A Deep Dive into the Psychiatry Board Exam: Content Areas, Structure, and Study Tips
To become board-certified by the American Board of Psychiatry and Neurology (ABPN), you will have to complete an ACGME-accredited psychiatry residency program in the United States or an equivalent residency program in Canada accredited by the Royal College of Physicians and Surgeons of Canada. You will need an active, unrestricted medical license in the United States or Canada and must complete any training requirements of the psychiatric specialty or subspecialty you select. If you do not have an unrestricted license at the time of application, be sure to submit updated licensure information by the time specified in the specific Information for Applicants publication for your exam. All applications for the Psychiatry Certification Examination are submitted online through the ABPN Physician Portal. Detailed eligibility and application information are available on the ABPN website.
Psychiatry Board Exam Format
The psychiatry certification exam has 8 hours and 20 minutes of testing time, plus an NDA/tutorial/survey, and up to 60 minutes of optional break time, and is delivered at Pearson VUE testing centers. The exam includes a tutorial and instructions, a required nondisclosure agreement, 425 scored questions, and a post-examination survey. The examination is administered in eight alternating sections, consisting of either stand-alone questions or linked-item sets. The total testing time is approximately 8 hours and 20 minutes, exclusive of the nondisclosure agreement, tutorial, and survey.
Break time is not included in this total, but 60 additional minutes are available for breaks that can be used at any time between sections, though they are optional. Breaks can be taken in any pooled increment up to 60 minutes. If you exceed your allotted break time, it will be deducted from your remaining exam time. You can track this on the break screen, which will have a negative number if your 60-minute break time has been used.
Psychiatry Certification Exam Question Formats
The exam comprises two question formats: linked-item sets and stand-alone items. Each type is presented in its own section.
Linked item sets usually consist of two to ten multiple-choice questions related to a case that may be presented in a video clip of 1 to 5 minutes, an audio clip, or text. Some linked-item questions require headphones, which Pearson VUE provides. A question in a linked-item set may need more than one answer. The correct number of answers must be entered to advance to the following item in the set. No credit is provided for partially correct questions.
Stand-alone items are often vignette-based, but the questions are not linked to other questions. Like linked-item questions, fact-based questions are included, though they are mainly being replaced by vignette-based questions, which are more relevant to clinical practice. Stand-alone questions are typically one-best-answer multiple-choice questions.
What to Know About Psychiatry Certification Exam Questions
There are typically three levels of questions on the Psychiatry Certification Exam. These include questions that directly test your knowledge, which are primarily recall of knowledge, and require little judgment. They ask a simple question and offer clear responses.
The next-level questions on the psychiatry board exam best describe those that test your ability to recognize a specific situation or condition and are usually presented as a vignette. For this type of question, you might need to make a diagnosis, so it is essential to understand the DSM-5-TR criteria. Still, you should recognize that the case may present incomplete or conflicting information, and represents the uncertainty often encountered in clinical practice. This is a more realistic reflection of real-world clinical scenarios.
The third level of questions evaluates the ability to synthesize information and make a treatment decision. To accomplish this, you need factual knowledge about patient characteristics such as age, sex, gender identity, race, ethnicity, sexual orientation, disability, socioeconomic status, native language, and the ability to recognize pertinent details. You must also demonstrate high-level professional judgment to identify the relevant diagnostic information provided in the vignette. Information on origin and/or occupation is sometimes mentioned in case vignettes in test questions. Some patient characteristics may be necessary for the diagnostic process, including factors that increase the clinical likelihood of a patient's case. Their inclusion can also lead to wrong conclusions and misdiagnoses in actual clinical practice, including those that could be associated with harmful patient stereotypes.
The ABPN has practice questions available to gauge your preparedness. They offer a Psychiatry Certification Demonstration Exam to familiarize applicants with the exam interface, question types, and functionalities. The demonstration exam takes 70 minutes and includes a nondisclosure agreement, a 60-minute exam with four sections, and a five-minute survey.
Study Tips for the Psychiatry Boards
The pass rate of the psychiatry board exam was 98% in 2024. Using the ABPN content outline, focus on high-yield areas. These include mood disorders, psychotic disorders, anxiety, trauma-related disorders, substance use disorders, psychopharmacology, and ethics. Other topics are tested more for reasoning than depth. Don't study topics that don't appear on the content outline for the test.
Psychopharmacology is extensively tested on the exam. You should review the mechanisms of action, common and dangerous side effects, drug–drug interactions, and what to do when a patient develops a complication. You may be given a question describing a complication that asks you what to do, rather than simply identifying the drug. Some favorite topics are long-acting injectables, antidepressant switching strategies, mood stabilizer monitoring, clozapine, lithium toxicity, serotonin syndrome, and neuroleptic malignant syndrome.
You should be able to distinguish between closely related conditions, such as bipolar II disorders and major depressive disorder, delirium and dementia, schizoaffective disorder and schizophrenia, or PTSD and adjustment disorder. When you review a case in which you are asked for a likely diagnosis, always note the most likely alternative diagnosis and ask which feature rules it in or out.
Carefully review ethics, professionalism, and systems-based practice. These questions are sometimes deceptively simple, and it's easy to overthink. The correct answer usually prioritizes patient safety, informed consent, least restrictive alternatives, and appropriate supervision. When in doubt, choose the option that protects the patient and follows the standard process.
When reading vignettes, train yourself to ask three questions before looking at the answers: When approaching a vignette, train yourself to ask three key questions before reviewing answer choices:
- What is the diagnosis?
- What is the most immediate clinical risk?
- What is the next best step in management?
Many incorrect options are technically accurate but inappropriate for the moment described. The exam rewards timing and prioritization more than exhaustive workups.
Don't neglect the overlap of neurology and psychiatry, particularly conditions like epilepsy, traumatic brain injury, neurocognitive disorders, Parkinson disease psychosis, and medication-induced syndromes. You should recognize when symptoms suggest a medical or neurologic cause and respond appropriately.
When using question banks, review the rationales for both correct and incorrect answers, and note areas of weakness so you can return to them for further study.
Finally, manage endurance. The exam is long, and cognitive fatigue often occurs. Practice doing blocks of practice questions under timed conditions. Resist the impulse to change answers on test day unless you are sure you misread the question—most experienced test-takers who fail report second-guessing and overcomplicating straightforward scenarios rather than a lack of knowledge.