This one-day examination is administered annually in October. Written at the level of proficiency expected from second-year residents and covering a wide spectrum of knowledge in internal medicine, including acute and chronic care, inpatient and ambulatory problems, and essential clinical skills. The examination emphasizes 10 content areas central to the training of a general internist: cardiology, gastroenterology, endocrinology, pulmonary and critical care medicine, rheumatology, nephrology, hematology/oncology, infectious disease, neurology, and general internal medicine. A committee of 10 expert physician-authors creates the content blueprint, writes test items according to well-established principles of examination construction, and reviews each question on multiple occasions before inclusion. This committee includes four ACP representatives, three APM representatives, and three APDIM representatives. ACP provides expertise in test development. The National Board of Medical Examiners scores the examination and prepares analytic reports.