The Game of Boards: Examination (preparation) is Coming

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As a resident, I received one of the most enduring pieces of advice from a friend who had recently sat through the American Board of Internal Medicine (ABIM) Nephrology Board examination.

You’re already late to study for it, you better start now.”  

That same year, in 2014, the pass rate for First-time test takers dropped to 80%. Although the passing rates improved to 89% in 2015 and 90% in 2016, the last two years have plateaued to an 83% passing rate. The reason behind low passing rates is a matter of debate, but if you’re a 2nd year nephrology fellow, I know the flurry of panic that can be induced by this high-stake examination.  There are many resources available and recently our very own Samira Farouk summarized the most popular resources used to study for the boards. On those grounds, let’s break down some of the most popular study tools for board prep and how I fared using them.

July was a month of reckoning. Freshly graduated, fellowship was over and the ASN’s Board Review Course and Update (BRCU) that I had paid $975 for in April was set to start on July 28, 2018. My endeavor began by reading the active Nephrology Self-assessment program (NephSAP) issues to prepare. Although the NephSAP is a great tool, I quickly realized I couldn’t expect myself to read all the active issues in one month (some issues were more than 100 pages long!). I fell victim to passive reading, with the goal of finishing the text instead of consolidating the information. Also, each NephSAP includes details on recent publications. Given the time interval between publications and their appearance on the boards, you’re not likely to encounter some of the material presented in the active versions of the NephSAP.

It was time to change my strategy. I recommend downloading the Certification Examination Blueprint from the ABIM website. The content is divided into 10 sections and each of the medical content categories includes content subsections and specific topics that may appear in the exam with a percentage assigned to each for a typical exam. I began to fill in each section and created a review of each subject I might be tested on. I used UpToDate in part because of how easy it is to search the site however, in retrospect, I could have certainly used Renal Fellow Network to fill out my review as well!

The Costanzo became my means to review basic physiology. It is presented in an easy-to-follow format and was concise enough for board review in my opinion. The CJASN Update For The Clinician on Renal Physiology is excellent, and be sure not to miss out on Biff Palmer’s article on Regulation of Potassium Homeostasis.

I decided to attend ASN’s live review course because I spent a third of my 2nd year without electricity in my home, and I felt underprepared.  I had never gone to a review course before because my mind tends to wander during lectures, especially for such long periods of time. However, this is exactly why I recommend going to the BRCU. Undoubtedly, it was an intense week, but the lectures were dynamic and kept me focused. The speakers were rock stars which is fitting because the course was offered the week before Lollapalooza in Chicago. The course also follows the ABIM blueprint which was ideal because I had already outlined my review notes based on the same blueprint.

By August I had 8 weeks left before the exam and I wanted to enter a more active phase of studying by incorporating questions and recall. I began answering the Kidney Self-Assessment (KSAP) questions as part of a more active studying strategy. Each KSAP module is designed to include content from each of the ten ABIM nephrology blueprint categories and attempts to cover the same percentage that is assigned to each in a typical exam. This merged flawlessly with my review notes. After each week was done, I would review my notes from prior weeks until I could achieve recall. I also made my own flashcards. By focusing on my weak areas and re-testing my knowledge with questions, I felt more confident as the summer progressed. The KSAP became my principal study tool paired with my review notes and notes from the BRCU material.

By the end of September, I had finished all the KSAP questions and the questions provided by the BRCU. The NephSAP struck back with a vengeance during my last week of studying. Hungry for more questions to test my knowledge, I remembered that all archived issues are available to ASN members as well as the evaluation answers and explanations. Also available are the NephSAP core knowledge questions  which are a supplement to the issues to assist in preparation for the initial board certifications or recertification.  

If you’ve already registered to take the boards this year on October 23, that means you’ve already conquered at least 5 prior board examinations. This exam is composed of 4 blocks with 60 questions each and you’re allowed 2 hours to complete each question block. You also have up to 100 minutes of break time divided between 3 breaks. I hope this information will assist you along your quest and you won’t fear when Fall approaches. Stay tuned throughout the summer for board review pearls and more advice from RFN!

Krystahl Andújar
NSMC Intern


  1. I’m a first year fellow and want to ace my in service exam. Only studying so far has been UpToDate around cases (didn’t take notes).
    What’s my best strategy in time left (mostly in service)….BRCU with as many ksap Qs? Should I start with the ones about to expire or the latest ones (realistically can’t do all).
    Any advice would be appreciated.
    How much do the in service exams in the first year matter?

  2. As a first year fellow, what’s the expectation for the in-service exam. My goal is to ace it but haven’t started formal study. Should I purchase the online and print versions of the BRCU and just do as many ksap questions? Should I start with the ones about to expire or the latest ones? I won’t have time for Nephsap. So far, I’ve been reading UpToDate around cases but alas, didn’t make notes. Does the BRCU mirror the exam? Any advice/input would be highly appreciated

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