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Geoff Comp, DO
By Geoff Comp, DO on March 06, 2024

Mastering the ABEM Oral Board Exam: Tips for Success and Pitfalls to Avoid

After residency training, the ABEM Oral Board Exam is the second major hurdle in becoming a board-certified Emergency Medicine physician. While the pass rate is high (~91% in 2023), examinees must be ready to play the game by ensuring they know the format, standards, and rules. ABEM offers the virtual exam twice yearly; the 2024 dates are April 16-19, 2024, and September 10-13, 2024.

Exam Structure

The oral exam consists of 7 cases: 5 standardized single-patient encounters and 2 structured interviews. ABEM derives the test content from The Model of the Clinical Practice of Emergency Medicine, with specific competencies assessed using the ABEM Knowledge, Skills, and Abilities (KSAs)

The Standard Single Patient Case 

This format involves a patient encounter, where you will have 15 minutes per case to ask questions to perform a physical exam, request medications, tests, and imaging, and articulate possible procedures or consults. You are in charge of the pace. Utilize a structured approach to patient assessment and explain your thought process as you work through it. Giving additional information may help in getting some other higher-level points!

Each patient case is scored from 1-8 in the domains of:

  • Data acquisition
  • Problem-solving
  • Patient management
  • Resource utilization
  • Outcomes
  • Interpersonal relations and communication skills
  • Comprehension of pathophysiology
  • Clinical competence

Structured Interview

The structured interview format evaluates decision-making skills and reasoning through a series of questions based on the main phases of patient care: history, physical exam, differential diagnosis, testing, treatment, final diagnosis, disposition, and transitions of care. If you have successfully provided an appropriate answer, the assessor may cut you off or interrupt you. Make sure only to answer the question you are asked! Don’t babble through these cases. The examiner will ask why you ask specific historical questions, how you develop a differential diagnosis, why you order specific tests and imaging, and how you disposition the patient. There are a possible 25 overall points for the scoring of this section. 

Tips for Exam Day: 

  • Do the cases the same way every time.
    • Avoid getting into the habit of fast, rapid questioning to try to identify the diagnosis and then complete a workup tailored towards that. 
    • Ask the same questions every time to ensure you get all the extra points instead of focusing on what you think you need to ask to confirm. 
    • The same applies to the physical exam. Do a thorough physical exam to ensure you don’t miss something. 
  • Have an intro script for every case.
    • “What do I see when I walk in the room?” Follow with a rapid progression through a primary survey or pediatric assessment triangle.
  • Practice 
    • Practice with a friend or mentor to get a good rhythm and strategy.
  • Use your blank sheet.
    • You are allowed a blank sheet when each scenario starts. Think of things you want to remember to ask and use as a reminder about your case's progression and flow. 
  • Ask for anything you need.
    • Nothing happens unless you specifically ask for it. Don’t forget to request IVs, place the patient on a monitor, etc.
  • Don’t forget these things about the history and exam:
    • Request a complete set of vital signs on all patients. 
    • Ask EMS/family for collateral information.
    • Be thorough with your medical/surgical/social history, allergies, and current medications.
    • Ask for allergies before you give ANY medications.
    • Don’t forget back, skin, and GU for the physical exam!
    • Determine if there are classical physical exam findings. If there is concern for aortic dissection, ask for abnormal pulses. Are there specific abnormal heart sounds, fundoscopic exam findings, and even POCUS (they may say unavailable, but you can always try!)
  • Know some drug doses
    • Know doses for ACLS, PALS, and common medications. If you don’t know the dose, ask if you can discuss dosing with the pharmacy.
  • Follow each intervention with a status update.
    • There’s no magical time to “wait” for medication or an intervention to work. When you give a drug, immediately request an effect, repeat vital signs, etc. This will make sure that you are appropriately proceeding down the resuscitation pathway.  
    • Example: “I would like to have 1 L of normal saline via IV. What is the repeat heart rate after administration?"
  • Empiric treatments.
    • Treat pain and nausea, if indicated.
  • Procedures
    • If you would like a procedure performed, simply say you would like it to happen without specific detail (“I will perform rapid sequence intubation for hypoxic respiratory failure”). 
    • If the goal of the scenario is to ask about the procedure, the examiner will ask you to describe it. If not, the response will be “the patient is successfully intubated.”
  • Communicate with the patient.
    • Update the patient and ask if there is anyone else they would like you to notify.

The Future of the ABEM Certification Process

The Becoming Certified Task Force recently announced that in 2026, ABEM will be phasing out the oral board exam and replacing it with the new in-person certifying exam. After the 2025 fall testing, the virtual Oral Certification Exam will retire. The new certifying exam will have clinical care cases based on guided scenarios as well as objective structured clinical examination (OSCE) cases, which will assess communication, professionalism, and technical skills related to patient care. Stay tuned for more information from ABEM and Hippo about ways to prepare for the new exam!

Published by Geoff Comp, DO March 6, 2024
Geoff Comp, DO