CREOG In-Training Exam: the complete guide for OB-GYN residents

The CREOG In-Training Examination is the annual knowledge exam taken by obstetrics and gynecology residents across the United States. It is not a board exam, but it is the closest thing residents have to a yearly check on their medical knowledge, and it is often the best early predictor of how ready they are for the ABOG Qualifying Exam. This guide explains the format, who takes it, how results are used, and how to prepare without letting it take over residency.

What is the CREOG In-Training Exam?

The exam is run by the Council on Resident Education in Obstetrics and Gynecology (CREOG), part of the American College of Obstetricians and Gynecologists (ACOG), and is administered with the National Board of Medical Examiners. ACOG formally calls it the In-Service Training Examination, though most residents know it as the CREOG exam or CREOG In-Training Exam.

According to ACOG, its purpose is to provide a quantitative assessment of each resident's medical knowledge in obstetrics and gynecology. It serves two goals: a self-assessment opportunity for individual residents, and a way for residency program leadership to review the medical knowledge of individual residents and the program as a whole. Questions address the objectives in the most recent edition of the CREOG Educational Objectives: Core Curriculum for Residents in Obstetrics and Gynecology.

CREOG exam format and structure

ACOG publishes the exam structure on its In-Service Training Examination page:

• 300 questions, divided into five test blocks of 60 questions each.
• Each block is 60 minutes long.
• Suggested breaks of 10 minutes after the first, second and fourth blocks, and a suggested 60-minute break after the third. Breaks are optional and taken at each examinee's own pace.
• Held once a year, with each resident completing the exam in a single day (residents with certain accommodations may take it over two days).
• Taken on laptops in a secure exam browser, administered by the residency program with a chief proctor, either on site or with virtual proctoring.

Five hours of testing is a long day. Stamina and pacing matter almost as much as knowledge, especially for junior residents taking it for the first time.

Who takes the CREOG exam and when?

The exam is taken by OB-GYN residents in every year of training. U.S. residents are usually registered by their residency program manager, and the cost is typically covered through the program's CREOG Activity Fee. International OB-GYN residents can take it only by arranging to sit with a participating program, and faculty members can apply to take it separately. There are no makeup or alternate days, although ACOG notes the exam is not required and an examinee can miss it for a year. Your program will tell you which day within the testing window you are scheduled.

Because it is taken every year, the CREOG exam tracks your progress from PGY-1 to PGY-4. Results are released to program directors and program managers through the NBME's online portal, and programs use them alongside other measures of resident progress.

The CREOG content outline: where to focus

The exam is built around the CREOG Educational Objectives, the core curriculum for OB-GYN residency. In practice that means the breadth of the specialty:

• Obstetrics: prenatal care, maternal medical complications, labor and delivery, obstetric emergencies and postpartum care.
• Gynecology: benign gynecology, gynecologic surgery and perioperative care, pelvic floor disorders and urogynecology.
• Reproductive endocrinology and infertility: menstrual disorders, contraception, infertility and menopause.
• Gynecologic oncology: screening, premalignant disease and the evaluation and management of gynecologic cancers.
• Primary and preventive care: screening, health maintenance and the general medical care of women.

The best guide to where you should focus is your own score report. Junior residents usually find the subspecialty areas they have not yet rotated through to be weakest, while senior residents often discover gaps in primary care and preventive medicine. ACOG's own "Countdown to CREOG" resource highlights the most missed topics from previous exams, which is a useful signal of where residents commonly struggle.

A realistic CREOG study plan

The best preparation is steady and woven into residency, not a last-minute cram. A phased approach:

Phase 1, year-round habit: answer a small set of questions most days in tutor mode, ideally matched to your current rotation. Read every explanation. Over a year, this builds coverage far more effectively than occasional marathons.

Phase 2, targeted review: in the months before the exam, use your previous score report and your question bank analytics to rank your weakest areas, and give those areas dedicated time, especially subspecialties you have not yet rotated through.

Phase 3, stamina: in the final weeks, practice timed 60-question blocks in 60 minutes, and complete at least one session of several consecutive blocks to rehearse the length of the real day.

Phase 4, review and repeat: when your results arrive, compare them with your own analytics, agree on priorities with your program, and carry them into the next year's cycle.

Exam technique for the CREOG exam

Each block gives you one minute per question, so aim for a steady pace and avoid spending several minutes on any single item. Read the lead-in first, then scan the stem for the details that decide the answer, such as gestational age, parity, symptoms and test results. Flag uncertain items and return to them at the end of the block if time allows. Use the breaks: eat, hydrate and step away from the screen so your concentration in the last two blocks matches the first.

Common mistakes

• Treating the exam as unimportant in junior years and missing the chance to build good habits early.
• Cramming in the weeks before the exam instead of practicing steadily through the year.
• Ignoring the score report instead of using it to direct the next year's study.
• Underestimating the stamina needed for five hour-long blocks in one day.

The best way to prepare for the CREOG exam

The most effective preparation is consistent question practice throughout the year with a bank that covers the full CREOG curriculum, explains every answer and tracks your performance by topic. That turns each rotation into exam preparation and gives you a clear picture of your weak areas long before test day. The same habits also build directly toward the ABOG Qualifying Exam at the end of residency.

Passmed's CREOG In-Training Exam question bank offers board-style vignettes written by physicians, detailed explanations for every option and performance analytics that track your progress across obstetrics, gynecology and their subspecialties.

Frequently asked questions

How many questions are on the CREOG exam?

The exam has 300 questions in five blocks of 60, with 60 minutes allowed for each block.

Is the CREOG exam the same as the In-Service Training Examination?

Yes. ACOG formally calls it the In-Service Training Examination, while most residents and programs refer to it as the CREOG exam or CREOG In-Training Exam.

Who sees my CREOG results?

Results are made available to your program director and program manager through the NBME portal. Programs use them to review individual and program-wide medical knowledge.

Is the CREOG exam required?

ACOG states that the exam is not required and that an examinee can miss it for a year, but most residency programs expect residents to take it every year as part of their training.

What does the CREOG exam cover?

Questions address the objectives in the current CREOG Educational Objectives, the core curriculum for OB-GYN residents, spanning obstetrics, gynecology, its subspecialties and primary and preventive care.

Exam format and administration details in this guide were checked against the American College of Obstetricians and Gynecologists (CREOG) (accessed October 2026). Arrangements can change, so always confirm current dates and fees on the ACOG website or with your residency program.