How the Certifying Exam works
The Emergency Medicine Certifying Exam is now an in-person Objective Structured Clinical Examination (OSCE). Here is how it is built and how to prepare.
Exam format
The exam runs as two testing sessions. Each session contains 4 Clinical Decision-Making cases at 15 minutes each and 6 communication or procedure cases at 10 minutes each. Throughout the clinical decision making cases you manage a simulated trackboard, prioritizing and multitasking across patients just as you would in a real emergency department.
The 8 ABEM case types
1.Clinical Decision-Making (CDM)
The core of the examYou receive a chief complaint, obtain history and physical findings, order and interpret studies, manage the patient, and disposition appropriately. These cases test your ability to recognize emergencies, manage evolving scenarios, and reassess after interventions. Each one runs alongside a trackboard of other patients who need attention.
2.Difficult Conversations
CommunicationDeliver bad news, discuss goals of care, navigate end-of-life decisions, or address sensitive topics such as substance use or an unexpected diagnosis. The examiner evaluates your empathy, clarity, and ability to maintain a therapeutic relationship under emotionally charged circumstances.
3.Managing Conflict
CommunicationInterpersonal friction with consultants, nursing staff, patients, or families. You de-escalate, negotiate, and advocate for your patient while maintaining professionalism and collaborative relationships.
4.Patient-Centered Communication (PCC)
CommunicationElicit the patient's perspective, address their concerns and health literacy, give clear discharge instructions, and reach a shared decision. The focus is whether you communicate in a way the patient can understand and act on.
5.Prioritization
TrackboardManage a busy trackboard with multiple patients at varying acuity. The examiner evaluates your ability to triage, delegate, and identify which patient needs you most urgently while ensuring no patient is neglected.
6.Procedures
SkillsUsing task trainers or simulation equipment, you demonstrate procedural competency. You verbalize the indications, consent, preparation, technique, and post-procedure assessment. Common procedures include airway management, chest tubes, central lines, abscess drainage, and nerve blocks.
7.Ultrasound
InterpretationInterpret point-of-care ultrasound images in the context of a clinical scenario. You identify normal and abnormal findings and integrate them into your decision-making. Common applications include FAST, cardiac, aortic, biliary, renal, and soft tissue ultrasound.
8.Reassessment and Troubleshooting
Evolving casesAfter an initial intervention or stabilization, the patient changes. You recognize the deterioration, identify the cause, and adjust your management. These cases test whether you follow up on results, reassess vital signs, and modify your plan when things do not go as expected.
Tips for the exam
Trackboard management
During the clinical decision making cases you carry a trackboard of other patients. Check it at natural transition points, after ordering studies or while waiting for results, and delegate appropriately. Do not ignore it, but do not let it pull you off a critically ill patient in front of you.
Time management
You have 15 minutes per clinical decision making case and 10 minutes per communication or procedure case. State your differential early, do not perseverate on one detail, and if you are stuck, verbalize your thinking and move forward.
Communicate constantly
Narrate everything: what you are thinking, what you are looking for, what you are ordering, and why. If you are unsure, say so and describe how you would resolve the uncertainty.
Disposition is part of the case
Every case needs a disposition: the admission or discharge plan, the level of care, follow-up, and return precautions. Incomplete dispositions lose points.