Taking a medical board exam is a process that’s as mentally taxing as it is time-consuming—and it doesn’t always go as planned. According to the American Board of Internal Medicine, failure rates can reach as high as 25% for first-time test takers in certain specialties. For those who don’t pass, the consequences stretch beyond professional delays. Failing an exam can shake confidence, complicate credentialing, and affect your mental health.

Board exams determine whether a physician can practice independently, qualify for hospital privileges, or even secure a new job. The exams vary widely in format and duration, and can leave you with questions as you plan your board exam prep strategy. How long are medical board exams? Are breaks included? What happens if the exam isn’t going well?

Knowing what to expect—and how to prepare—can make all the difference when it’s time to test.

Understanding the Exam Format

Medical board exams differ by specialty, but most share one feature in common: they’re long.  Internal medicine and pediatrics exams span 8–10 hours. Family medicine exams last approximately 7 to 8 hours. And surgical boards are often split into separate written and oral exams that extend the process over several months.

Long medical board exams are intentional. Each section is designed to assess clinical knowledge and decision-making. While scheduled break time is built in, the time pressure remains.

To understand the full scope of your specific board exam prep including content areas, format, time limits, and scoring, consult your specialty’s certifying board. Organizations like the American Board of Internal Medicine (ABIM), American Board of Family Medicine (ABFM), American Board of Pediatrics (ABP), and American Board of Surgery (ABS) offer detailed exam blueprints, sample questions, and policy guides that are essential for planning.

The Risks of Delaying Certification

Failing the boards  doesn’t mean you’re not a good doctor—but it can complicate your career trajectory. “Yes, it’s a lot of money, and it may make it harder to convince your employer to support you for another year,” says Dr. Laura Rachal, a quadruple board-certified physician and faculty member at Tulane University. “But it’s better to delay the exam than to sit for it when you’re not ready. Passing on the first attempt is ideal, but you’re allowed multiple attempts. What’s harder to recover from is the psychological impact of failing.”

Many jobs allow a grace period—typically one to two years—to obtain certification, but some hospital systems or state boards may restrict practice without board certification. And after three failed attempts, candidates often face mandatory waiting periods and additional conditions before retesting.

3 Strategies for Medical Board Exam Preparation

Dr. Rachal has helped countless residents and fellows prepare for medical boards, and her philosophy is clear: preparation should be intentional, self-aware, and structured around your actual knowledge gaps. “The recipe for success,” she says, “is knowing what you don’t know. That’s the hardest part.”

Start with Your Weak Spots

Rather than spending hours reinforcing what already feels familiar, Dr. Rachal recommends leveraging in-service training exams to identify weak spots. Start reviewing those early—ideally nine to six months in advance—and build a study plan that revisits them multiple times. And don’t get caught in the trap of perfectionism. “You’re not going to be perfect at your boards. The goal is to identify your weaker areas and gain enough confidence in them,” she says.

Make Time Without Burning Out

Timing matters, but so does consistency. During less demanding rotations, when physicians might be working 40 hours instead of 80, Dr. Rachal encourages them to devote about 20 hours per week to studying—without sacrificing well-being. “You shouldn’t study all your off-hours. Use half that time to study and the other half to do something that makes you human,” she says. “If studying becomes something you hate, you won’t keep doing it.”

Pace Yourself to Protect Your Energy

That balance is especially crucial when burnout is already high across the profession. “Wanting to open a book after an 80-hour week just isn’t realistic,” she adds. “You have to build in time and give yourself space.”

4 Tools and Techniques that Work

Effective study isn’t just about time—it’s about using the right methods. Dr. Rachal emphasizes the importance of aligning your prep with your learning style. Some learners do best with visual aids, others with audio lectures or interactive flashcards.

Match Your Study Format to Your Learning Style

“Using a technique that doesn’t match your learning style is a waste of time,” Dr. Rachal explains. “If you’re an auditory learner, don’t force yourself to sit with dense textbooks. Use audio content. Find what works and stick with it.”

Use the Sandwich Method for Study Momentum

On difficult days, Dr. Rachal leans into what she calls the “sandwich method”: begin with a test questions you like and are confident in, tackle something more challenging next, and finish with another strength. “It builds momentum,” she says. “You leave the study session feeling capable, not defeated.”

Take Practice Exams to Build Endurance

Practice exams are also essential—not just for content review, but to simulate the timing and pressure of the actual test day. Many board prep programs offer question sets organized by specialty, helping you zero in on the areas that need reinforcement.

Simulate Real-World Distractions

Dr. Rachal recommends taking practice tests in a variety of settings to build focus and endurance. Studying in environments with moderate distractions—like a bustling coffee shop—can train you to maintain concentration even when conditions aren’t perfect. Practicing under stress helps build the mental endurance needed for an exam that can stretch across eight to ten hours.

Confidence is the Final Ingredient

Dr. Laura Rachal’s advice to her residents the night before their board exam is simple but powerful: “You’ve trained for this. What you know, you know—and what you don’t know, you’re not going to learn in the next 12 hours. Get a good night’s sleep. Pack a good lunch. And you’ve got this.”

That mindset matters. Confidence isn’t just a feel-good sentiment—it’s an evidence-based asset. As she puts it, “If you’re walking into the test thinking you’re going to fail, you’ve already lost half the battle.”

Plan with Purpose. Prepare with Confidence.

Board exams are challenging—there’s no way around that. But with the right approach, you can turn that challenge into a stepping stone rather than a stumbling block. From knowing what to expect on exam day to creating a study strategy built around your own learning style and bandwidth, every step you take to prepare with intention will help you sit your exam with more confidence and control.

Whether you're six months out or just beginning to plan, you don’t have to figure it out alone. Oakstone’s board prep materials are designed with busy physicians in mind, offering expert-led content in flexible formats to support your success on exam day—and beyond.

Explore Oakstone’s board prep solutions to find the tools that work for your schedule, your specialty, and your study style.