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Studying for the Boards

May 25, 2025
by Mark David Siegel

Hello everyone:

This note is for those of you taking the Boards this summer, or next summer, or the summer after that.

Most of our graduates pass the Boards the first time they try. But not all. Sometimes life gets in the way. Sometimes studying is inadequate or ineffective. If August comes and you’re not ready, hold off and wait a year.

The most important reason we study is to be good doctors. Last week, one of our MICU patients was choking on saliva while being sedated with ketamine. From the recesses of my brain, I remembered reading somewhere that ketamine can cause hypersalivation, which turned out to be his problem. We stopped the ketamine, his mouth dried up, and we extubated him soon after.

We also study to pass the Boards. For most residents completing the MKSAP question bank will prepare you well. MKSAP questions are like the Boards if a bit more difficult. You’ll see questions on clinical problems you may not see as residents, like how to treat a patient with newly diagnosed breast cancer or when to start biologics on a patient with Crohn’s. MKSAP is also well-written, concise, and realistic, and you can import your In-Training Exam (ITE) report so you can focus on areas of weakness.

There are other great question banks. Some residents swear by UWorld. Others love AMBOSS NEJM Knowledge +. As a Yale resident you can access AMBOSS for free through our library. Whatever resource you choose, if you’re taking the Boards this summer, aim to finish most of your studying by the end of June so you can focus on chief residency, fellowship, or new clinical jobs. You can use July and August to reinforce weak spots and review questions you got wrong (or got lucky).

Your performance on MKSAP and In-Training Exam (ITE) are markers of readiness. If you’re getting at least 65-70% of the MKSAP questions correct on your first attempt, you’re probably fine. If your last ITE score was above the 60th-70th percentile, you’re likely on track. But even if your scores were lower, you can easily pass once you commit to a sound study plan.

So what’s a sound study plan? Here are some principles, many of which I learned from Dr. Jack Contessa, our recently retired GME education specialist (the GME office has hired a new specialist, starting next month):

  1. Make studying a regular habit, whether you’re taking the Boards this summer or in the future. I’m enrolled in Maintenance of Certification (MOC), and I try to do ~6 practice questions a day (3 internal medicine, 3 PCCM).
  2. Read the explanations, even if you get the answer right. I’m constantly getting answers right for the wrong reason. Learn why that answer is right.
  3. Don’t fool yourself. Don’t take credit for guesses.
  4. Take timed exams to reproduce test conditions.
  5. Practice spaced repetition by coming back to topics after a week or two to refresh your memory. To build lasting knowledge you need to forget and then reconstruct what you learned. Testing yourself on information you learned 5 minutes ago doesn’t accomplish as much as you might think.
  6. Change study locations: home, hospital, coffee shop.
  7. Change media: read study materials, listen to podcasts, watch videos.
  8. Focus on areas that need work and use your ITE as a guide.
  9. Take notes and make flashcards
  10. Don’t study when you’re tired. You’ll forget everything. We need sleep to remember.
  11. Practice interleaving: change subjects (a little cardiology, a little ID, a little hematology, etc.)
  12. Read question stems carefully, and try to answer the question before looking at the multiple choice options.
  13. Enjoy studying. It’s not just about studying for the test. Medicine is amazing, and studying will give you the tools and instincts you need to ask good questions, teach your colleagues, and take great care of your patients.

You can all ace the Boards. Don’t hesitate to reach out to me or your APDs if you want to discuss your study plans.

Enjoy your Sunday, everyone. We’re going to Citi Field this afternoon to see the Mets take on the Dodgers.

Mark

P.S. what I’m reading:

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