Medical Toxicology Cognitive Expertise Exam

Cognitive Expertise Examination

Medical Toxicology–certified physicians must pass Medical Toxicology Cognitive Expertise Examination in years 6-10 of certification to renew their Medical Toxicology certification. The examination is a secure, proctored, comprehensive examination administered in Pearson VUE professional computer-based testing centers across the United States.


Medical Toxicology-certified physicians must meet the eligibility criteria set by their primary board.

Exam Process

Registration and Scheduling

ABP- and ABPM-certified Physicians

  • Physicians who wish to take the MedTox Cognitive Expertise Examination will register through their primary board
  • ABEM notifies physicians when he or she can contact Pearson VUE to schedule an appointment to take the exam

ABEM-certified Physicians

  • Physicians who wish to take the MedTox Cognitive Expertise Examination will register for the exam online via their Personal Page starting in the spring of even-numbered years. There are five steps to the registration process:
    • Select the Medical Toxicology Cognitive Expertise Examination
    • Update medical license information and confirm that your medical license(s) comply with ABEM’s Policy on Medical Licensure
    • Verify that your contact information is correct
    • Pay the fee in U.S. funds
    • Review billing information to make sure it is correct
  • When registration is complete, physicians will see how to schedule an appointment with Pearson VUE to take the examination.

Taking the Exam

The Medical Toxicology Cognitive Expertise Examination is about eight hours in length, with approximately six hours and twenty minutes devoted to actual testing time. This criterion-referenced exam consists of 300 single-best-answer, multiple choice questions, with between 10-15 percent having a pictorial stimulus.

Sample Examination Questions

Content Specifications

The 2012 Core Content of Medical Toxicology forms the basis of each Medical Toxicology examination. The percentage distribution below describes the relative weight given to different content areas of the core content when constructing ABEM examinations.

  • 1.0 Principals of Toxicology: 10%
    • 1.1 - 1.2: 7%
      Includes Pharmacology/Toxicology and Molecular Components/Mechanisms
    • 1.3-1.6: 3%
      Includes Cytotoxic Mechanisms, Principles of Radiation, Mutagenesis and Carcinogenesis, Mechanisms of Reproductive, Developmental Toxicology
  • 2.0 Toxins and Toxicants: 50%
    • 2.1 Drugs: 22%
    • 2.2 Drugs of Abuse: 6%
    • Industrial, Household, and Environmental: 15%
    • 2.3 Toxicants: 5%
    • 2.4 Natural Products: 1%
    • 2.5 Warfare and Terrorism: 1%
    • 2.6 Radiological: 1%
  • 3.0 Clinical Assessment: 10%
  • 4.0 Therapeutics: 10%
  • 5.0 Assessment and Population Health: 10%
  • 6.0 Analytical and Forensic Toxicology: 10%

Passing Criterion and Scoring

The Medical Toxicology Cognitive Expertise Exam is criterion referenced. A criterion-referenced exam uses a predetermined standard, against which all candidates are evaluated. All candidates meeting the standard will pass the exam. Quotas or required percentages of candidates passing are not used to determine the passing score.

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 ABEM quality standards are not used in determining candidates’ final scores.

Your final score on the Medical Toxicology Cognitive Expertise Exam will be determined by first adding together the number of scored questions you answered correctly. This number-correct score will be used to determine your final score, which will range from 0 to 100.

The passing standard for the Medical Toxicology Cognitive Expertise Examination is a score of 70 or higher.

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 participating physicians to thoroughly understand the Core Content. The panelists then evaluate each test question and assess how a candidate who meets the standard would perform. The panel then recommends a passing standard (score) to the Medical Toxicology Subboard. The Subboard weighs this recommendation and uses it to determine a final passing score.


Physicians will receive the results of their Medical Toxicology Cognitive Expertise Examination from their home board.

Dates and Fees

  • Medical Toxicology Cognitive Expertise Examination