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He helped me prepare for my ABIM exam focusing on process and approach. We all know the information. Taking the test is a game, and Sean helped me figure out how to play it!
Kyle F.
The ABIM Longitudinal Knowledge Assessment (LKA) replaces one high-stakes exam day with questions delivered every quarter for five years. You must open at least 500 of the 600 questions offered, you get up to five minutes per question with any resource except another person, and ABIM makes a single pass/fail decision at the end of year 5 (ABIM LKA FAQs, ABIM).
It is open-resource, but it still has a passing score. This guide explains the rules, how the time bank and quarterly reports work, what happens if you fall below the standard, and how internists use the reports to stay above it.
The LKA at a glance
| Topic | Official rule | Source |
|---|---|---|
| Assessment period | A 5-year cycle: questions arrive every quarter and ABIM makes one pass/fail decision at the end of year 5. You stay reported as Certified while you meet the participation requirement and other MOC requirements. | ABIM: Longitudinal Knowledge Assessment |
| Participation requirement | Open at least 500 of the 600 questions offered over the 5-year cycle. Up to 100 may go unopened; unopened questions expire at the end of each quarter. | ABIM: FAQs (LKA) |
| Time and resources | Up to 5 minutes per question, with a time bank for questions that need longer. Answer on any internet-connected device, using any resource except another person. | ABIM: LKA, how it works |
| Feedback | Immediate feedback after each question, with rationale and references; quarterly progress reports from the second year. | ABIM: LKA, how it works |
| Performance standard | Meet or exceed the passing score at the end of year 5 to continue in the LKA. If you do not, you keep certification but must pass the traditional, 10-year MOC exam the following year. | ABIM: FAQs (LKA) |
| Result | Final score report and pass/fail decision in February of the year after year 5. | ABIM: FAQs (LKA) |
| Cost | Included in the annual MOC fee: $220 a year for the first certificate and $120 for each additional certificate. | ABIM: MOC fees |
| MOC points | 0.2 MOC points for every question answered correctly. | ABIM: LKA, how it works |
How the LKA works, quarter by quarter
Questions open at the start of each quarter, on January 1, April 1, July 1 and October 1, and close at the end of March, June, September and December (ABIM LKA FAQs). A question you open is scored. A question you leave unopened is not, but it expires when the quarter closes and counts against the 100 you are allowed to skip over the five years (ABIM LKA FAQs). ABIM built that allowance for “life happens” quarters: a new baby, a move, a heavy service block.
Each question allows up to five minutes, and a time bank covers the ones that need longer (ABIM). You can answer on a phone, tablet or computer, and you see the correct answer, the rationale and references straight away (ABIM). Every correct answer earns 0.2 MOC points (ABIM).
When you enroll matters. The enrollment window runs from December 1 of the year before your assessment is due to November 15 of that year, and joining late uses up part of the skip allowance (ABIM):
| If you enroll and start answering | Unopened questions left for the 5-year cycle |
|---|---|
| December 1 – March 31 | 100 |
| April 1 – June 30 | 70 |
| July 1 – September 30 | 40 |
| October 1 – November 15 | 10 |
Is the ABIM LKA open book?
Yes, with one limit: you may use any resource except another person (ABIM). But five minutes is not long enough to research a question from scratch, and ABIM describes the content as knowledge a physician typically would not need to look up extensively in practice. It asks you to treat the LKA as an assessment (ABIM LKA FAQs).
The habit that works: commit to an answer from your own knowledge first, then use a reference only to confirm a dose, a threshold or a guideline detail, and save the time bank for long vignettes. Physicians who look everything up tend to run short of time on exactly the questions where a lookup would have helped.
What is the passing score for the ABIM LKA?
ABIM calls it the performance standard: the score you must meet at the end of the five-year cycle (ABIM LKA FAQs). ABIM’s LKA pages do not publish it as a single number. Instead, each quarterly progress report shows your current score next to the current passing score, where both sit in the distribution of all participants, and your correct and incorrect answers by content area over the past year, split by how confident you were (ABIM LKA FAQs).
Progress reports start once you have answered enough questions, usually early in year 2, and each arrives three to four months after the quarter it covers. That lag matters. A slide below the standard in a busy spring may not show up on a report until the autumn.
What happens if you do not pass the LKA
Missing the performance standard does not cost you certification on the spot. You are unenrolled from the LKA and must pass the traditional, 10-year MOC exam the following year to remain certified (ABIM LKA FAQs). That exam is taken at a test center, with a $700 test center fee on top of the annual MOC fee and half off the first retake after a fail (ABIM MOC fees).
Two other cases. If you are in a grace year, you cannot use the LKA at all and must pass the 10-year exam by the end of that year (ABIM). If your certification has lapsed, you can use the LKA to regain it, but you are reported as Not Certified until you pass at the end of year 5 (ABIM).
LKA or the traditional 10-year exam?
| LKA | Traditional, 10-year MOC exam | |
|---|---|---|
| How you take it | Quarterly questions online, on your own device | One exam at a test center |
| Resources | Any resource except another person | Test center rules |
| Cost | Included in the annual MOC fee | $700 test center fee plus the annual MOC fee |
| When you get a decision | February after year 5 | After the exam administration |
| Grace year or failed LKA | Not available | Required |
For most internists in active practice, the LKA is the lower-stress route: no test center day, no separate fee, and feedback every quarter. The 10-year exam suits physicians who would rather prepare once and be done, and it is the only route after a failed LKA cycle or in a grace year. ABIM also offers focused versions, including Internal Medicine: Inpatient, for physicians who concentrate their practice in one area (ABIM LKA FAQs).
Using the progress reports to stay above the standard
- Read the content-area table every quarter. Two weak areas in a row are a study list, not bad luck.
- Watch confident misses. The report separates questions you got wrong while feeling sure. Those point to outdated knowledge, the kind that changes with new guidelines.
- Keep a short miss log. One line per wrong answer, with the rationale ABIM gave. Review it before the next quarter opens.
- Decide what to do after question 500. If you stop opening questions after 500, your score stays where it is; if you keep going, it can move either way (ABIM LKA FAQs). Comfortably above the standard, you can keep answering as you have been. Close to it, check the latest report before you decide.
When a tutor helps with the LKA
Most internists do not need a tutor for the LKA. Help makes sense in two situations: when your progress reports sit near or below the passing score with a year or two left in the cycle, and when an LKA cycle has ended below the standard and the 10-year exam is due the next year.
ABIM preparation at The Boards Professor is led by Dr. Sean Moazezi, a board-certified internist, with Dr. David Wadie. Sessions focus on how you approach a question rather than reteaching medicine you already know: reading the stem for the decision being tested, committing before you look anything up, and working through your report’s weak content areas with live questions. Sessions run online by live video (Zoom or Google Meet) around clinical schedules.