Written Exam


The following training requirements must be completed before a candidate may sit for the Written Exam for primary certification in Internal Medicine:

  • Demonstrate clinical competence in the practice of internal medicine by submitting a copy of your residency Program Director’s Report form by Aug. 1 of the year you will take the exam.
    • Complete 12 months of a non-medicine track internship followed by 36 months of an internal medicine residency (not necessarily running 36 consecutive months). Candidates may receive advanced standing credit for training in the internship which has been granted by the ACOI, which may be applied towards the 36 months of internal medicine residency requirement.
    • Complete 12 months of a medicine track internship followed by 24 months of an internal medicine residency or 36 months of an internal medicine residency.
    • Complete 12 months of an AOA-recognized internship followed by 48 months of a combined emergency medicine/internal medicine residency training program. The residency training must contain 24 months of emergency medicine and 24 months of internal medicine and meet the basic requirements for training as approved by the AOA.
    • Complete 48 months of a combined internal medicine/pediatrics residency training program. The residency training must contain a minimum of 24 months of internal medicine training and 18 months of pediatrics training and meet the basic requirements for training as approved by the AOA.
  • Adhere to the AOA Code of Ethics.
  • Submit a Program Director’s Report Form that shows clinical competence.


Once training requirements for eligibility are met, candidates must submit the following:

  • A completed application.
  • Required exam registration fees.
  • Initial certification applicants and applicants who have not completed their training must submit a Program Director Report verifying clinical competence and expected completion date of training.
  • If you have completed your training in an ACGME residency program, you must submit a letter from the AOA stating that the ACGME residency training has been AOA-recognized. Please visit this webpage to begin the training verification process.

Exam Fees

An exam fee of $800 must be submitted with your completed application. No application will be considered complete until all fees have been paid. Exam applications submitted after Aug. 6, 2021, will incur a $240 non-refundable late fee. No applications will be accepted after Sept. 5. All cancellations must be made in writing. No exam fees are refunded unless the candidate withdraws from the examination process, which will result in a loss of board eligibility. Cancellation fees are outlined below.

Exam Cancellation Fees

  • 0 – 30 days before the exam: no refund
  • 31 days or more prior to the exam date: 50% refund
  • No refunds of late fees
  • Rejected Applications: 75% refund
    Note: Prior to submitting your application, please be certain that you meet the criteria to apply

Fall 2022 Exam Dates and Deadlines

The Internal Medicine Written Exam will be administered Sept. 20-22, 2022, via a remote-proctored platform. Applications are due by the final deadline of August 20, 2022. Please note that the first deadline is July 20, 2022. Candidates will receive information on how to register with MonitorEDU once their application is deemed complete.

All candidates requesting exam accommodations must submit requests at the time of application or by Aug. 20, 2022.

Exam Content Outline

The Internal Medicine Written Exam tests the knowledge and understanding of basic science and clinical knowledge, skills and principles critical to the practice of Internal Medicine. The 320-item exam is broken down into the following sections and will include the content outlined below:

Section 1: 80 items (2 hours)
Scheduled optional break (10 minutes)
Section 2: 80 items (2 hours)
Scheduled lunch break (30 minutes)
Section 3: 80 items (2 hours)
Scheduled optional break (10 minutes)
Section 4: 80 items (2 hours)
Total seat time: 8 hours, 50 minutes
Total exam time: 8 hours

Primary Certification: Internal Medicine
a. Allergic rhinitis
b. Anaphylaxis
c. Atopic dermatitis
d. Contact dermatitis
e. Eosinophilia
f. Food allergy
g. Immunoglobulin E
h. Mastocytosis
i. Nasal polyps/asthma/aspirin sensitivity
j. Primary immune deficiency diseases
k. Serum sickness
l. Urticaria and angeioedema
a. Aortic and vascular disease
b. Arrhythmia
c. Cardiac pharmacology
d. Cardiomyopathy/heart failure
e. Congenital heart disease
f. Coronary artery disease
g. Infection
h. Pericardial disease
i. Preoperative risk stratification
j. Pulmonary hypertension and embolism
k. Syncope
l. Valvular heart disease
a. Acne and rosacea
b. Alopecia
c. Autoimmune cutaneous diseases
d. Cutaneous drug reactions
e. Cutaneous features of autoimmune diseases
f. Cutaneous findings of nutritional disorders
g. Cutaneous infections
h. Eczema and dermatitis
i. Papulosquamous disorders
j. Photosensitivity
k. Pigment disorders
l. Purpura
m. Skin lesions
n. Urticaria and angioedema
o. Vascular dermatoses
a. Adrenal disorders
b. Bone and calcium disorders
c. Diabetes mellitus
d. Endocrine tumors, endocrine impact from neoplasms
e. Hypertension
f. Hypoglycemia
g. Hypothalmic disorders
h. Lipid disorders
i. Nutritional disorders
j. Ovarian disorders
k. Pituitary disorders
l. Polyglandular disorders
m. Testicular disorders
n. Thyroid disorders
a. Biliary tract
b. Colon and anorectal
c. Esophagus
d. Gastrointestinal bleeding
e. Liver
f. Mesentery and peritoneum
g. Nutrition
h. Pancreas
i. Small intestine
j. Stomach
a. Coagulation
b. Hematologic malignancies
c. Myeloproliferative disorders
d. Platelet disorders
e. Porphyria
f. RBC disorders
g. Transfusion medicine
h. WBC disorders
Infectious disease
a. Cardiovascular infections
b. Central nervous system infections
c. Eye infections
d. Fever of unknown origin
e. GI related infections
f. HIV disease
g. Immunodeficiency syndromes (non-HIV)
h. Infection prevention and control
i. Infections of bone and joint
j. Lab diagnosis of infectious diseases
k. Nosocomial/hospital-acquired infections
l. Organism-specific infections
m. Renal and urinary tract infection
n. Respiratory tract infections
o. Sepsis and bacteremia
p. Sexually transmitted infections
q. Skin and soft tissue infections
r. Travel-related infections
s. Use of antimicrobials
a. Acute and renal failure
b. Chronic kidney disease
c. Glomerular disorders
d. Hypertension
e. Nephrolithiasis
f. Other kidney disorders
g. Renal physiology of pregnancy
h. Tubulointerstitial disease
i. Undifferentiated bladder and kidney disorders
j. Urinary tract infections
k. Water and electrolyte balance
a. Amyotrophic lateral sclerosis
b. Cerebrovascular disease
c. CNS infections
d. CNS tumors
e. Cranial nerve disorders
f. Degenerative/nutritional/alcohol
g. Dementia
h. Diabetes peripheral neuropathy and autonomic neuropathy
i. Headache
j. Movement disorders
k. Multiple Sclerosis
l. Muscle/neuromuscular diseases
m. Peripheral neuropathy
n. Seizure
o. Spinal cord
P. Vertigo
Obstetrics and gynecology
a. Breast disorders
b. Cervical and uterine disorders
c. Menopause
d. Menstrual disorders
e. Ovarian disorders
f. Pregnancy
g. Reproductive health
h. Sexually transmitted diseases
i. Vulvovaginal disorders
a. Breast cancer
b. Cancer prevention and screening
c. CNS tumors
d. Endocrine tumors and complications
e. Gentiourinary cancer
f. GI malignancy
g. Gynecologic malignancies
h. Head and neck cancer
i. Hematologic tumors
j. Hepatobiliary
k. HIV related malignancies
l. Lung cancer
m. Paraneoplastic / oncologic emergencies
n. Sarcoma
o. Skin
p. Suvivorship
q. Toxicity of treatment
a. Conjunctivitis
b. Uveitis/scleritis
c. Retinal findings
a. Diseases of the ear
b. Oropharyngeal diseases
c. Upper respiratory disorders
a. Anxiety disorders
b. Eating disorders
c. Mood disorders
d. Personality disorders
e. Schizophrenia
f. Sexual disorders
g. Somatiform disorders
h. Substance use disorders
a. Antiphospholipid antibody syndrome
b. Crystal-induced arthropathies
c. Heritable disorders of connective tissue
d. Infectious arthritis
e. Inflammatory myositis
f. Metabolic bone disease
g. Orthopedic disorders
h. Osteoarthritis
i. Other connective tissue disorders
j. Other rheumatic disorders
k. Rheumatoid arthritis
l. Seronegative Spondyloarthropathies
m. Systemic lupus erythematosus
n. Systemic sclerosis
o. Vasculitis
Adolescent medicine 1-4%
Bioethics 1-4%
Critical care medicine 1-4%
Clinical epidemiology 6-10%
Disease prevention 1-4%
Geriatric medicine 2-6%
Nutrition 3-7%
Occupational medicine 1-4%
Substance abuse 1-4%
OMM/OMT 1-4%

Exam Scoring

Scoring Criteria

AOA reports candidates’ certification results using standardized scaled scores. Scaled scores are more valid and reliable compared to raw scores and make scores comparable across different forms of the exam. The AOA reports scores on a 200 to 800-point scale with a scaled score of 500 or higher required to pass.

  • A scaled score of 500 represents the minimum level of knowledge and skill necessary to pass the exam as established by AOA Certifying Boards.
  • The highest possible scaled score is 800.
  • The lowest possible scaled score is 200.
  • Overall scores are based on the total number of items answered correctly, regardless of content area.

Results by content area

  • When possible, a breakdown of exam scores by content area is provided to help you identify your areas of strength and areas that may need more development.
  • The number of items for each content area indicates the relative amount of test questions on the exam for that content area.
  • Content area scores are not weighted to calculate your overall score; each content area is scored separately after the overall analysis is complete.