The American Board of Pediatrics ITE & Board Certifying Exam

By Loren Deutsch

The ABP Annual In-Training Exam (ITE) is a 3-hour exam with approximately 150 multiple-choice questions with a single-best answer and no scheduled breaks. Although first-year residents generally begin residency training on July 1, most start orientation and onboarding in mid-to-late June. This means that Pediatric residents have to get a jump on ITE preparation because the annual exam is scheduled over two weeks beginning in early to mid-July. This seems unfair to first-year Pediatric residents, but it also provides a great opportunity to identify and begin learning the ABP content.

The annual ITE and the Initial Certifying Exam share the same content outline, and the ITE is a condensed version of the General Board Exam. Both exams assess knowledge of content from 24 domains, such as Fetal and Neonatal Care, Ethics, and Patient Safety, and four universal physician tasks. All questions have a single best answer. For more information about the content on the annual ITE, click the outline.  

• The ABP Initial Certifying Exam is a 7-hour exam and contains four sections, each with 82-88 questions, for a total of approximately 330-350 multiple-choice questions. There is a total of 1.50 hours for scheduled breaks: a 15-minute break after section one, a 60-minute break after section two, and a 15-minute break after section 3. In 2026, this annual board-certifying exam is scheduled over 3 days between October 13 and October 15.

Because of the shared content outline between the annual ITE and the Initial Certifying Exam, I would recommend a similar plan for both exams based on an integrative approach with a weekly workflow for test preparation. The approach comprises interconnected components that provide a roadmap for test preparation through recall practice, spaced repetition, self-reflective strategies, and progress tracking. This weekly workflow prioritizes the highest-yield content first, though an alternative is to prioritize the content based on your work schedule. Either way, the following provides a no-frills example starting with the first three weeks of test preparation.

Disclaimer: The example below does not contain instructions or self-reflective strategies, and it is not individualized to a specific resident or attending. Instead, the example is intended as a framework to understand the key components of a weekly workflow. All practice questions are completed in timed and test mode. Review and redo the incorrect answers from practice blocks of questions targeted to one topic when achievement is below 70%. The new achievement goal for redo blocks is 80% or above.

The ABP offers three exams: the Annual In-Training Exam (ITE), the Initial Certifying Exam, and, every other year, the Subspecialty Certifying Exams.

Since the early 1970s, the American Board of Pediatrics (ABP) has assessed general pediatric knowledge of residents; strengths and relative weaknesses, progress from year to year, and a performance comparison among trainees in the United States and Canada. 

• The ITE is a 3-hour exam and includes approximately 150 multiple-choice questions with no scheduled breaks.
• The Initial Certifying Exam is a 7-hour exam and contains four sections, each with 82-88 questions, for a total of approximately 330-350 multiple-choice questions. There is a total of 1.50 hours for scheduled breaks: a 15-minute break after section one, a 60-minute break after section two, and a 15-minute break after section 3.
• The Subspecialty Exams are 5-hour exams and contain two sections, each with approximately 100 questions, for a total of approximately 200 multiple-choice questions. There is an optional 30-minute break between the two sections and a 15-minute survey at the end of the exam.

In 2026, the Subspecialty Exams are scheduled in the summer and fall, and in 2027, they are scheduled for the spring. Click subspecialty exams for the complete exam schedule.

Sample Week 1

• Complete a half-length comprehensive pretest (100Qs) to establish a baseline from which to measure progress.
• Use an error analysis to clarify reasons for content and process errors.

 Sample Week 2

• Do 1-2 blocks (15-20Qs per block) x 3 days. Each block is targeted to Clinical Subspecialties content or to Critical Care (the highest-yield topic within Clinical Subspecialties).
• Review incorrectly answered questions from completed targeted blocks.
• Redo the same incorrectly answered questions.
• Do 1 block x 1 day (30Qs) of used targeted questions (correct/incorrect). This practice block is referred to as a maintenance block and provides spaced repetition.
• Do a quarter-length comprehensive assessment (50Qs) to assess progress.

Sample Week 3

• Do 1-2 blocks (15-20Qs per block) x 3 days. Depending on progress, each block is targeted to Clinical Subspecialties content (or Critical Care) unless completed at 75% accuracy or above. If so, continue with unused Clinical Subspecialties content or the next highest-yield subtopic, Painful Disease States.
• Review incorrectly answered questions from completed targeted blocks.
• Redo the same incorrectly answered questions.
• Do 1 block x 1 day (30Qs) of used targeted questions (correct/incorrect). This practice block is referred to as a maintenance block and provides spaced repetition.
• Do a quarter-length comprehensive assessment (50Qs) to assess progress.

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