Adult Rheumatology In-Training Examination


The Adult Rheumatology In-Training Examination (ITE) allows program directors to identify areas of strength and weakness in their program, and fellows to evaluate their progress and compare results against national outcomes as reported in the score reports. The ACR In-Training Examination Taskforce develops the Adult Rheumatology ITE with support of the National Board of Medical Examiners (NBME).

The exam is offered once a year and administered at your home institution.

Adult Rheumatology In-Training Examination News

The 2024 Adult Rheumatology In-Training Examination took place March 26–27. Please check back for information about the 2025 examination.

Registration Information

Training program administrators, including the program director, assistant program director, program coordinator, and division director, will have access to register their rheumatology fellows when registration opens. Fellows may not register themselves for the exam. Before registering your fellows, please make sure your training program roster is updated. 

International Programs
International training programs must contact Janet Mitchell at to register your program with the ACR,before being able to register your fellows for the exam. International rheumatology training programs must be approved by the Accreditation Council of Graduate Medical Education or the Royal College of Physicians and Surgeons of Canada.

Registration Fees

Cost of registration is based on the member status of the examinee.

  • A fellow in training who has an active FIT or Transitional ACR membership: $300 per FIT
  • A fellow in training who does not have an active FIT or Transitional ACR membership: $435 per FIT

Learn more about joining the ACR.

Cancellation Policy
Institutions can cancel exam registrations up to eight days before the exam administration and will be eligible for a full refund. Cancellations requested within seven days of the exam administration are ineligible for a refund.

About the Exam

The ITE is a web-based examination consisting of 200 items. The exam is administrated to fellows at an onsite, secure testing location designated by the training program. The ITE is offered in a two-day window to allow programs to test all their fellows in training and provide clinic coverage. Fellows in training can be divided evenly among the two days or all FITs can take the exam on the same day.

Exam Timing

The total testing session is 7 hours and 55 minutes to complete the exam. There are 5 sections consisting of 40 items each with a 10-minute break after sections 1, 2, and 4; and a 30-minute break after section 3. There is an optional 15-minute tutorial at the start of the exam and a short satisfaction survey at the end of the exam.

  • The exam start time is 9:00 AM your local time
  • All FITs must start the exam at the same time
  • The exam must be completed during the allotted time
  • There is no make-up date for the exam

Practice Exam

The 2024 Practice Exam is not yet available; however, the 2023 Practice Exam is the same version as the 2024 exam, without the updated copyright screen.

The updated 2024 Practice Exam will be posted once the final version is live.


Exam Administration 

Each program must designate a chief proctor(s) to oversee the administration of the exam. The chief proctor is responsible for the following:

  • Performing workstation certification on each computer that will be used during the exam. This certification must be performed before the test day on each computer that will be used for web-based testing.
  • Preparing examinee workstations – boot up each workstation
  • Distributing instruction sheet which includes examinee login information
  • Providing examinees with Examinee Startup Code for launching the exam
  • Monitoring the testing session online
  • Ending the exam session and completing a Test Administration Report

Program Managers: Update your training program information

Training Program Update

The ACR relies on you to keep your training program records current, so all faculty members receive ACR correspondence in a timely manner.


Training Program Update Instructions


Frequently Asked Questions

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