What Are Dimension 1 and Dimension 2 on the ABPN Exam, and How Do They Affect Exam Preparation?

Last updated on September 30th, 2024

Here’s a representative question I received from a colleague preparing for the ABPN exam.

“What exactly do we study for Dimension 2? Is it just interwoven into all the other topics? There are a bunch of extra topics that don’t seem to be assigned to any specific topic tested on. Would some of it be those?”

Let me briefly present Dimension 1 to set the context. For example, Dimension 1 on the ABPN exam fo Psychiatry Certification lists 24 topics.

• 19 topics are the categories of DSM psychiatric disorders, such as depressive disorders, paraphilic disorders, neurocognitive disorders, and all the other DSM-5-TR categories. In total, this entire group of psychiatric disorders accounts for approximately 84% (with a possible range of 80-89%) of the exam total.
• 1 topic is Neurologic disorders and, as such, includes neurologic disorders not listed in the DSM, meaning disorders beyond neurocognitive disorders and delirium. Instead, they include the entire range of other neurological disorders, such as headaches, seizure disorders, movement disorders, demyelinating disorders, and others. Together these neurological disorders account for 4-6% of the exam total.
• 1 topic is Other conditions that may be a focus of clinical attention.” These DSM-listed conditions (that are not psychiatric disorders) include the category of “medication-induced movement disorders and other adverse effects of medications” and the category of “other conditions that may be a focus of clinical attention.” This latter category includes suicidal behavior, abuse and neglect, relational problems, educational/occupational/housing/economic problems, problems related to the legal and health care systems, and various personal/psychosocial/environmental circumstances. This entire Dimension 1 topic accounts for 1-3% of the exam total.
• 1 topic is Developmental processes and development through the life cycle and accounts for 4-6% of the exam total.
• 1 topic is Forensic psychiatry, and accounts for 1-2% of the exam total.
• 1 topic is Dimension 2 topics without a corresponding Dimension 1 topic and account for 3-5% of the exam total.

Now let me present the Dimension 2 list of topics, and I’ll then describe how they relate to Dimension 1 topics.

As you can see, the Dimension 2 lists 9 categories of ABPN exam questions (and their range of percentages) that the ABPN calls ‘cross-cutting’ topics because each of them applies to each Dimension 1 listed psychiatric disorder.

In Dimension 1, we know that one psychiatric disorder category is “depressive disorders.” You might, for instance, ask yourself, “How will depressive disorders be tested?” and “What do I need to know about them?”

Dimension 2 answers the above questions by providing the subcategories of exam questions tied to each disorder. For example, what jumps out from the table above is that there are 4 cross-cutting Dimension 2 categories that account for a large percentage of questions on each psychiatric disorder. They are:

1. Neuroscience and mechanisms of disease
2. Clinical aspects of psychiatric and neuropsychiatric disorders
3. Treatment
4. Diagnostic procedures.

All told, these 4 cross-cutting topics on psychiatric disorders account for approximately 80% of all the exam questions tied to psychiatric disorders, which you may recall, themselves account for approximately 84% of total exam questions. If we multiply 0.84 x 0.8 we get 0.67 or 67% of total exam questions are on these 4 aspects of psychiatric disorders.

Dimension 2 lists another 5 cross-cutting topics which, as you can see above table, each account for a small total percentage of exam questions. Irrespective of this fact, you may still feel confused on how they relate to Dimension 1 topics. The answer is that (for the most part) they, too, cross-cut with psychiatric disorders.

For example, exam questions on neurocognitive disorder due to Alzheimer’s disease are going to mostly focus on its “big 4” crossing-cutting topics: 1) relevant neuroscience and mechanisms of disease, 2) clinical aspects, 3) how it’s diagnostically evaluated and 4) how it’s treated and managed.

But notice too that some exam questions on NCD due to Alzheimer’s disease can focus on the legal aspects relevant to dementia. Such legal questions might be about the power of attorney for health-care decisions, guardianship, right to die, and others. Other exam questions might be about how the clinician should communicate to the caregiver about the progressive nature of the disease, how the last days of the patient’s life may look, and how the caregiver is at high risk of burnout. The ethical dimension may play out in an Alzheimer’s case in regard to end-of-life care and competing ethical principles. Still, other exam questions may be about systems of care and healthcare policies related to dementia prevention, assessment, and care.

Now, as the ABPN itself states, the cross-cutting relationship between the Dimension 1 and Dimension 2 topics is not perfect. That’s why in Dimension 1, there is that additional category of Dimension 2 topics without a corresponding Dimension 1 topic. For example, Practice-based learning may not be tied to a particular psychiatric disorder.

How Best to Study for the ABPN Psychiatry Boards Given These Cross-Cutting Dimensions

The best way to start your exam preparation is to focus on the main psychiatric disorders and, then to focus on the main cross-cutting topics listed in Dimension 2. This means focusing mostly on the neuroscience/mechanisms of disease, clinical presentations, diagnostic procedures, and treatment aspects of the main psychiatric disorders.

However, there are topics that account for a small percentage of exam questions but still enough that you can’t afford to ignore them. The first 2 on the list below are from Dimension 1, and the further 5 are from Dimension 2.

ABPN Exam: Dimension 1 Topics

• Developmental processes and development through the life

• Forensic Psychiatry

ABPN Exam: Dimension 2 Topics

• Interpersonal and communication skills

• Behavioral/social sciences & psychosocial mechanisms of diseases

• Professionalism, ethics, and the law

• Practice-based learning and improvement

• Systems-based practice

The best way to get a handle on these minor-but-still-important topics is to first focus on them directly and not through a psychiatric disorder. For example, to understand the fundamentals of medical ethics, you’re likely to learn them most efficiently by first reviewing a general presentation on medical ethics in psychiatry. Only then can you review how each of these ethical principles applies to specific disorders or patient populations.

Categories of Presentations in the Beat The Boards! Psychiatry Certification Course

With these concepts in mind, this is how the Beat The Boards! courses are designed: most presentations are on psychiatric disorders, with each presentation’s length approximating the importance of that disorder on the exam, that is, disorders that have more associated exam questions have longer presentations in the review course. Additionally, there are several presentations that focus on non-disorder topics, that present facts and concepts that are best learned through direct presentation. For example, in the Beat The Boards! Psychiatry Certification Course, these are the non-disorder presentations:

• Suicide

• Violence and Aggression

• Forensics and Ethics

• Psychotherapy Review

• Behavioral Sciences & Neuropsychology

• Systems-based Care

• Public Policy

• Epidemiology

• Neuroimaging

Additionally, there are presentations that present the ABPN exam format and tips and concepts for passing the exam. These presentations include:

• Exam Information

• How to Study For and Take the Exam

Lastly, there are presentations that are part of the course that provide background information. These are considered optional, and the recommendation is not to focus on these until and unless all other directly relevant presentations are consumed first. These ‘background’ lectures include:

• Biostatistics

• Medical Research Methods

• Mental Status Exam

• Cortical Syndromes

If you have questions or comments, email me at drjack@ americanphysician.com. Thanks and take care.

Yours In APBN Exam Success,

Jack Krasuski, MD

Founder

American Physician Institute for Advanced Professional Studies