Board Prep Timeline for Residents Also Applying to Fellowship

You’re a PGY-2 heading into PGY-3. You’ve got an in-training exam score email sitting in your inbox, a co-resident just matched into a competitive fellowship, and your program director casually reminded you, “Don’t forget, boards are right after graduation.”

You’re thinking: I have to be a good resident, crush my boards, and apply to fellowship. In the same year. On the same tired brain.

Here’s how you do it without lighting yourself on fire.

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Big Picture: Parallel Tracks, Not Competing Priorities

You’re running two timelines:

• Certification board exam (e.g., ABIM, ABS, ABP) after residency
• Fellowship application + interviews usually starting 9–12 months before that exam

They are not separate projects. They feed each other. Strong board-level knowledge makes you better in interviews; a disciplined application year helps you not panic-cram for boards six weeks before the test.

Think in three phases:

1. Foundation (PGY-1 to early PGY-2) – Set habits, fix weaknesses, align rotations.
2. Application Year (late PGY-2 through PGY-3) – Heavy lift: fellowship apps + early board prep.
3. Final Push (last 4–6 months of residency) – Lock in board content once applications calm down.

Here’s the timeline, concretely.

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PGY-1: Quiet Setup That Pays Off Later

You’re not applying to fellowship yet. But future-you will either thank you or swear at you based on what you do now.

Months 1–3 of PGY-1: Just Survive, But Capture Data

At this point you should:

• Figure out which exam and format you’ll face

  • Internal med: ABIM – mostly multiple choice, heavy on bread-and-butter medicine
  • Surgery: ABS QE – more operative decision-making
  • Pediatrics: ABP – similar style to ABIM but pediatric-focused

• Log what repeatedly embarrasses you on rounds.

  • Start a simple note on your phone or a Google Doc:
    • “ICU: vasopressors – confused about when to switch”
    • “Renal: glomerulonephritis patterns”
    • “Cards: anticoagulation around procedures”

• Do very light QBank exposure (seriously light):

  • 5–10 questions a day, 3–4 days a week. Untimed, learning mode.
  • Just to get used to board-style thinking, not to “study for the boards.”

You’re building awareness, not mastery.

Months 4–6 of PGY-1: Establish an Actual Study Habit

At this point you should:

• Choose your primary question bank for boards:

  • IM: UWorld (non-negotiable), consider a secondary bank (AMBOSS, MKSAP questions).
  • Surg: TrueLearn + SCORE.
  • Peds: MedStudy or PREP.

• Create a micro-habit schedule:

  • 15–20 questions per weekday.
  • One 1–2 hour “learning block” on a lighter weekend day to review missed questions.

• Align your habit with your reality:

  • On wards: 10 questions pre-call, 10 post-call the next day = done.
  • On lighter rotations (clinic/elective): 20–30/day.

If you can’t consistently do 10–20 questions as a PGY-1, you’re not going to magically do 60/day as a PGY-3 applying to fellowship.

Months 7–12 of PGY-1: Turn ITE into a GPS

You’ll usually have an In-Training Exam (ITE) near the end of PGY-1.

At this point you should:

• Treat the ITE as your baseline board score:

  • Don’t freak out about percentile; look at domain breakdown.
  • “Weak: nephrology, rheumatology, heme-onc.” Good. That’s your map.

• Implement targeted blocks:

  • 60–70% of questions from weak areas.
  • 30–40% from mixed or strong areas to maintain breadth.

• Start building a personal “board notes” system:

  • One consolidated place: Notion, OneNote, Google Doc, or a physical notebook.
  • Only write down:
    • Repeatedly missed concepts
    • Mnemonics or decision trees
    • High-yield algorithms (e.g., AFib anticoagulation, sepsis management steps)

You’re not doing “hardcore board prep” yet. You’re building infrastructure so PGY-3 doesn’t feel like starting from zero.

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PGY-2: Decide Fellowship, Align Training, Ramp Up

This is where the board timeline and fellowship timeline start overlapping.

Early PGY-2 (Months 1–3 of the Year): Decide Your Route

At this point you should:

• Make a real decision about fellowship:

  • Yes/No and which field (Cards, GI, Heme/Onc, Pulm/CCM, etc.).
  • If you’re unsure by mid-PGY-2, you’re already behind for niche, super-competitive fields.

• Talk to:

  • A recent grad who matched in your chosen fellowship.
  • A faculty mentor in that subspecialty.
  • Your PD or APD about rotation planning.

• Align your rotations:

  • Front-load your future fellowship’s rotations in late PGY-2 / early PGY-3.
  • Example: future cardiology fellow → aim for CCU, consults, and echo during PGY-2–PGY-3 early so your letters can mention concrete work.

This directly affects your board prep: the more subspecialty content you see on the wards now, the less you’ll have to brute-force later.

Mid PGY-2 (Months 4–6): Build a Two-Track Study Plan

Now board prep and fellowship prep start to share a brain.

At this point you should:

• Increase board-related questions:

  • 25–35 questions per day on average.
  • Try one timed block (10–15 questions) per week.

• Start fellowship-specific reading layered on top:

  • Want GI? Skim ASGE guidelines and basic hepatology decision trees.
  • Want Cards? ACC/AHA guidelines for CHF, AFib, ACS.

Aim for overlap: a hemodynamics concept you learn for your future fellowship goes straight into your board foundation.

• Build a single reading pipeline:
  • For each rotation, choose:
    • 1 board review resource (e.g., MKSAP section, MedStudy videos)
    • 1–2 key guidelines/landmark review articles related to your intended fellowship.

You are not doing separate “board time” and “fellowship time” for basic concepts. Core medicine should count for both.

Late PGY-2 (Months 7–12): ITE #2 and Early Fellowship Prep

Now the timeline tightens. ERAS (or SF Match for some fellowships) is on the horizon.

At this point you should:

• Take ITE seriously as your board predictor:

  • Aim to be safely above the “at risk” zone.
  • If you’re below average or borderline:
    • You need an actual remediation plan now, not in PGY-3.
    • Consider: dedicated weekly study group, faculty tutor, or a structured board course.

• Start early fellowship application prep:

  • Update CV with:
    • Presentations
    • QI projects
    • Any poster you half-finished—finish it.
  • Identify letter writers:
    • Two from your desired subspecialty
    • One from a core rotation who can vouch for your overall competence

• Integrate fellowship topics into board prep:

  • If applying for Heme/Onc, don’t ignore oncology chapters “for later.”
  • You want to walk into interviews already sounding like someone with board-solid general knowledge and a focused subspecialty interest.

Resident Board and Fellowship Timeline Overview

Period	Event
PGY-1 - Start light QBank and track weaknesses	Months 1-6
PGY-1 - Build habits, take first ITE	Months 7-12
PGY-2 - Decide fellowship, align rotations	Months 1-6
PGY-2 - Ramp questions, plan applications	Months 7-12
PGY-3 - ERAS, interviews, steady questions	Months 1-6
PGY-3 - Dedicated board prep, final push	Months 7-12

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PGY-3 (or Final Year): The Tightrope Year

This is the year that breaks people who didn’t plan. You’ll have:

• ERAS submission
• Fellowship interviews (often bunched into brutal weeks)
• Senior responsibilities on service
• Last ITE
• Board exam date creeping closer

PGY-3 Months 1–3: ERAS + Maintain Your Baseline

ERAS for most internal medicine-based fellowships opens in June with submissions soon after; other specialties vary slightly, but the chaos is similar.

At this point you should:

• Finish 90–100% of your primary QBank at least once:

  • If you haven’t, you’re behind. Prioritize high-yield areas now.
  • Shift to timed blocks for most of your sessions.

• ERAS / application tasks:

  • Personal statement drafted and edited.
  • LoRs requested with clear deadlines.
  • Program list made (reach/realistic/safe).

• Protect a minimum floor of board study:

  • Even during application madness:
    • 10–15 questions per day, non-negotiable.
  • That’s your “heartbeat.” You stop that for two months, you will feel it later.

PGY-3 Months 4–6: Interview Season + Board Insurance

This is the danger window. Travel, virtual interviews, late nights, extra calls to cover co-residents on interviews.

At this point you should:

• Run efficient, portable board prep:

  • QBank app on your phone/tablet.
  • 10–20 questions between interviews, on planes, at the hotel.
  • Short review of your “worst systems” each week (one-hour block).

• Use interview prep to secretly help boards:

  • Every “Tell me about a case…” → you review pathophys and management.
  • When you prep for fellowship journal clubs or case presentations, you’re reinforcing board-level knowledge. Treat it that way.

• Keep track of your cumulative question counts:

  • Residents love to lie to themselves about how much they’ve done.

Target Cumulative QBank Progress by End of PGY-3 Interview Season

Category	Value
End PGY-1	800
End PGY-2	2000
Mid PGY-3 (Post-Interviews)	3000

If you’re nowhere near those numbers and your ITE is weak, you need to make some hard choices: fewer moonlighting shifts, less elective fluff, more textbook + QBank time.

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6 Months Before Boards: Shift From Survival to Attack

Now we’re in the real “board prep” period. Fellowship apps are mostly done, maybe you’ve already matched. Use that relief wisely.

6 Months Out: Structured, Exam-Focused Plan

At this point you should:

• Lay out a content plan by month:

  • Month 1–2: Systems you’re weaker in + high-yield bread-and-butter (cards, pulm, ID).
  • Month 3–4: Remaining systems + mixed question blocks.
  • Month 5: Full-length practice exams + review of misses.
  • Month 6: Polish, review notes, lighter volume.

• Do 40–60 questions most days:

  • Mix of:
    • Timed blocks (20–30 questions)
    • Smaller “topic review” blocks for weak areas.

• Add a secondary resource if it fits:

  • Board review videos during commutes.
  • Condensed review books (MKSAP Board Basics, MedStudy “Core” books, etc.).

This is where your PGY-1 and PGY-2 habits either make this sustainable or miserable.

3–4 Months Out: Simulate and Correct

At this point you should:

• Take a full-length or near full-length practice exam:

  • Schedule it like the real thing: quiet space, minimal breaks, similar timing.
  • Example: multiple 60–70-question blocks in one day.

• Do a brutal, honest review:

  • Categorize misses:
    • Knowledge gap
    • Didn’t read question carefully
    • Changed right answer to wrong
  • If your score is bad in multiple major domains, this is your red alert.

• Adjust based on results:

  • If you’re weak across the board:
    • Consider a short, intensive board review course.
  • If you have 2–3 weak systems:
    • Rebuild them aggressively with focused reading + questions.

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2 Months Before Boards: Fellowship Match + Final Push

Most fellowship matches occur in this window or slightly before. Emotionally volatile month.

At this point you should:

• Expect 1 week of productivity dip around Match:

  • Match week is noisy—emails, congratulating co-residents, processing your own result.
  • Plan for that. Do not schedule your most intense study block that same week.

• Narrow your focus:

  • Go from “learn all of medicine” to:
    • High-yield patterns
    • Algorithms
    • Classic board traps

• Revisit every “persistent miss” topic from your notes:

  • If it’s been on your wrong-answer list for 6 months and you still don’t get it, fix it now.
  • Or accept you’ll miss a couple of those and not obsess if they’re low-yield.

This is also the time to shut down anything non-essential:

• Say no to new QI projects
• Say no to “fun but optional” teaching extras
• Guard sleep ruthlessly

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Final 2–4 Weeks: Taper Smart, Don’t Panic

You’re almost done. Do not do the classic resident move of trying to do 150 questions/day and then walking into boards half-delirious.

At this point you should:

• Run exam simulations:

  • One more full-length practice if timing allows.
  • Several days of:
    • 2–3 timed blocks
    • Focused review of rationales, not just your score.

• Switch gradually to review mode:

  • Re-read your consolidated notes.
  • Hit the highest-yield topics daily:
    • For IM: CHF, AFib, COPD/asthma, pneumonia, sepsis, diabetes, CKD, GI bleeds, etc.
    • For Surg: trauma, acute abdomen, periop management, postop complications.
    • For Peds: vaccine schedules, congenital heart disease patterns, asthma, seizures.

• One week before:

  • Drop total question volume slightly.
  • Increase review, decrease new content.
  • Fix your sleep schedule to match exam day.

• Day before:

  • Half day of light review max.
  • No new topics. No all-nighters. You’re not a med student cramming for pharmacology anymore.

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Sample Weekly Structure During Final 3 Months

To make this less abstract, here’s what a good PGY-3 late-year week looks like when you’re on a moderate rotation (not ICU, not nights):

Day	Questions	Other Study	Notes
Monday	40–50	30 min notes review	Post-call? Adjust volume.
Tuesday	50–60	1 video/lecture	Timed blocks.
Wednesday	40–50	None	Busy clinic day.
Thursday	50–60	30–45 min focused topic	Weak system.
Friday	40–50	Review missed questions	Lighter day.
Saturday	60–80	1–2 hours reading	Longer block.
Sunday	20–30	High-yield skim	“Maintenance” day.

Adjust for ICU/nights by dropping question volume 30–40% but preserving some daily work.

Study Time Allocation in Final 3 Months

Category	Value
QBank Questions	60
Content Review/Notes	25
Practice Exams	15

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Common Mistakes Residents Make (And What To Do Instead)

You’re not special; I’ve seen the same three screwups for years.

1. Treating fellowship and boards as totally separate worlds

   • Wrong: “I’ll do boards after I match.”
   • Better: Every rotation, every guideline, every case → ask, “How would this be tested?”

2. Ignoring ITEs

   • Wrong: “I didn’t study but still passed, so I’m fine.”
   • Better: Use each ITE as a compass. Adjust within weeks, not years.

3. All-or-nothing study patterns

   • Wrong: 0 questions for three weeks, then 300 questions on a random Sunday.
   • Better: 20–40 questions most days. Small, boring, consistent.

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Final 3 Takeaways

• Start early, small, and consistent in PGY-1 and PGY-2 so PGY-3 isn’t a disaster.
• Make fellowship prep and board prep feed each other, not compete with each other.
• In the last 6 months, treat board prep like a scheduled rotation: daily work, clear plan, no magical thinking.