Medical Toxicology

Dates and Fees

  • Medical Toxicology Certification Examination

Medical toxicologists specialize in the preventing, evaluating, treating, and monitoring an injury or illness from toxic exposure. Physicians attain subspecialty certification in Medical Toxicology by meeting the eligibility criteria, fulfilling specific credential requirements of their primary board, and successfully completing the Medical Toxicology subspecialty certification examination.

The American Board of Pediatrics (ABP) and the American Board of Preventive Medicine (ABPM), and ABEM offer subspecialty certification in Medical Toxicology. ABEM is responsible for examination development, administration, scoring, and analysis. Each sponsoring board is responsible for credentialing its respective candidates and notifying them of their examination results.

Each sponsoring board appoints members to the jointly sponsored Medical Toxicology Subboard. There are four members from ABEM, two from ABP, and two members from ABPM. The primary functions of the Subboard are to develop examinations in Medical Toxicology and credential individuals at the request of individual sponsoring boards.


Physicians seeking Medical Toxicology certification must:

  1. Be certified by an American Board of Medical Specialties (ABMS) Member Board or the American Osteopathic Board of Emergency Medicine (AOBEM)
  2. Successfully complete fellowship training as specified in the eligibility criteria
  3. Apply through their home board, whether ABEM, ABP, or ABPM
  4. Be actively participating in their primary Board MOC program
  5. Fulfill the ABEM Policy on Medical Licensure
  6. Comply with the ABEM Policy on Board Eligibility for Subspecialty Certification

Exam Process

The Medical Toxicology Certification Examination is offered every other year, in even numbered years.


To apply, physicians must complete the current year’s application. In January of each even-numbered year, fellowship programs will receive application forms for their fellows. ABEM-certified physicians and candidates who have completed a two-year, ACGME-accredited Medical Toxicology fellowship may also request an application form by contacting ABEM.

ABEM encourages physicians to submit applications well before the deadline and mail them using a method that provides confirmation of delivery. The following must be submitted for an application to be complete:

  • Completed, signed, and notarized current-year Medical Toxicology certification application form
  • Application fee in U.S. funds

The application fee covers the cost of processing the application only and cannot be refunded under any circumstances.

ABEM recommends physicians retain a copy of each form and supporting document submitted. Applications and related information become property of ABEM, and submitted documentation will not be returned.

A final review of an application will be completed when all information is received. Applications that are incomplete will be closed April 1 of the following year. Physicians with closed applications must submit new applications if they wish to apply. They must meet all requirements in place at the time the new application is submitted. ABEM mails notification regarding whether the physician's application has been approved.


Physicians who apply through ABEM and have approved applications will receive information about how to register for the exam and schedule an appointment at a Pearson VUE testing center.

Physicians who apply through the ABP and ABPM will be registered by ABEM and notified when they can schedule an appointment to take the examination.

Taking the Exam

The Medical Toxicology Certification Examination is approximately eight hours, with six hours and twenty minutes devoted to actual testing time. This criterion-referenced exam has 300, single-best-answer, multiple choice questions, and 10-15 percent of questions will have a pictorial stimulus. The examination is administered at over 200 Pearson VUE professional computer-based testing centers throughout the United States.

All candidates achieving a final score of 72 or greater will pass the examination.

Sample Exam Questions

Content Specifications

The 2021 Core Content of Medical Toxicology is the basis for all Medical Toxicology examination content.
Core Content of Medical Toxicology

It is published in the Journal of Medical Toxicology. Hendrickson RG, Bania TC, Baum CR, Greenberg MI, Joldersma KB, Keehbauch JN. The 2021 core content of medical toxicology. J Med Toxicol 2021 Jun 29. doi: 10.1007/s13181-021-00844-5. Online ahead of print.

Exam Question Distribution


Principles of Toxicology (1.0)


Principles of Pharmacology/Toxicology (1.1)
Principles of Molecular Components/Mechanisms (1.2)


Principles of Radiation (1.3)
Mutagenesis and Carcinogenesis (1.4)
Principles of Epigenetics (1.5)
Mechanisms of Reproductive and Developmental Toxicology (1.6)


Toxicants and Toxins (2.0)


Medications and Drugs (2.1)


Household Items (2.2)


Supplements (2.3)
Food Poisoning (2.4)
Fungi (2.5)
Plants (2.6)
Envenomations (2.7)


Agents of Warfare/Terrorism (2.8)


Radiological (2.9)


Clinical Assessment (3.0)


Therapeutics (4.0)


Assessment and Population Health (5.0)


Analytical and Forensic Toxicology and Workplace
Drug Testing (6.0)


Environmental Toxicology (7.0)
Addiction Toxicology and Substance Use (8.0)
Occupational Toxicology (9.0)

Passing Criterion and Scoring

The Medical Toxicology Certification Exam is criterion referenced. A criterion-referenced exam uses a predetermined passing score, which is adopted by the Subboard as reflecting its performance standards (The Core Content of Medical Toxicology). All candidates meeting the standard will pass the exam. Quotas or required percentages of candidates passing are not used to determine the passing score.

The score on the exam is a scaled score that ranges from 0 to 100 and does not include field test items. In addition to the field-testing process, each question receives a thorough review before it is used in scoring the examination. Questions that do not meet Subboard’s quality standards are not used in determining candidates’ final scores.

Determining a Passing Score

Best practice in testing suggests that the passing score for an examination be substantially connected to the content and performance standards defined by The Core Content of Medical Toxicology.

In order to maintain this connection, the passing score is typically reviewed every five to seven years, or when the format or content of the exam changes significantly (such as when the Core Content is revised). The process involves a representative panel of clinically active, Medical Toxicology–certified physicians who are trained in a process called “standard setting.” This process requires the participating physicians to thoroughly understand The Core Content of Medical Toxicology. The panelists then evaluate each test question and assess how a candidate who meets the Subboard’s standard would perform. The panel then recommends a passing standard (score) to the Subboard, which weighs this recommendation and uses it to determine a final passing score. Because the content of the 2022 exams will change (based on the 2021 Core Content), the passing standard of the Medical Toxicology Certification Examination will be examined in 2022 to determine a passing score.

2020 Medical Toxicology Certification Examination Scoring FAQs


ABEM sends candidates the results of their examination in writing within 90 days of the date of the examination. Results are also posted on candidates' ABEM Personal Page.