The ACOI Internal Medicine In-Service Examination (ISE) is a web-based assessment exam for residents to assess their progress during training. The exam is developed by a committee of expert physician-authors and is used by residents, program directors, and physicians alike.

The exam is designed to:

  • Give residents an opportunity for self-assessment
  • Provide program directors the opportunity to evaluate their programs
  • Identify growth opportunities and areas in which residents may need additional training or assistance

The 2023 ISE has been updated and the test blueprint/content outline is below. Although the entire assessment is osteopathic in nature, starting in 2023, ACOI has identified the number of questions specifically dedicated to OMM.

Blueprint Topic Count
A (Allergy/Immunology) 13
B (Cardiology) 17
C (Endocrinology) 18
D (Gastroenterology) 19
E (General Medicine) 18
F (Hematology/Oncology) 19
G (Infectious Disease) 15
H (Nephrology) 20
I (Neurology) 9
J (Pulmonary) 20
K (Rheumatology) 19
M (Osteopathic Manipulative Medicine) 13
Grand Total 200











What You Need to Know

ACOI In-Service Exam

The American College of Osteopathic Internists Internal Medicine In-Service Exam (ISE) is a web-based assessment exam for residents to measure their progress mid-year.

About the Exam

The ISE is developed by a committee of expert physician exam writers and is used by residents and program directors (PD). It is modeled after the American Osteopathic Board of Internal Medicine's certification exam. The exam is administered annually at each training site the first Friday in March.

About the 2024 Administration

Programs will have the option for in-person testing, remote proctoring and testing, or a combination of both; using a third-party software (Zoom).

Registration Fees

  • Regular registration – November 1, 2023 – January 30, 2024: $195 per resident;
  • Late registration - After January 31, 2024: additional $30 per resident.

Important dates for the 2024 In-Service Exam

Registration: Registration will open November 1, 2023.

The 2024 ISE will be offered twice on March 1st (7:30 AM – 12:30 PM, and 1:00 PM – 6:00 PM).

The exam is designed to:

  • Give residents an opportunity for self-assessment;
  • Give program directors the opportunity to evaluate their residents and program;
  • Identify areas in which residents need extra assistance before the end of their training year.

Who should take the ISE?

The ISE is designed for residents at the midpoint of their training year. In addition, faculty members, program directors, and other physicians and health care professionals with an interest in internal medicine may take the examination to test their medical knowledge against that of residents or to prepare for the certification exam.

Before the Exam

  • Residents are advised not to study for this exam;
  • Special accommodations for those who need them can be made ahead of time. Residents should alert their program director of any special needs as soon as possible and if approved by the program director, the PD should notify ACOI 3 weeks prior to the exam;
  • A few weeks prior to the testing window, proctors will receive instructions to set up their residents in the system and test technology to ensure everything works before the exam date.

Exam Day

  • The total testing time will be 5 hours.
  • There will be 5 hours devoted to the exam itself, which includes 15-30 minutes for instructions from the proctor;
  • The exam will consist of 200 questions;
  • The exam will cover several specialties as well as general internal medicine.

After the Exam

  • Results will be made available to programs for distribution roughly 5-6 weeks after the exam window;
  • Programs will receive a report that shows the percent of questions correct for each examinee as well as each examinee's percentile rank

Still Have Questions?

For general information about the ISE, contact Kara Kerns –

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