For nearly all medical specialties, maintenance of certification is a reality that can produce significant anxiety not to mention some non-insignificant financial outlays. The American Board of Family Medicine was one of the first specialty boards to mandate maintenance of certification (MOC) and it has become a big business for the specialty boards. This has come with a significant degree of controversy especially for the American Board of Internal Medicine whose maintenance of certification process was deemed to be too onerous and expensive without evidence of significant benefit. The ABIM responded by changing the requirements in recent weeks to appease its members.  At iMedicalApps, We have reviewed several family medicine board review apps in the past.

The maintenance of certification process allows for periodic examination of a specialty board’s members. In family medicine, this is typically 7-10 years between certification exams. When the time comes to take or retake the certification exam, family physicians currently have a multitude of options for board review.

Options currently available include: materials completed the during MOC process (Self-Assessment Modules (SAMs), CME quizzes available through the American Academy of Family Physicians (AAFP) including those in their journal, The American Family Physician), attend a board review course offered by state or national family medicine organizations, purchase a CD-ROM of questions from various medical and educational organizations, practice for the exam using the official ABFM app or review questions from board review books (such as Swanson’s) or other apps.

The options are nearly limitless, but few have been studied or proven to improve success on the certification exam. In fact, the ABFM discourages the use of preparing for the exam by studying questions alone. They regularly report outcomes on the exam at the annual Program Directors Workshop and state time and again that those who only prepare via completing board review questions do worse than those who have a robust reading program as part of their preparation plan.

One of the more recent entries into the board review arena is the NEJM’s Knowledge Plus for Family Medicine. This is also available for Internal Medicine. I was given access to both for the purposes of this review but will focus on the Family Medicine app. The NEJM has been continuously published since January 1812. It has a much deserved reputation as the most prestigious medical journal in the world.

More recently, the NEJM has expanded its educational opportunities to include their popular NEJM Journal Watch to their Case of the Week, Image Quiz, etc. They have even created a number of excellent apps of their journal (one of the first to offer their journal on mobile devices), image quiz challenger, etc. We have reviewed a number of these outstanding offerings in iMedicalApps over the years.

My first attempts to use the apps on my iPad and iPhone came with some trouble. The issue is that subscribers must first sign up online and complete registration submitting key user information (your specialty for example) before you can download and use the apps. For less clear reasons, you must also complete setup of the app on the iPad before you can use the iPhone version.

I had no trouble setting up the Internal Medicine versions once my account was created by the excellent NEJM customer support. The internal medicine apps “just worked.” The Family Medicine app finally started to work on the iPad, but remained “stuck” half-downloaded on my iPhone 6 for unknown reasons for about a day and half before the issue remedied itself.

70427-IMG_1573  70427-IMG_0066

Once you are set-up and fully registered with the web versions of NEJM Knowledge Plus, you can log into the iPad and iPhone apps with the same username/password. The product forces you to set up a study plan. The app “knows” the dates of the upcoming ABFM certification exams and allows you to select when you plan to take the exam. Then it asks you how long you plan to study each week—even suggesting what it thinks would be ideal (about 10 hours by default). I found this “individual learning plan” outstanding and not dissimilar to what we sometimes create for our residents who need a structured reading plan.

70427-IMG_0065  70427-IMG_0068

The app’s main screen is the Dashboard where you can see your progress across the different subsections of the specialty of Family Medicine and is divided into categories exactly matching those on the ABFM exam. It also shows a section where you can choose multiple practice exams and a Recharge section where you can quickly take a knowledge assessment across multiple categories. The app is a bit easier to follow on the iPhone due to screen size differences, but it still worked remarkably well on the small screen.

70427-IMG_0062  70427-IMG_0067


Clicking on a subject category such as Ambulatory Care brings up another interesting feature of the NEJM Knowledge Plus system—the ability to rate your own “pre-test” confidence about the category and subcategories.


Clicking “Continue” brings you to the 1st in a series of seemingly endless questions in each category. A progress bar at the top shows your progress in each section. The questions include straight multiple choice, brief case based questions and multi-media questions with X-ray’s, EKG’s, photos, etc. Before the app reveals the correct answer, it asks you to state how confident you are about your answer. This is another very unique feature of the NEJM app compared to standard question banks. It would be nice to disable this feature though for those who just want to more rapidly review questions. The app tracks your correct/incorrect response and displays your mastery (or lack thereof) of the material on the Dashboard.