal of Medicine. You may even notice that many of the articles cited as references were published in NEJM. As an added perk to your knowledge+ subscription, any referenced articles published in NEJM can be accessed free of charge, even if you are not a subscriber to the journal.

In terms of ease of use, Knowledge+ is the epitome of quick recall. Its shorter prompts and brief learning points allow test takers to shuffle through a multitude of questions in short periods of time, such as while waiting in line at the grocery store. 

In Knowledge+, the main workflow difference is your ability to rate how confident you are in your answer prior to submitting a final response. Submitted answers are followed by key learning points. While the main explanations to questions are shorter than with the other programs, particularly regarding incorrect answers, more detailed explanations can be accessed if necessary. At the end of every question, Knowledge+ provides links to journal articles and guidelines addressing the key learning points.

Unique to Knowledge+ is a set of questions dealing with chronic pain management which will leave physicians with high yield clinical pearls applicable to daily clinical practice; particularly regarding safe and effective opioid prescribing practices. Knowledge+ also includes a module on complex medical care which features questions more akin to those from UWorld or MKSAP in terms of complexity.

However, what makes Knowledge+ truly stand out is its unique adaptive learning system which helps curb both under and overconfidence. As previously mentioned, prior to answering a question, the software asks the test taker to rate their level of confidence in a particular response. The program uses this information to identify uncertainty or frequently missed subjects. Knowledge+ will then emphasize questions within this topic to direct study time towards weaker areas and ensure competence and confidence on test day. Conversely, if questions within a topic are consistently being answered correctly, the program will test this knowledge less frequently. There is always the option of using the “recharge learning” feature during which mastered content is quickly reviewed to prevent memory decay.

BOTTOM LINE: Knowledge+ is a unique platform that learns about your strengths and weaknesses as you use their software for board studying. This information is then used to reinforce weaker subjects and correct over confidence. This is an easy to use, quick recall program that ensures your time studying is used efficiently.

MKSAP (Medical Knowledge Self-Assessment Program) is a board review program released by the American College of Physicians. This very popular software was initially released in the 1960s and since then its popularity has only grown. In fact, many internal medicine programs provide MKSAP for their residents as they prepare for the American Board of Internal Medicine exam.

If Knowledge+ is a quick recall program great for on the go, MKSAP feels more like a critically ill patient who needs complete and undivided attention. Prompts tend to be longer and explanations more thorough with clear and detailed reasoning even for incorrect answers. As the correct answer is revealed, a clear educational objective is delineated, and key points are highlighted for quick reference and memory consolidation. Similar to Knowledge+, MKSAP links questions to relevant journal articles but also provides direct reference to where the content can be found in the MKSAP textbook.

In terms of content, the main difference is MKSAP’s identification and inclusion of hospitalist content. This comprises both clinical knowledge as well as topics like quality improvement and patient care related safety issues. For those particularly interested in Hospital Medicine, MKSAP selects the highest yield hospital medicine topics to mirror the Focused Practice in Hospital Medicine blueprint.

MKSAP features are directly dependent on which plan is purchased. Choosing a MKSAP plan feels like deciding which options are necessary for your new car. In the most basic plan, MKSAP is a wonderful comprehensive internal medicine board review question bank. However, if one splurges for the most complete plan, the platform also provides access to its full electronic text and helpful learning tools such as digital flash cards. The complete plan even provides access to an integrated VisualDx self-assessment tool in which the learner tests their ability to identify common internal medicine conditions from high resolution images. One may even add a “booster pack” loaded with tons of additional questions.

BOTTOM LINE: MKSAP is probably the gold standard of review materials for ABIM. It is a thorough review program with the added benefit of highlighting inpatient content for budding hospitalists. For those able to spend extra cash, the program has nice added features such as VisualDx, visual flashcards and even additional questions.

Rounding out the list is UWorld. Like that car you have been driving around since college and are waiting to upgrade after residency, UWorld is familiar and reliable.

UWorld’s internal medicine question bank is similar to their other products which many have used prepping for the USMLEs. Many questions feature integrated media such as high-resolution clinical pictures and radiologic images. A noticeable difference between Uworld and the other ABIM review programs is its ability to categorize questions not only by system but also by practice setting including outpatient clinic, emergency department, or medicine wards. This may be most helpful as one uses the question bank to prepare for upcoming rotations. Hospitalist learners will also find these to be a convenient feature to concentrate on content most applicable to taking care of patients admitted to the medical wards.

Content-wise, UWorld features challenging and high yield questions that are promptly followed by in depth explanations, concise tables, and flowcharts that make even the most complex topics seem manageable.
UWorld does not have many extra features aside from its main question bank. However, it does allow the learner to take digital notes as they progress through the question bank and features an option to generate flash cards for on the go reviewing.

BOTTOM LINE: Uworld features challenging questions that are simplified by excellent explanations featuring graphs, tables and algorithms.

In terms of pricing differences between the aforementioned platforms, they charge similar prices to residents for their entry level options ($400). For MKSAP this means you have unlimited access to the digital platform but not to visual flashcards or Visual Dx. For a similar price, NEJM+ provides unlimited access to their complete platform. However, spending the same amount on the Uworld grants the learner access only for 90 days and does not include the option to reset the question bank. Those extra features incur significant price increases.

There you have it: a quick review of three of the most popular board review aids for internal medicine. After all is said and done, I have found that choosing the right board review software is not a one size fits all endeavor. If you learn best by sifting through data quickly and on the go, then Knowledge+ may appeal the most to you. If you are the kind of learner that remembers things best by having flowcharts and diagrams to reference regularly, then UWorld can prove invaluable. However, if you want tested and tried software with tons of features to add to as you course through your board preparations, then MKSAP may be the most appropriate choice for you.  Best of luck on your board exams and happy studying!
Posted by Diego Suarez on Jan 29, 2020 6:26 PM America/New_York