New ABEM exam!

[Dr Mantis Toboggan]

In person in Charlotte, looks like some sim cases/OSCE action… ​ After a rigorous review of feedback and ongoing engagement with emergency physicians, health care leaders, and the public through the Becoming Certified Task Force, ABEM is heading into the future with a new Certifying Exam in 2026. The new exam will be held in person at the AIME Center, a professional assessment center in Raleigh, NC. The current virtual Oral Certification Exam will conclude at the end of 2025. The new Certifying Exam will continue to uphold the high standards of the specialty while contributing to innovative assessment in Emergency Medicine. Why is ABEM making a change? Over the past two years, the Becoming Certified Task Force has reviewed the process for physicians to become ABEM certified. We thank everyone who participated in surveys, forums, summits, and meetings throughout the Becoming Certified Initiative. We heard your feedback! Summary of Feedback | Key Findings Key findings from the Becoming Certified Initiative identified the need to: Assess the additional skills and competencies important to the specialty. Create an assessment that is even more relevant to practice and with the added flexibility to adapt to changes in practice. Provide a format that can assess the aspects of emergency medicine practice that is not easily replaced by A.I. Provide candidates with a meaningful assessment experience. The current format of the Virtual Oral Exam cannot adequately grow in size or structure to meet these needs. How and where will it be administered? The Certifying Exam will take place in person at the AIME Center in Raleigh, NC. This professional assessment center was created by the American Board of Anesthesiology for high-stakes assessments for board certification. Multiple administrations will take place each year to allow candidate flexibility in scheduling. What are the focus areas for this assessment? Patient-centered Communications High-stakes Communications and Difficult Conversations Procedural Skills Managing Conflict Clinical Decision Making/Shared Decision Making Team Management Leadership Troubleshooting Task Switching Prioritization How will you assess these competencies? There are two assessment sections (each approximately 80-90 minutes) that make up the new Certifying Exam: Clinical Care cases and objective structured clinical examination (OSCE) cases: Clinical Care cases are based on guided scenarios that will require candidates to converse with an examiner to show how they prioritize patient care, assess their adaptability to unexpected clinical changes, and interact with various sources of information. OSCE cases will assess communication, professionalism, and technical skills related to patient care. There will be five interactive scenarios that could involve standardized patient actors or procedural equipment.​

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[Brigade4Radiant]

So people complaining about the oral exam and they want us to do some crappy OSCE

 

[LChristmas]

Gonna be super fun getting there from anywhere west of the Mississippi...

 

[gruemd]

"We've heard your feedback...and beatings will be changed to a new kind of beating, and will continue until morale improves!"

Seriously, who the *#@! works there and thought that this was a good idea? "You know what we'll do? We'll take the oral exam, make it worse, and put it in a less central geographic location!"

glhf to all those yet to board certify, jfc

 

[xaelia]

Well – can tell you in Aus/NZ ACEM has two parts to fellowship:

The "Primary Exam" which is basic knowledge, requires both a $2200 6-hour online exam that can only be taken in Auckland, Brisbane, Melbourne, Perth, Sydney AND a $2500 ~1 hour oral exam that can only be taken in Sydney.

The "Fellowship Exam" which is comprehensive clinical and leadership skills, a $3000 6-hour online exam that can only be taken in Auckland, Brisbane, Melbourne, Perth, Sydney AND a $4100 ~2 hours of OSCE stations spread over TWO DAYS that can only be taken in Sydney.

And, the pass rate for each of the "Primary" exams is ~85%, while the pass rate for each of the "Fellowship" exams is 60%.

So, yeah, could be worse, right?

 

[Arcan57]

Bonus points if they have weird equipment packs so you're using a completely unfamiliar kit in an artificial environment to test your skills. Sort of the mechanical skills version of those grainy photocopies of x-rays on the written exam. "I think this is an x-ray of the chest?"

 

[xaelia]

There's a summary linked to a description of the high-fidelity OSCE environment they're building –

"Each examination room will be equipped with a computer and simulated electronic health record typical of those found in emergency department nationwide. The keys on the computer keyboard will be engineered to a specific level of intermittently dysfunctional stickiness per our scoping surveys, and the mouse tracking will be jerky and imprecise.

During each OSCE, as the examiner prompts you with information about the case, you will be required to find the correct order set and respond to several simulated best practice alerts. Failure to properly execute the electronic ordering system will result in simulated nurse actors entering the room at later points in the exam, including in subsequent OSCE encounters, to interrupt and ask for clarification of prior orders.

You should also expect to be interrupted by circulating simulated ED technicians requesting EKG interpretation unrelated to the current case, as well as phone calls with critical lab values not necessarily related to your current case.

In further efforts to increase realism, examination rooms will be equiped with speakers capable of providing synthetic background noise including typical psychiatric and substance abuse vocalisations, construction noise, telephone rings, and call bell alarms. If you cannot hear the examiner due to the background noise, you may ask for prompts to be repeated, but they will provide reduced information at each subsequent request."

 

[cyanide12345678]

So annual fees, then extra tests to do online on top of initial certification and then some weird practice improvement research crap.

Aren’t other specialties just asking you to take a test after 10 years will while abem is trying to be relevant and make it seem like the credentials mean something by going through all these hoops….

 

[Pudortu]

I know this seems like a dumb question, but those of us already board certified don’t have to do this correct?

 

[valianteffort]

I know this seems like a dumb question, but those of us already board certified don’t have to do this correct?

you can if you want to experience it by paying the fee. but no, not mandatory.

 

[Franzd'Epinay]

So people complaining about the oral exam and they want us to do some crappy OSCE

A real monkey's paw scenario.

- "This exam is bad [so you should get rid of it]"

- "We hear you, the exam is bad. We'll now change the format of the exam"

Can't say I'm surprised, though.

 

[RustedFox]

There's a summary linked to a description of the high-fidelity OSCE environment they're building –

"Each examination room will be equipped with a computer and simulated electronic health record typical of those found in emergency department nationwide. The keys on the computer keyboard will be engineered to a specific level of intermittently dysfunctional stickiness per our scoping surveys, and the mouse tracking will be jerky and imprecise.

During each OSCE, as the examiner prompts you with information about the case, you will be required to find the correct order set and respond to several simulated best practice alerts. Failure to properly execute the electronic ordering system will result in simulated nurse actors entering the room at later points in the exam, including in subsequent OSCE encounters, to interrupt and ask for clarification of prior orders.

You should also expect to be interrupted by circulating simulated ED technicians requesting EKG interpretation unrelated to the current case, as well as phone calls with critical lab values not necessarily related to your current case.

In further efforts to increase realism, examination rooms will be equiped with speakers capable of providing synthetic background noise including typical psychiatric and substance abuse vocalisations, construction noise, telephone rings, and call bell alarms. If you cannot hear the examiner due to the background noise, you may ask for prompts to be repeated, but they will provide reduced information at each subsequent request."

Please tell me that this is a creative writing joke/project that I wish I had written.

 

[DO3]

I feel bad for the folks who have to take this test, but I feel worse for the residency programs who are gonna have to figure out a way to try and prepared their residents for this exam.

 

[AlmostAnMD]

Please tell me that this is a creative writing joke/project that I wish I had written.

Even tho it's sarcastic it's a description of the highest fidelity simulation even imaginable and would be worth any fee to take

 

[Arcan57]

So annual fees, then extra tests to do online on top of initial certification and then some weird practice improvement research crap.

Aren’t other specialties just asking you to take a test after 10 years will while abem is trying to be relevant and make it seem like the credentials mean something by going through all these hoops….

Medicine and Peds have moved to the modules during period of certification model also.

They should just make it based on employment. Work x number of hours of clinical EM/year and you stay certified. Drop below that number for y number of years and you have to take a test to prove you still have the knowledge base to be a safe doc.

 

[RustedFox]

Even tho it's sarcastic it's a description of the highest fidelity simulation even imaginable and would be worth any fee to take

You know I skimmed it at first and missed the obvious jokes that gave it away.

Bravo, author.

 

[Rekt]

I’m betting this will easily be >$2000.

 

[HemorrhagicShock]

EM is such a stupid specialty, and the people running the specialty are even dumber and self-serving

Get off this Titanic before it fully sinks.

 

[TooMuchResearch]

I know this seems like a dumb question, but those of us already board certified don’t have to do this correct?

We don't, which is why I wasn't sure why ABEM sent me the email.
The specialty is a dumpster fire and I am no longer an idealist.

 

[sylvanthus]

Wait is this real or satire?

 

[BoardingDoc]

Wait is this real or satire?

@xaelia made a delightful satire response to what is an actual change that is being made as posted by @Dr Mantis Toboggan

 

[RustedFox]

EM is such a stupid specialty, and the people running the specialty are even dumber and self-serving

Get off this Titanic before it fully sinks.

Yep.
I mean... I really can't stand it anymore. This monster has become something ELSE.

 

[GonnaBeADoc2222]

Well tbh anyone who started EM residency in 2022 or 2023 is kind of dumb. So they only have themselves to blame.

This.

Why would you everrrr choose this speciality if you were matching in 2021 onward?

Really really dumb.

Like...absurdly dumb.

"Dead patients stacked in hallways, pay cuts, no PPE, poor job outlook, zero nurses? Mmmm yeah baby give me some of that."

 

[xaelia]

@xaelia made a delightful satire response to what is an actual change that is being made as posted by @Dr Mantis Toboggan

FWIW, I do generally appreciate the challenge of protecting the public by ensuring a competent medical workforce.

As frequently crops up on other threads, every group seems to have that oblivious mouth-breather risk to patient safety or decaying fossil resistant to change in medical practice. Then, new resident graduates are a heterogeneous bunch with differing skills and affinity for practice improvement. How do you set the bar for minimum competency? How do you reliably assess it? How do you eliminate biases in this process?

Neither the ongoing milestone assessments from training nor one-off high-stakes written/oral/OSCE examinations are perfect tools. There will be folks who are going to be perfectly capable physicians who run up against a wall in one of those steps and have a legitimate beef – but how do you separate those from the folks who should spend the rest of their lives away from hands-on patient care?

These licensing boards (ABEM, ABIM, etc.) have mutated into vehicles for self-enrichment, unfortunately, but I do respect the greater problem faced when acting in good faith.

 

[RustedFox]

FWIW, I do generally appreciate the challenge of protecting the public by ensuring a competent medical workforce.

As frequently crops up on other threads, every group seems to have that oblivious mouth-breather risk to patient safety or decaying fossil resistant to change in medical practice. Then, new resident graduates are a heterogeneous bunch with differing skills and affinity for practice improvement. How do you set the bar for minimum competency? How do you reliably assess it? How do you eliminate biases in this process?

Neither the ongoing milestone assessments from training nor one-off high-stakes written/oral/OSCE examinations are perfect tools. There will be folks who are going to be perfectly capable physicians who run up against a wall in one of those steps and have a legitimate beef – but how do you separate those from the folks who should spend the rest of their lives away from hands-on patient care?

These licensing boards (ABEM, ABIM, etc.) have mutated into vehicles for self-enrichment, unfortunately, but I do respect the greater problem faced when acting in good faith.

Right on.
I think a lot of torch-lighting and pitchfork-grabbing would be quelled if the existing tools were improved.
They're not perfect, but they're not even -adequate- in how they're written.

 

[ssynara]

This.

Why would you everrrr choose this speciality if you were matching in 2021 onward?

Really really dumb.

Like...absurdly dumb.

"Dead patients stacked in hallways, pay cuts, no PPE, poor job outlook, zero nurses? Mmmm yeah baby give me some of that."

Because I want to do EMS since it's all I know so far 🥲

AOBEM looking kinda nice lately though...

 

[Vash86]

I don't remember being consulted about this. Do any of you? If they heard our concerns then the oral boards would cease to exist. Instead, they only care about making money.

Don't forget to sign the petition to end oral boards if you haven't already.

Sign the Petition

Remove American Board of Emergency Medicine Oral Exam Requirement

www.change.org

EMRA is also voicing its concerns about this and has issued a statement.

EMRA Has Your Back

We are advocates representing our members, protecting the practice of emergency medicine and supporting EM physician training.

www.emra.org

Please voice your concerns to EMRA!

 

[EctopicFetus]

I don't remember being consulted about this. Do any of you? If they heard our concerns then the oral boards would cease to exist. Instead, they only care about making money.

Don't forget to sign the petition to end oral boards if you haven't already.

Sign the Petition

Remove American Board of Emergency Medicine Oral Exam Requirement

www.change.org

EMRA is also voicing its concerns about this and has issued a statement.

EMRA Has Your Back

We are advocates representing our members, protecting the practice of emergency medicine and supporting EM physician training.

www.emra.org

Please voice your concerns to EMRA!

EMRA = pathetically sad organization with a bunch of ACEP future leader wannabes.

 

[Vash86]

EMRA = pathetically sad organization with a bunch of ACEP future leader wannabes.

Perhaps. However, so far, they are the only ones doing anything about it, unless you count comments on a forum holding much merit? If you have any better ideas on how to get our voices heard and make change then I'm all ears.

 

[hundreddaysoff]

The ABEM oral board was one of the biggest wastes of time in my life.

That said, seems to me that established emergency docs have every financial incentive to support more barriers to entry in our field. Eg, even more expensive and ridiculous Board exams, especially those that favor docs with fantastic patient communication skills.

I don't have a huge dog in this fight as I don't expect to be working full-time in the pit within 5 years. If I am, something has gone very wrong.

But, if you're a newly boarded attending and don't want (even more) massive competition for your job and pay racing to the bottom over the next few years, seems to me that ABEM is a bit of minor grift you should now support. (As opposed to major grift like the AMA that takes our money but helps us not at all.)

Am I wrong?

 

[TooMuchResearch]

I don't remember being consulted about this. Do any of you? If they heard our concerns then the oral boards would cease to exist. Instead, they only care about making money.

Don't forget to sign the petition to end oral boards if you haven't already.

Sign the Petition

Remove American Board of Emergency Medicine Oral Exam Requirement

www.change.org

EMRA is also voicing its concerns about this and has issued a statement.

EMRA Has Your Back

We are advocates representing our members, protecting the practice of emergency medicine and supporting EM physician training.

www.emra.org

Please voice your concerns to EMRA!

Nah, oral boards were a good time. Bring back Chicago Marriott oral boards.

 

[Birdstrike]

"Let make it harder to become ED physicians while simultaneously making it easier for nurses and PAs to do the same." - Not Socrates