The ABPMR supports the Americans with Disabilities Act and makes reasonable accommodations in examination procedures for individuals with documented disabilities. Refer to the ABPMR Policy on Requesting Accommodations under the ADA and the Application for Accommodations Form.
Next Part II Exam
The Part II Examination is designed to test how well a candidate applies their medical knowledge to real-life patient scenarios (vignettes).
Candidates are evaluated on the competencies taught in residency training, including data acquisition, problem solving, patient management, systems-based practice, and interpersonal and communication skills. These competencies comprise the examination domains A-E.
Each domain is administered and scored independently—how a candidate performs in Domain A has no bearing on their score for Domain B, for example. As candidates move through each vignette, examiners will provide all of the information necessary to answer the questions within the current domain only.
Domain A: Data Acquisition
This domain is used to evaluate the acquisition of data that is critical to the provision of quality patient care. The appropriateness of the critical data identified by the candidate should be reflected in this rating. The components of this domain include:
- patient history
- physical examination components
- functional evaluation
- response to psychosocial aspects of illness and functional limitations
This domain addresses the following question: Did the candidate identify the appropriate data required to correctly diagnose and manage the patient?
Domain B: Problem Solving
This domain addresses the appropriateness of the candidate’s organization of data collection activities in relation to patient management decisions. The components of this domain include:
- integration of medical knowledge with clinical data
- prioritization of rehabilitation goals and medical issues/formulation of management plan
- generation of a differential diagnosis
- use of evidence-based medicine
- application of research and statistical methods
- use of information technology
This domain addresses the following question: Did the candidate, in an appropriately organized manner, collect data to select among reasonable alternative diagnoses while ensuring patient stabilization and anticipating future problems or support requirements?
Domain C: Patient Management
This domain addresses patient treatment decisions and the sequence of management actions. The components of this domain include:
- medication prescriptions
- exercise and modality prescriptions
- durable medical equipment prescriptions
- therapeutic and diagnostic injections
- use of evidence-based medicine
- comprehensive therapeutic care plan including patient monitoring and followup
- promotion of health and function and prevention of disease and injury
- management of complex medical problems
This domain addresses the following question: Did the candidate treat or direct the appropriate treatment(s) at the appropriate times? Did the candidate efficiently arrive at an informed and appropriate management plan?
Domain D: Systems-Based Practice
This domain addresses the candidate’s ability to operate within the healthcare system to supplement patient management. The components of this domain include:
- knowledge of practice and delivery systems
- evaluation of risks, benefits, limitations, and costs of available resources
- resource use/justification
- healthcare referrals
- team management
This domain addresses the following question: Did the treatment plan include proper referral of the patient at an appropriate time? Did the candidate properly take risks and benefits into account when formulating a plan of care?
Domain E: Interpersonal and Communication Skills
This domain rates the demonstrated concern, knowledge, and skill of the candidate in dealing with the patient’s questions and concerns, as well as with the concerns of the patient’s family. The components of this domain include:
- communication skills with patients, families, and health professionals
- listening skills
- demonstration of compassion, sensitivity, and respect for patients, families, and colleagues
- sensitivity to diversity issues
This domain addresses the following question: Is the candidate able to provide appropriate explanations and respond ethically and sensitively to the patient and/or the patient’s family? Can the candidate communicate effectively and ethically with consultants and hospital support staff as well as other interested parties?
The Oral Exam
Examination sessions are scheduled throughout each administration, approximately three hours apart. Each candidate will complete two 50-minute examination sessions separated by a short break. From the check-in process through both examination sessions, candidates should plan on a total of 2½ to 3 hours for the examination.
The Part II Examination consists of:
- Two 50-minute examination sessions with a 10-minute break in between
Each 50-minute exam session consists of:
- Two Part II examiners
- Four patient vignettes
Over the course of the 110 minutes, candidates will encounter four examiners and manage eight patient vignettes.
Examiners will begin each vignette by presenting a clinical case description and then ask the candidate questions about that case. As the examiners lead the candidate through all five domains (see descriptions above), they will provide additional details regarding evaluation, diagnosis, and treatment. The information needed to answer each domain’s question(s) will be provided within that domain.
The vignettes are designed to provide an opportunity for the candidate to demonstrate application of knowledge to a patient scenario, including clinical skills, communication and interpersonal skills, and systems knowledge. Vignettes are structured specifically for the Part II Examination and are not intended to replicate all aspects of an actual case seen in practice.
Examiners and Examiner Conflicts
All ABPMR Part II examiners complete thorough training before administering the Part II Examination. Each examination session includes two examiners assessing a single candidate’s performance, which helps to promote score reliability.
Before the scheduling process, examiners review a list of Part II Examination candidates to ensure they are not paired with a candidate familiar to them. If candidates recognize an examiner or have any other conflict of interest concerns at the start of an exam session, they should immediately notify the proctor observing the exam.
The two examiners in each exam session will take turns leading the candidate through the four patient vignettes in the 50 minutes allotted. It is the examiners’ responsibility to watch the time and move candidates through the vignettes; candidates should not worry about keeping time.
Although examiners administer the vignettes individually, both examiners in each session will evaluate the candidate on all four vignettes. Examiners may take notes throughout the session on all vignettes in order to formulate an evaluation. Candidates should remember that all four of their examiners are working independently of the others; no examiner knows how a candidate scored in another session or how their partner examiner is scoring the candidate in the same session.
All examination sessions are recorded for quality assurance and exam security.
Candidates should remember that the Part II Examination is an evaluation, not an educational experience. Examiners are instructed to not give feedback to candidates during or after the examination.
Part II Examination Performance FAQ
Because the Part II Examination is an interactive process, we recommend that candidates practice patient scenarios with a mentor or study partner, taking a case through all five domains of the examination, to prepare for the exam. For more preparation tips, check out our Preparation Tips sheet or the Test-taking tips on our Exam Day page.
What are examiners looking for?
The Part I Examination is a test of your medical knowledge. The Part II Examination is a test of how well you can apply your medical knowledge and other skills to patient care—because providing good PM&R care goes beyond medical knowledge.
For example, you may know the etiology of ankylosing spondylitis, but how well do you target exactly which data and testing you need to make a diagnosis, including a differential? What tools do you use when a patient asks for an out-of-network referral? How do you respond to the patient’s family when they’re concerned about future complications?
The Domain descriptions above provide good information about the different elements examiners are looking for as you move through the case and manage your patient. Just keep in mind that this exam brings together all parts of your training—your knowledge and skills, but also your empathy and ability to work in a system—and evaluates how well you apply them to your patients, including the thought process behind your decisions.
If I miss an important response in Domain A, will that affect me later in the vignette?
No. Missing something in one domain may affect your performance within that domain, but all domains are scored independently and you will be given all the information you need within each domain to answer that domain’s questions.
For example, if you miss an important aspect of the physical exam in Domain A, it may negatively impact your performance in that domain. However, at the start of Domain B, the examiner will give you the relevant patient history and physical exam findings that you need for the differential diagnosis and next steps in patient management. Your performance in Domain A doesn’t carry forward to Domain B, and the examiner will give you all the information you need as you move through the case.
What to Expect on Exam Day
After applying for the Part II Examination, it's time to start preparing.
Click the link below for more information on preparation and the logistics of exam day.
Administrative Policies for Part II
The ABPMR’s administrative policies govern and protect our certification examinations. The policies related to the Part II Examination are listed and linked below.
Accommodations for Persons with Disabilities
The ABPMR has the right to halt your session and remove you from the examination because of disruptive or unprofessional behavior. If you are removed from an examination because of disruptive behavior, no refund of fees will be available.
It is your responsibility to sign into your examination session 30 minutes early as instructed. The ABPMR cannot alter its administration of the examination for candidates who do not arrive in a timely manner. A process is in place and accommodations will be made for demonstrated technical issues, but candidates are also responsible for completing the pre-checks of equipment and internet before their exam sessions. Any candidate who is not available at the start of the check-in process will not be permitted to take the Part II Examination, and make-up examinations will not be available to late or missing candidates.
Irregularity, Nondisclosure, Cooperation
All candidates are required to sign the ABPMR Examination Irregularity Policy, Nondisclosure Policy, and Cooperation Agreement as part of the application process prior to their scheduled examination and are required to adhere to those policies before, during, and after the exam.
The ABPMR reserves the right to conduct and report research studies of its examinations and its examination data for the purposes of quality assurance, examination development, and benefit to the specialty. Individual candidate confidentiality will not be violated or compromised in these efforts.
Medical Licensure Policy
Applicants are required to possess a current, valid, and unrestricted license to practice medicine in at least one jurisdiction in the United States, its territories, or Canada. Evidence of unrestricted licensure in the state or states in which the physician practices will be required prior to issuance of the certificate.
If any license currently held by the candidate is restricted or qualified in any way, the applicant must provide full details of the restriction or qualification. The ABPMR may, in its sole discretion, determine whether to investigate any questions relating to the applicant’s licensure status. The ABPMR reserves the right to approve or deny the application after review. Read the complete ABPMR Licensure Policy for more information.
Part II Examination Appeal Policy
Exam Dates & Fees
Application Deadlines & Fees
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