- Identity Check: Which CIME This Sheet Covers
- The One-Page Fact Block
- What Not to Memorize as Fact
- The Seven Preparation Areas at a Glance
- Chapters 1 and 2: The Rules Behind Every Rating
- Body-System Cheat Notes
- Complex Cases: Where Memorization Fails
- Eligibility and Renewal Quick Reference
- Scheduling the Seven Areas
- Frequently Asked Questions
- CIME here means Certified Independent Medical Examiner, awarded by the American Board of Independent Medical Examiners (ABIME).
- The dated 2026 physician exam fee is US$995; required ABIME training costs extra.
- The verified sitting time is four hours, delivered online; the passing score and pass rate are not published.
- Seven AMA Guides sixth-edition training areas shape preparation, but they are not an official weighted blueprint.
Identity Check: Which CIME This Sheet Covers
The acronym "CIME" is shared by several unrelated credentials, which is why a lot of search results are misleading. This cheat sheet covers Certified Independent Medical Examiner, the physician credential administered by the American Board of Independent Medical Examiners. It is built around impairment evaluation, the AMA Guides, and the medicolegal skills of a physician who performs independent examinations. If you want the background on the credential itself, start with What Is CIME? or What Does CIME Stand For?, then come back here for the one-page review.
The rule for this page is simple: every number below comes from reviewed ABIME-related sources, and anything the sources do not confirm is flagged as unverified rather than guessed. For a candidate, that discipline matters. An impairment rater who writes down a plausible but unconfirmed figure is making the same kind of error this exam is designed to screen out.
The One-Page Fact Block
Print this table or copy it into your notes. It captures what is actually confirmed for the 2026 cycle.
| Item | What the sources support |
|---|---|
| Credential | Certified Independent Medical Examiner (CIME) |
| Issuing body | American Board of Independent Medical Examiners (ABIME) |
| Delivery | Online examination; third-party proctor/testing vendor not identified |
| Physician exam fee (dated 2026) | US$995; no member/non-member split found; required training is extra |
| Sitting time | Four hours (verified) |
| Availability window | Copy varies between 24 hours and one week; confirm at registration |
| Question count and format | Not confirmed for 2026; an archival booklet mentions 120 multiple-choice questions |
| Passing score | Numerical score not published in reviewed current materials |
| Pass rate | Not publicly disclosed |
| Certification cycle | Five years; 100 points (60 CME/CPD + 40 exam or ACIME MAPP route) |
| Training requirement | At least 16 ABIME-sponsored hours per the dated 2026 brochure |
Costs beyond the exam fee are covered in CIME Certification Cost 2026, and the timing details live in CIME Exam Dates 2026.
What Not to Memorize as Fact
A cheat sheet earns its keep as much by what it tells you to ignore as by what it tells you to recall. The following items circulate widely online but are not confirmed for the current exam:
- A weighted domain blueprint. Historical five-domain layouts and old three-way 25% splits exist in archival material. They are not current weights, and no dated weighted outline was verified.
- The exact number of questions. The 120-question figure comes from an archival booklet and has not been confirmed for 2026. Full item-format specifications are also unverified.
- A numerical passing score. It is not published in the current materials reviewed. See CIME Passing Score 2026 for how to reason about this gap.
- A pass rate. ABIME does not publicly disclose one, so any percentage you see quoted is unsupported. The reasoning is laid out in CIME Pass Rate 2026.
- Calculator, book, and proctor rules. Current reference-count and open-book or calculator policies need confirmation directly with ABIME before exam day.
The Seven Preparation Areas at a Glance
Preparation follows seven published ABIME AMA Guides sixth-edition training areas from the August 2026 course. These are unweighted issuer-course topics, not an official weighted or exhaustive examination blueprint. The optional South African RAF bonus session is not a general CIME examination domain and should not take study time unless it applies to your practice. Broader medicolegal preparation is also necessary. For a deeper walk through each area, see CIME Exam Domains 2026.
- Key concepts and methodology of AMA Guides Chapters 1 and 2
- Spine impairment rating
- Upper and lower limb impairment rating
- Nervous system impairment rating
- Psychiatric impairment rating
- Internal medicine, pulmonary, cardiology, eye and ENT impairment
- AMA6 complex case studies
Chapters 1 and 2: The Rules Behind Every Rating
Key Concepts and Methodology of AMA Guides Chapters 1 and 2
These chapters are the grammar of the whole system. Every body-system chapter assumes you already know how the Guides define and apply impairment, so errors here propagate into every case you rate.
- Know the difference between an impairment rating and a disability determination; raters rate impairment, and disability involves factors beyond the medical findings.
- Be able to state when maximum medical improvement matters and why a rating before it is problematic.
- Understand the stepwise logic of the sixth edition: diagnosis-based classes, then adjustment for modifiers, rather than a single lookup.
- Recognize the Guides' rules on rounding, combining, and avoiding double counting across body parts.
- Be ready to explain your rating logic in writing, since a defensible report is part of the job.
If you are newer to the framework, the plain-language explainers at What Is A CIME? and CIME Training give context before you dive into the methodology.
Body-System Cheat Notes
Spine
Spine Impairment Rating
Spine cases reward careful region-by-region thinking.
- Separate cervical, thoracic, and lumbar regions and rate each on its own findings.
- Distinguish axial pain-based presentations from radiculopathy and from neurological deficit.
- Check that your diagnosis, grade modifiers, and physical findings tell a consistent story.
Upper and Lower Limbs
Upper and Lower Limb Impairment Rating
Limb chapters are the most diagnosis-heavy, with many regional grids.
- Practice identifying the correct diagnosis grid before touching modifiers.
- Watch for conversion across hand, wrist, elbow, and shoulder, and for how regional values roll up.
- Know how range of motion, strength, and functional history serve as modifiers rather than stand-alone ratings.
Nervous System
Nervous System Impairment Rating
Neurology cases test whether you can separate central from peripheral findings and keep categories straight.
- Be fluent in distinguishing brain, spinal cord, cranial nerve, and peripheral nerve contributions.
- Know when electrodiagnostic findings support, or fail to support, the clinical picture.
- Avoid rating the same functional loss under two different chapters.
Psychiatric
Psychiatric Impairment Rating
Psychiatric rating is where examiner judgment and documentation discipline are most visible.
- Understand the role of validated instruments and structured functional assessment versus impression alone.
- Be able to describe how a rating depends on documented function, not diagnosis label by itself.
- Recognize the medicolegal sensitivity of consistency and credibility findings.
Internal Medicine, Pulmonary, Cardiology, Eye and ENT
Internal Medicine, Pulmonary, Cardiology, Eye and ENT Impairment
This is the breadth area. It is less about one deep skill than about knowing which chapter and which test result drives the class.
- Know which objective tests anchor pulmonary and cardiac rating, and which findings must be current.
- For eye and ENT, expect rating logic that depends on measured function rather than description.
- Build a one-line map for each system: what is measured, what is graded, what modifies.
Complex Cases: Where Memorization Fails
The final preparation area, AMA6 complex case studies, is where a cheat sheet stops helping and a method has to take over. Complex cases combine body parts, comorbidities, and records that do not line up neatly. The skill being tested is sequence: identify each impairment, rate it in the correct chapter, avoid double counting, and combine appropriately.
To see how hard candidates generally find this part, and how that squares with what is and is not known about scoring, read How Hard Is the CIME Exam?.
Eligibility and Renewal Quick Reference
Eligibility
Eligibility requires qualifying medical licensure, practice and specialty credentials, and a clean conduct record. Two points are in conflict across official documents: five versus ten years of practice, and 15 versus 16 training hours. The dated 2026 brochure specifies at least 16 ABIME-sponsored hours. Treat this as a verification task, not a guess, and use CIME Requirements 2026 as a checklist for the questions to put to ABIME.
Recertification
The certification and maintenance-of-certification cycle is five years and requires 100 points. Sixty points come from CME/CPD earned in the most recent three years. The remaining 40 come from either a recertification exam or the ACIME MAPP route. Current renewal and registry charges are unverified, so budget by asking rather than assuming.
| Renewal component | Points |
|---|---|
| Recent CME/CPD (last three years) | 60 |
| Recertification exam or ACIME MAPP route | 40 |
| Total per five-year cycle | 100 |
Whether this investment pays off depends on your practice setting. The tradeoffs are analyzed in Is the CIME Certification Worth It?, with earnings context in CIME Salary Guide 2026 and employment pathways in CIME Jobs.
Scheduling the Seven Areas
Generic study advice is not what this exam needs, but the order in which you tackle the seven areas does matter, because later areas lean on earlier ones. One logical sequence:
Methodology first
- Chapters 1 and 2 until you can explain the rating sequence from memory.
- Confirm exam logistics and policies with ABIME while this is fresh.
Spine and limbs
- Spine regions, then upper and lower limb grids, using worked examples.
Nervous system and psychiatric
- Separate central from peripheral rating logic.
- Review documentation expectations for psychiatric rating.
Breadth systems and complex cases
- One-line maps for internal medicine, pulmonary, cardiology, eye and ENT.
- Finish with multi-region cases that force you to combine everything.
Why this order? Methodology is the dependency for everything, and complex cases are only useful once the individual systems are familiar. For a fuller plan, see the CIME Study Guide 2026. When you are ready to test recall under realistic conditions, try the practice questions on the main practice test site. Note that practice-question allocations there are editorial and should not be read as exam weights.
Key Takeaway
Treat the seven areas as a map of what to learn, not a map of how points are distributed. Because no weighted blueprint is verified, balanced competence across all seven beats over-investing in any single one.
Frequently Asked Questions
The dated 2026 physician exam fee is US$995. No member versus non-member split was found, and required ABIME training is an additional cost. Renewal and registry charges are unverified.
The verified sitting time is four hours, delivered online. The third-party proctoring or testing vendor was not identified, and availability-window copy varies between 24 hours and one week, so confirm details when you register.
A numerical passing score is not published in the reviewed current materials, and the pass rate is not publicly disclosed. Be skeptical of any specific figure quoted without a source.
No current dated weighted outline was verified. The seven areas are unweighted issuer-course preparation topics from the AMA6 training route, and older equal-weight splits should not be treated as current.
The cycle is five years and requires 100 points: 60 from CME/CPD in the most recent three years and 40 from a recertification exam or the ACIME MAPP route.
For a broader introduction to the credential, you can also read CIME Certification and keep this CIME cheat sheet bookmarked as a quick reference while you prepare.