ABEM Oral Board Exam: How to Play the Role and Pass the Test

You crushed the written exam, and now the only thing standing between you and your ABEM certification is oral boards. How do you prep - especially for a virtual test? Host Kim Bambach, MD, reviews pearls & pitfalls with guests Krystin Miller, MD, and Jennifer Yee, DO.

OVERVIEW: The American Board of Emergency Medicine is continuing a virtual oral board exam format through the end of 2021 (and possibly beyond). This nerve-wracking final hurdle of training is a high-stakes - but remote - role play. Don’t freak out. Host Kim Bambach, MD, walks you through the pearls and pitfalls as described by Krystin Miller, MD, and Jennifer Yee, DO.

ABEM Oral Board Virtual Format

• 6 SINGLE CASES: Using Zoom, the proctor presents 6 single-patient cases and 1 structured interview. Candidates interact with the examiner for each step of the patient encounter including history, physical, diagnosis, treatment, and disposition.
• 1 STRUCTURED INTERVIEW: This is a new type of case that began with virtual. It's a more probing question about why you're doing what you're doing. This represents a chance to explain your thought process and your approach to caring for the patient.

HOW TO APPROACH THE CASES
Practice, practice, practice. Develop a rock-solid routine so you don't forget any steps. Dr. Miller and Dr. Yee recommend prepping a notepad with a 4-quadrant setup, then making notes for each case to explain your encounter:

• History
• Physical exam
• Labs/Imaging
• Actions

Check out the example from Foundations of Emergency Medicine.

GRADING
It's complicated. Generally:

• 8 competencies, with up to 8 points per competency
• Average 5.75 to pass the case; if your average is too low, examiners will ask a series of questions as a second-tier grading opportunity

PEARLS

• Start the case start with a general phrase: What do I see when I walk in the room?
• When you first hear the patient stem and vitals, decide if the patient is "sick" or "not sick". This will guide you on whether critical actions are required before obtaining additional history. If the patient is sick, establish IV access, administer supplemental O2 if indicated, place the patient on the monitor, and start resuscitation.
• You may ask EMS and family for collateral information.
• For your physical exam, start with general categories. Remember neuro, back, skin, and GU when relevant.
• Beta-hCG, tetanus, and POC glucose are commonly forgotten!
• Know the doses for ACLS/PALS medications.
• Don't forget to treat the patient's symptoms like pain and nausea and not just arrive at the diagnosis. Symptom control is often a critical action.
• Reassess frequently (ask the patient, obtain repeat studies).
• Discuss the diagnosis with the virtual patient and display empathy. These skills are also assessed on the exam.
• SUSPEND DISBELIEF and play the game - don't assume that your examiner knows the steps you took to get to your diagnosis or treatment plan.
• DRESS FOR SUCCESS: Treat this exam as a job interview. While you're expected to behave as though you're in the emergency department, you need to dress for the boardroom. Suits, not scrubs.
• PRACTICE: Check out the Okuda book for examples!

Key Resources

• ABEM Virtual oral exam information: https://youtu.be/v17oK2vdP2o
• ABEM Types of Cases and Samples: https://www.abem.org/public/become-certified/oral-exam/types-of-cases-and-samples
• Foundations of Emergency Medicine oral board note sheet: https://foundationsem.com/wp-content/uploads/2016/06/Intro-Oral-Board-Note-Sheet-1.pdf
• The "Okuda book" for oral boards review: Okuda Y, Nelson B. Emergency Medicine Oral Board Review Illustrated. Cambridge: Cambridge University Press; 2015.