The American Board of Internal Medicine (ABIM) Longitudinal Knowledge Assessment (LKA) is a modern approach to maintaining certification for internal medicine physicians.

The ABIM LKA is a five-year cycle exam where internal medicine physicians answer questions on a quarterly basis. This exam is designed to provide ongoing feedback about performance and uses the same ABIM MOC exam blueprint as the traditional exam.

Over the five-year period, a total of 600 questions are posed, with the opportunity to skip up to 100 questions.

You should begin the 5-year LKA cycle in the year that you're due for an assessment.

Each quarter, the ABIM will add 30 questions to your Physician Portal.

Over the 5-year assessment period, the ABIM will send you 600 questions. You can skip up to 100 questions.

Physicians have four minutes to answer each question, so you need to be efficient and focused during the assessment.

Participants have a 30-minute time bank each year that can be used to extend the time for any question in one-minute increments. 

The most significant difference between the LKA and the traditional 10-year exam is its structure. Instead of a single high-stakes exam taken every decade, the LKA spreads the assessment over five years. Physicians answer 30 questions per quarter, totaling 120 questions annually and 600 questions over the entire cycle. This format allows for more frequent engagement with the material, helping physicians stay current in their field.

Another critical difference is the LKA’s focus on feedback. After each question, physicians receive immediate feedback, including whether they answered correctly, the rationale behind the correct answer, and references for further reading. This continuous feedback loop helps identify knowledge gaps and reinforce learning, making the LKA not just an assessment tool but also an educational resource.

Additional nuances:

• Length of testing time. The LKA is a 5-year-long exam where you're answering questions each quarter. The traditional MOC exam is one 10-hour day.
• Testing location. The traditional MOC exam requires you to be in a testing center. The LKA is not proctored, and you can answer questions from any internet-connected device.
• How often you need to re-take the exam. The traditional MOC exam is taken every 10 years. The LKA is taken every 5 years, and your certification remains active throughout the 5 year period. Both exam options allow you to maintain your certification for 10 years.
• Cost. One big difference between the traditional ABIM MOC exam and the ABIM LKA is the cost. The traditional MOC exam carries a separate fee, while the LKA cost is covered by your MOC fees.

For the most part, Internists we've talked to who've taken the ABIM LKA have been really happy with their testing experience. Overall feedback is that the questions are very related to their actual practice. They like that it's a lower-stress 10-year option, but feel like the testing cycle is drawn-out and the material still covers a huge amount of information (the entire ABIM MOC exam blueprint).