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.
    • 12 months of a medicine track internship followed by 24 months of an internal medicine residency or 36 months of an internal medicine residency.
    • 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.
    • 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 as follows:

Exam Cancellation Fees

  • Before Aug. 6, 2021: $100 cancellation fee
  • Between Aug. 6 and Sept. 5, 2021: $400 cancellation fee
  • After Sept. 5: No refunds will be allowed

Fall 2021 Exam Dates and Deadlines

The Internal Medicine Written Exam will be administered Sept. 20-24, 2021 via remote proctored platform. The application period usually opens in April, and applications are due by the final deadline of Sept. 5. Candidates will receive information on how to register with MonitorEDU once their application is deemed complete.

All candidates requesting exam accommodations must submit their requests at the time of application or Aug. 6, 2021.

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 seven-hour exam consists of 320 multiple choice questions in the below areas: Primary Certification

Primary Certification
  1. 1. Allergy/Immunology
  2. 2. Cardiovascular disease
  3. 3. Endocrinology
  4. 4. Hematology
  5. 5. Gastroenterology
  6. 6. Oncology
  7. 7. Nephrology/Hypertension
  8. 8. Rheumatology
  9. 9. Pulmonary diseases
  10. 10. Infectious disease
  11. 11. Dermatology
  12. 12. Otorhinolaryngology
  13. 13. Neurology
  14. 14. Obstetrics/Gynecology
  15. 15. Ophthalmology
  16. 16. Psychiatry
    • 1-5%
    • 10-14%
    • 7-11%
    • 4-8%
    • 9-13%
    • 6-10%
    • 8-12%
    • 6-10%
    • 9-13%
    • 8-12%
    • 1-4%
    • 1-4%
    • 2-6%
    • 1-4%
    • 1-4%
    • 1-4%
  1. 18. Adolescent medicine
  2. 19. Bioethics
  3. 20. Critical care medicine
  4. 21. Clinical epidemiology
  5. 22. Disease prevention
  6. 23. Geriatric medicine
  7. 24. Nutrition
  8. 25. Occupational medicine
  9. 26. Substance abuse
  10. 27. OMM/OMT
  • 1-4%
  • 1-4%
  • 1-4%
  • 6-10%
  • 1-4%
  • 2-6%
  • 3-7%
  • 1-4%
  • 1-4%
  • 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.