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Date Updated: June 25, 2012

Internal Medicine Advanced Clinical Examination

The Internal Medicine ACE is a web-based examination designed to assist residency program directors in assessing the baseline competency of new residents, and to measure the effectiveness of the fourth year subinternship experience at medical schools. This assessment aids in identifying knowledge gaps early so that instruction may be tailored accordingly. The exam consists mainly of test items that describe clinical situations and require examinees to provide one or more of the following:

  • a diagnosis
  • a prognosis
  • an indication of underlying mechanisms of disease
  • the next step in medical care, including preventive measures

In addition to the traditional multiple-choice, one-best-answer items, the exam includes several sequential item sets that unfold and challenge residents to use their clinical knowledge in problem solving and in managing patients over time. The ACE is delivered using test administration and proctoring software developed by the NBME, and a variety of test delivery environments can be supported. 

Program directors will receive:

  • A scaled score roster
  • A keyword phrase item analysis (if there are at least 10 examinees)
  • Norm data reflecting the performance of 2010 first-year residents and fourth-year students from LCME-accredited medical schools
  • Individual performance profiles identifying areas of strength and weakness

For more information, please email us at: gmeliaison@nbme.org

Content Outlines


"This is potentially a very important tool to enable us to get a better idea of what the weaknesses (and strengths, of course) of our internship class are from the outset."

Residency Program Director,
Internal Medicine

Sample Item

Fourteen hours after admission to the hospital for treatment of severe hypertension, a 32-year-old woman has stridor. On admission, she was given captopril. She appears anxious. Her blood pressure is 140/85 mm Hg, pulse is 140/min, and respirations are 32/min. Examination shows swelling of the lips and tongue. Diffuse stridorous wheezes are heard on auscultation. There is diminished air movement. Which of the following is the most appropriate next step in management?

(A)  Observation only
(B)  Measurement of serum captopril
(C)  Measurement of serum IgE
(D)  X-ray of the chest
(E)  Tracheal intubation


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