Learning to succeed in the FMCLA and new 5-year cycle

When things happen in the world of family medicine, I get calls about them. As the chief medical officer here at the AAFP, it’s part of the job.

One of those new things in family medicine is how physicians get certified, which is changing this year. Two main shifts are at the core of the discussion. If you are due to take your recertification this year, instead of the one-day exam you will take the FMCLA (Family Medicine Certification Longitudinal Assessment). Second, the cycle has shortened from 10 years to five years.

Combined, this is a large change for lots of family physicians, especially those like me who hadn’t ever taken the longitudinal assessment and preferred the one-day exam. It’s a change that has snuck up on many, including me. So, when I got calls from members about these changes, I didn’t have the answers that I wanted to have.

Fortunately, 2025 marked the first year of my new certification cycle, opening the door for me to get firsthand experience in the first cohort of family physicians in the five-year cycle. And since I also hadn’t done the FMCLA, it provided an opportunity for me to try out a new way of doing things.

Staying on top of it all

If you had asked me months ago, “Margot, what are you nervous about going into your board review year?” I would not have mentioned the FMCLA or the five-year transition. Neither was on my radar screen. This makes me laugh because if anybody should have known what was coming our way, it should have been me. After all, I meet with the ABFM on behalf of our members every quarter. Somehow, as I was hearing about the discussions going on, it simply never clicked that the changes were happening to me!

Chagrined, I look back through all the emails the ABFM sent and even the great videos on their website explaining the changes, and realize I simply missed the big picture.

My first takeaway: Don’t beat yourself up about missing information. Life happens. For the first time ever, I completed all my maintenance of certification requirements before Christmas. I was so busy celebrating checking off my MOC credits and making sure I had enough CME that I was not yet thinking about the examination itself. The reality is that the ABFM organized everything I needed in my portfolio. So while I may have been surprised that I wasn’t picking an exam date for April, what I needed to do next was pretty clear.

Learning to love (or at least tolerate) the FMCLA

The FMCLA has been available to family physicians for several years now, but I had no plans to enroll in it. I’m not the best test-taker and, to be transparent, board certification gives me a wicked case of nerves. I also have a general fondness for crossing items off my to-do list and then not having to think about them again. A one-day exam seemed like my clear preference.

Just thinking about FMCLA had me in my feelings. When am I going to find time to do questions every quarter? Will I forget I didn’t do them? How do I even study for a perpetual exam? Will I have to live with test anxiety in perpetuity? I felt nervous about the change, unsure about the next steps and frustrated at myself for having a better plan. Another important takeaway: It is OK to feel your feelings. Our feelings are valid. Acknowledging how I was feeling gave me the space to calm my nerves about failing the exam and allowed me to refocus on creating a pathway for my own individual learning journey.

The new cycle does a great job at putting you into a continuous learning spirit. The longitudinal assessment helps you to identify where you have some knowledge gaps, so you can really lean into thinking about how you can grow and then connects you to some resources. Combined with halving the cycle time for recertification, it means that your patients don’t have to wait a decade for you to learn a better way of doing something. What you learn today can benefit the patients you help tomorrow, which is wonderful. It also has me holding myself more accountable to that stack of American Family Physician (AFP) issues I’ve been meaning to read!

What it’s like taking the longitudinal assessment

The good news about the longitudinal assessment is that its questions are just like the exam test questions. You will still cover the same breath and depth as the one-day exam, but spread out over time. That shift presented me with a new challenge: How am I supposed to study now?

My usual board prep routine was a six-month combination of a board review course, question banks and reading AFP issues. Practice exams helped me identify what I was struggling to retain and then I focused on closing those gaps. Since the whole blueprint was getting tested on that one day, it was pretty straightforward what I needed to study.

With the longitudinal assessment, you get 25 questions per quarter but don’t know where those questions will come from in the blueprint. Imagine taking the exam but getting the questions in a random order and stretched out over a long period of time—that’s what the longitudinal exam is like.

How do you study for such an exam? There are a lot of ways to do so, and that’s why it is so important to be open to trial and error as it pertains to your learning style. Do you take all 25 questions at one time? Do you do one question every day or two? What are your study methods?

One of the most surprising things about the longitudinal assessment is how well it reflects the real-life situation of knowing most of what is going on but needing to check on that one last thing to be sure. If you’re in the middle of an office visit, chances are at some point you’ll need to look something up in the process. You won’t need to just look up sources; you’ll need to properly interpret and apply them to the patient’s situation to get the best out of that interaction.

The ability to strengthen our information mastery and application by using the open-book format for FMCLA is intentional and by design. In the assessment, you can use the internet or books to help you within the five-minute time limit for each question. You are not permitted to put the exam question into an AI search engine and will have to attest that you are not doing so. The longitudinal assessment can help you identify and shore up knowledge gaps, while also supporting the development of information-searching methods that can help you with your next patient in real time.

My tips for those entering the new ABFM cycle

After going through a couple of cycles of the longitudinal assessment with the five-year cycle, I’ve learned some firsthand tips that might be of use to anyone else in my situation.

First, it’s important to keep the longitudinal assessment in the right context. It is still possible to take the one-day exam if you want. Since you won’t take it until the fourth year anyway, FMCLA can offer you a longitudinal study plan leading into the exam. ABFM provides progress reports you can use to identify where you need additional education. In other words, the longitudinal assessment is low risk with no real penalty.

Be intentional about how you want to experience the assessment. I found that having a computer with two screens, having a stable Wi-Fi connection and already having my web browser open to Google so I could search AFP was super helpful. I thought I would prefer doing the questions after work, but it turned out Saturday morning was a better fit for me. I also found that spreading the questions out over several weekends was stressful, so now I pick one morning and knock them out at once with a break when needed. I have heard from colleagues that they take their questions on the train ride home, at the soccer game from the stands and even from the hot tub! The important thing is to flex to what works best for you.

ABFM exam resources

Resources still matter. Thankfully, the AAFP has a variety of options available to support us.

The American Family Physician journal is an incredibly powerful tool because it intentionally covers so much content from the exam blueprint. I find it incredibly helpful both during the assessment and after when I need to read up on items I missed.

Board Review courses can also help you brush up on everything that’s covered in the exam. Some family docs are taking the live course in their first year of FMCLA to get a refresher or as a catch-up if they find they need to take the one-day exam. Others are using the on-demand course to dive deeper into the topics where they find they are struggling from the immediate results each quarter.

There is no right way to prepare, and you can adjust as you progress along your own journey. And it is indeed a journey! Just this month I realized that while I’ve been focusing on the FMCLA process, I lost track of the ongoing maintenance of certification requirements!  Now I’m thinking about how to best balance the two going forward. I am grateful none of us will have to travel this journey alone. While I didn’t have FMCLA or the five-year cycle on my 2025 bingo card, it’s looking like the change might just be what I needed in the long run.