Adult Rheumatology In-Training Examination

The Adult Rheumatology In-Training Examination (ITE) provides program directors with valuable insights into the strengths and areas for improvement within their training programs. It also enables fellows to assess their individual progress and benchmark their performance against national results, as detailed in the score reports.

The exam is developed by the ACR In-Training Examination Subcommittee in collaboration with the National Board of Medical Examiners (NBME). It is administered once annually at each fellow’s home institution, with the option for remote testing available.

Registration Information

Registration for ITE 2026 will open in mid-January.

2026 Exam Dates
March 24–25

2026 Exam Fees
Active Transitional Member: $369
Non-Member: $499

International Programs
International training programs must contact Janet Mitchell at jmitchell@rheumatology.org 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.

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 7hours and 55 minutes to complete the exam. There are 5sections 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 2026 practice exam will be available early next year.
See 2025 ITE Practice Exam >

Questions?
Contact ITE@rheumatology.org.

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