Ultimate Guide to Board Exam Study Resources for EM-IM Residents

Preparing for the Emergency Medicine–Internal Medicine (EM IM) combined board exams is a marathon layered on top of an already demanding residency. You are mastering two specialties, two sets of clinical expectations, and ultimately two board certification pathways. The good news: with the right strategy and board exam resources, you can build an integrated, efficient study plan that serves both Emergency Medicine and Internal Medicine simultaneously.

This guide walks through the most effective board exam study resources for EM-IM residents, how to combine them, and how to use tools like Anki for USMLE-style recall and UWorld-type question banks to your advantage—all while functioning on a busy call and shift schedule.

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Understanding the EM-IM Combined Training and Board Pathways

The EM IM combined pathway leads to dual board eligibility:

• Emergency Medicine (EM)

  • Board: American Board of Emergency Medicine (ABEM)
  • Primary written exam: Qualifying Examination
  • Followed by: Oral (Oral Certifying Exam / OSCE-style) depending on ABEM current format

• Internal Medicine (IM)

  • Board: American Board of Internal Medicine (ABIM)
  • Primary exam: ABIM Certification Examination (written)

As an EM-IM resident, you must:

1. Meet training requirements for both specialties.
2. Pass both EM and IM certification exams.
3. Maintain competence in two different—but overlapping—approaches to patient care.

Why this matters for your study resources:

• Pure EM residents can focus on EM; pure IM residents on IM.
• EM-IM residents must be strategic, choosing resources that:
  • Overlap across both specialties (e.g., cardiology, pulmonary, critical care, toxicology, infectious disease).
  • Bridge acute care (ED) and longitudinal management (clinic/inpatient).

The best study plan leverages board exam resources that either:

• Explicitly target both EM and IM, or
• Can be combined to minimize redundancy and maximize yield.

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Core Question Banks for EM-IM Board Preparation

If you can only invest heavily in a few things, make those things high-quality question banks. For dual training, think in terms of:

• One core EM question resource
• One core IM board-style question bank
• Supplemental niche resources as needed

1. Emergency Medicine Question Banks

a. Rosh Review (EM)

Why it’s essential:

• Widely used for EM in-training and ABEM Qualifying Exam prep.
• Offers questions organized by topic, ABEM blueprint, and in-training categories.
• Explanations are concise and clinically focused.

How EM-IM residents should use it:

• Align Rosh question blocks with your EM rotations (ED, ICU, trauma).
• Focus on:
  • Resuscitation
  • Airway
  • Toxicology
  • Cardiology and EKG interpretation
  • Neurology and stroke
  • Trauma and surgical emergencies

Example routine on an EM block:

• 20–40 Rosh questions/day (timed, mixed).
• Review all explanations; create Anki USMLE-style flashcards from missed questions or key learning points (especially must-know EKGs, imaging patterns, and algorithms).

b. EM Board Review Courses That Include Qbanks

Some commercial EM review courses include extensive question banks:

• Emcrit/EM Board Review style courses
• Council of Residency Directors (CORD) partnered products
• EM-specific app-based Qbanks

For EM-IM residents:

• Prioritize products with:
  • Updated ABEM blueprint alignment
  • Strong emphasis on resuscitation and critical care (over rare zebras)

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2. Internal Medicine Question Banks

For IM, the gold standard remains:

a. UWorld for ABIM / Internal Medicine

UWorld is not just for USMLE. They now provide ABIM-focused content.

Why it’s high yield:

• Questions mirror ABIM style: multi-step reasoning, complex comorbidities, evidence-based management.
• Detailed explanations, tables, and algorithms.

UWorld tips for EM-IM residents:

1. Integrate with rotations
   • On IM wards or clinic, do 10–20 ABIM-style questions daily in related topics (e.g., heart failure week → focus on cardiology).
2. Learn guidelines, not trivia
   • Use UWorld to anchor guideline-based care: anticoagulation, diabetes, CKD, COPD, etc.
3. Don’t rush to complete the entire bank early
   • Aim to finish UWorld for ABIM at least once by the end of PGY-3/4, then selectively rework weak areas as boards near.

b. Other ABIM Question Banks

• MKSAP Qbank (American College of Physicians)
  • Excellent for breadth and guideline-based content.
  • Pairs well with MKSAP text for detailed review.
• BoardVitals / TrueLearn (IM)
  • More question volume, good for reinforcing weaker topics or late-stage board prep.

For dual training:

• UWorld + MKSAP is a classic combination:
  • UWorld: deeper explanations, high-level reasoning.
  • MKSAP: structured content, ABIM-style but slightly more straightforward.

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3. Integrating EM and IM Qbanks for Maximum Overlap

You do not have enough time to treat EM and IM as two independent study universes. You need to combine them intelligently.

High-overlap topics:

• Cardiovascular (ACS, arrhythmias, heart failure, valvular disease)
• Pulmonary (asthma, COPD, pneumonia, PE)
• Endocrine (DKA, HHS, thyroid storm, adrenal crisis)
• Infectious diseases (sepsis, meningitis, endocarditis, HIV)
• Renal (AKI, electrolyte emergencies, acid-base)
• Gastroenterology (GI bleed, pancreatitis, liver failure)
• Hematology/Oncology (acute leukemia, hemolysis, thrombotic microangiopathies)

Practical approach:

• For each major organ system, pair:
  • EM Qbank (Rosh) questions focused on acute presentations
  • IM Qbank (UWorld/MKSAP) questions on chronic and inpatient management

Example: Pulmonary week

• EM: Rosh questions on status asthmaticus, massive PE, tension pneumothorax, ARDS.
• IM: UWorld questions on COPD stepwise therapy, ILD, long-term management post-PE, pulmonary hypertension.

This gives you a 360° view: how to resuscitate in the ED and manage on the floor/ICU or in clinic.

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Textbooks, Review Books, and Core References

While Qbanks train your test-taking skills, you still need solid content foundations, especially given the breadth of emergency medicine internal medicine combined practice.

1. EM-Focused References

a. Tintinalli’s Emergency Medicine

• The classic comprehensive EM textbook.
• Too long to “read cover-to-cover” during residency, but excellent for:
  • Deep dives on confusing or high-risk topics (e.g., aortic dissection, toxicology).
  • Clarifying the “why” behind EM protocols.

Use case for EM-IM:

• When you repeatedly miss a topic on Rosh or in-service, read the relevant chapter/section in Tintinalli for context.

b. Rosen’s Emergency Medicine

• Slightly more pathophysiology-heavy than Tintinalli.
• Great for EM-IM residents who enjoy detailed mechanistic explanations.

Choose either Tintinalli or Rosen as your primary EM reference, not both cover-to-cover.

c. EM Board Review Books

• Examples include board-focused EM review manuals that summarize:
  • Algorithms, critical differentials, and classic ED presentations.
• Use them in the 3–6 months leading to the ABEM Qualifying Exam as a high-yield supplement.

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2. IM-Focused References

a. MKSAP (ACP)

• Combines concise text with associated questions.
• Well respected for ABIM prep and general IM knowledge.

For EM-IM residents:

• Use MKSAP as your IM backbone:
  • Read key chapters (cardio, pulm, ID, endocrine, nephro).
  • Do end-of-section questions plus the online question set.

b. Step-Up to Medicine / Comparable Summaries

• Useful early in residency (PGY-1/2) if you want a structured, high-yield overview.
• Helps bridge the gap from USMLE-level IM to ABIM-level IM.

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3. Integrated/Critical Care Resources

Given that EM-IM residents are often heavily involved in ICU care, you benefit from critical care-focused references:

• Marino’s The ICU Book
  • Excellent for concepts like hemodynamics, ventilators, vasopressors.
• EMCrit (podcast & blog)
  • High-yield, cutting-edge critical care pearls.
• The Internet Book of Critical Care (IBCC)
  • Free online resource pairing pathophysiology with bedside management.

These will help with both:

• EM in-service and resuscitation questions.
• IM/ICU consult-level expertise and ABIM-level reasoning in critical care.

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Using Anki, UWorld, and Other Tools Strategically

Flashcards and Qbanks are not inherently helpful; how you use them determines their value. EM-IM residents must be ruthless about efficiency.

1. Anki for EM-IM: How to Make It Work

Many residents associate Anki USMLE-style decks with step exams, but the same principles apply to boards and real practice.

a. What to Put in Anki

Focus your EM-IM Anki deck on:

• Hard-to-remember details with high stakes, such as:
  • Reversal agents and dosing (e.g., for anticoagulants, tox).
  • Risk stratification scores (Wells, PERC, HEART, CURB-65).
  • Diagnostic criteria (e.g., DKA, HHS, sepsis, ARDS).
  • Key guideline thresholds (e.g., BP goals in HTN; LDL goals; A1c targets).
• Algorithms and decision rules:
  • Chest pain work-up pathways (ED and outpatient).
  • Stroke timelines and inclusion/exclusion criteria for tPA/EVT.
• Classic board patterns:
  • EKG findings (Wellens, Brugada, hyperkalemia).
  • Radiographic signatures (PE, pneumothorax, SBO, CHF).

Create short, focused cards:

• One fact or concept per card.
• Use cloze deletions for guidelines and algorithms.

b. How Often to Review

Given residency constraints:

• Goal: 20–50 new cards per week (not per day), with consistent daily reviews.
• Keep total daily reviews manageable (≤150/day), or you will burn out and abandon it.

c. EM vs IM Content Balance

Use your rotation schedule:

• On EM rotations:
  • Bias Anki creation toward acute/emergency care (toxicology, trauma, procedures, ACLS).
• On IM rotations:
  • Focus on long-term disease management, preventive care, outpatient guidelines.

Over time, your personal deck becomes a board review and bedside micro-reference.

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2. UWorld Tips for EM-IM Residents

You might use multiple flavors of UWorld:

• USMLE Step-style UWorld (if still relevant early PGY-1):
  • Clean up any knowledge gaps left from med school.
• UWorld ABIM:
  • Your primary IM board prep Qbank.

Key UWorld tips:

1. Use “tutor mode” early, timed later.

   • Early in residency: focus on understanding explanations, not speed.
   • Closer to the exam: timed 20–40 question blocks to simulate testing conditions.

2. Tag questions for review.

   • “Incorrect + marked” questions can be re-done 2–3 months before boards.

3. Turn missed questions into durable memory.

   • Summarize the key learning point into a short Anki card (especially for guidelines and management algorithms).

4. Don’t chase 100% completion at the expense of true learning.

   • Better to do 70–80% with deep understanding and review than 100% rushed.

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3. Other High-Yield Digital Tools

• AMBOSS (IM and EM sections)
  • Excellent for quick topic reviews on call.
  • Integrated Qbank and “learning cards” style approach.
• UpToDate
  • Best for point-of-care decisions; not targeted to board style, but can support understanding for complex topics.
• MDCalc
  • For scoring systems (e.g., Wells, CHA₂DS₂-VASc, CURB-65).
  • Recreate high-yield scores in Anki form for exams.

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Building a Study Schedule That Works for EM-IM Residents

The best board resources are only as effective as the schedule that supports them. EM-IM residents face unique scheduling patterns:

• Shift-based EM months (nights, weekends, varying hours)
• Call-based or long-day IM months (wards, ICU)
• Ambulatory blocks with more predictable daytime hours

1. Macro-Planning: 5-Year View

Because EM-IM programs are typically 5 years, you must think longitudinally:

PGY-1 to PGY-2: Foundation and Systems

• Consolidate USMLE-level knowledge relevant to EM and IM.
• Start light but consistent question practice:
  • 10–20 IM questions + 10–20 EM-style questions per day (when feasible).
• Start a modest Anki deck focused on foundational guidelines and algorithms.

PGY-3 to PGY-4: Targeted Board Preparation

• Increase Qbank volume:
  • Aim to complete at least one full pass of:
    • Rosh (or equivalent EM Qbank)
    • UWorld ABIM
• Use in-service and in-training exam feedback to target weak areas.
• Start board-focused review books for both EM and IM.

PGY-5: Exam-Focused Year

• Intensify focused board studying:
  • 40–80 questions/day split EM/IM depending on upcoming exam.
• Revisit high-yield summaries, Anki decks, and review materials.
• Join or form EM-IM-specific study groups to cover crossover topics (e.g., undifferentiated shock, complex multi-morbidity patients in the ED).

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2. Micro-Planning: Weekly Schedules by Rotation Type

a. On EM Rotation

Study priorities:

• EM Qbank (Rosh or equivalent)
• EM-focused topics in Anki (ACLS algorithms, tox, trauma, EKG)

Sample weekly plan (EM month):

• Workdays (pre- or post-shift):
  • 20–30 EM questions (timed, mixed).
  • 20–50 Anki reviews (10–15 minutes).
• Off days:
  • 40–50 EM questions, 10–20 IM questions for maintenance.
  • 30–40 minutes of reading (Tintinalli or EM board review text).

b. On IM Wards/ICU

Study priorities:

• IM Qbank (UWorld ABIM, MKSAP Qs)
• IM Anki content (guidelines, chronic disease, inpatient management)

Sample weekly plan (IM wards):

• Busy call days:
  • 10–15 IM questions, 10–20 Anki cards.
• Non-call / golden weekends:
  • 40–60 IM questions.
  • 20–30 EM questions to maintain acute care thinking.

c. On Ambulatory / Lighter Months

Use these as board prep accelerators:

• 60–80 mixed questions/day across EM and IM.
• 45–60 minutes reading or video review (board review courses).
• More substantial Anki catch-up if needed.

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3. Tracking Progress and Adjusting

Keep a simple tracking system:

• Spreadsheet or app with:
  • Total Qbank questions done per resource.
  • Performance by organ system.
  • Missed high-yield topics.

Every 1–2 months, review and adjust:

• If cardiology is weak on both EM and IM in-service exams:
  • Dedicate 2–3 focused weeks to cardiology across both Rosh and UWorld.
• If you’re neglecting EM because IM boards are sooner (or vice versa), rebalance deliberately.

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Putting It All Together: A Sample Integrated Study Plan

Below is a sample integrated plan for a PGY-3 EM-IM resident in the middle of the program, assuming both EM and IM boards are approximately 1–2 years away.

Daily (Average) Targets

• Questions: 30–50 total questions/day
  • 15–25 EM (Rosh or equivalent)
  • 15–25 IM (UWorld/MKSAP)
• Anki: 50–100 review cards/day + 5–10 new cards from missed questions or clinical cases.
• Reading/Video: 20–30 minutes of targeted reading on weak topics.

Monthly Focus

• Each month, highlight 2–3 systems to emphasize:
  • Example: January → Cardio & Pulm; February → ID & Renal.
• Do questions from both EM and IM in those systems:
  • EM: acute decompensations, ED-based presentations.
  • IM: chronic management, complications, follow-up.

6-Month Cycles

• Aim to rotate through all major organ systems every 6 months:
  • Cardio, Pulm, ID, Renal, Endocrine, GI/Hepatology, Heme/Onc, Rheum, Neuro, Critical Care, Tox, Trauma.

By the end of your EM-IM residency, this cyclic, integrated approach ensures:

• Repeated exposure to core concepts in multiple clinical contexts.
• Strong alignment with both ABEM and ABIM blueprints.
• Confidence that your board exam resources have been used to their maximum effect.

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FAQs: Board Exam Study Resources for EM-IM Residents

1. Do I really need separate resources for EM and IM if I’m in an EM-IM combined program?
Yes. The exam styles, emphases, and blueprints differ significantly. You can leverage overlapping content, but you still need:

• An EM-specific resource (e.g., Rosh, EM board review books) for ABEM-style questions and ED-focused presentations.
• An IM-specific resource (e.g., UWorld ABIM, MKSAP) for ABIM-style reasoning, guidelines, and chronic disease management.

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2. How should I prioritize studying if my EM and IM boards are in different years?
Prioritize the exam that is sooner, but avoid letting the other specialty atrophy:

• In the year before the nearer exam:
  • 70–80% of your study time on that specialty’s Qbank and materials.
  • 20–30% on the other specialty to maintain familiarity.
• Once the first exam is over, flip the ratio.

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3. Is Anki worth starting if I’m already PGY-3 or PGY-4?
Yes, if you use it selectively and strategically:

• Don’t try to build a huge deck; focus on:
  • Repeatedly missed concepts in Qbanks.
  • High-yield guidelines, scores, and algorithms.
  • Critical care and toxicology facts. Even late in training, a small, high-yield deck can significantly improve retention for boards.

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4. How many total questions should I aim to complete before EM and IM boards?
Targets will vary, but reasonable benchmarks:

• Emergency Medicine:
  • 2,000–3,000 high-quality EM Qbank questions (e.g., Rosh + supplemental).
• Internal Medicine:
  • One full pass of UWorld ABIM (2,000–3,000 questions)
  • Plus 1,000–2,000 additional questions from MKSAP or similar.

Quality and review of explanations matter more than raw numbers, but hitting these approximate volumes, with thoughtful review and Anki integration, will set you up strongly for dual boards in emergency medicine internal medicine.

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By carefully selecting and combining EM and IM board exam resources, using tools like Anki and UWorld intelligently, and aligning your study plan with your rotation schedule, you can confidently prepare for both boards while growing into the versatile, high-impact physician that EM-IM combined training is designed to create.