November 6, 2014

The Journey Towards Certified Enlightenment: Practical Tips for Passing EM Boards

By Jeff Wiswell, M.D.

The Journey Towards Certified Enlightenment: Practical Tips for Passing EM Boards

Disclaimer: ABEM does not allow discussion of exam specifics or cases.  Everything contained in this article is open source information obtained from the public portion of the ABEM website or commonly used review books.


What are the Emergency Medicine Oral Boards?

The oral board exam for emergency medicine is kind of a strange beast.  You’ve spent your entire life taking written tests (including the prerequisite written emergency medicine exam)--essays, multiple choice, short answer, etc.  This test is so different from your established exam workflow that it requires special preparation.

Many of you have attended some type of practice session put on by your residency program--we had them annually and they were generally the most awkward conference day of the year since the attendings you'd shared good times and bad tried to act as if they never met you to maintain a sense of objectivity.

Whereas the written board exam demands the regurgitation of the minutiae of Rosen’s or Tintinalli’s, the oral boards examines your ability to navigate the process of an interaction in the ED, albeit being as far from that environment as possible--a non-descript floor of hotel rooms at the Chicago O’Hare Marriott.

Although question banks exist for the written boards, oral boards is far more difficult to prognosticate due to the subjective nature of human interaction.  Like any exam, one needs a framework for which to prepare for it.



- Review courses are a nice way to break the ice.  They’re expensive and an extra hassle but you can likely use CME funds to pay for it.  I found it’s better to wade through the awkwardness a few weeks before in a non-threatening, though similarly staged environment.  Additionally, get a review book to run over some common cases, either with yourself or a partner.

- Think like you would in the ED, but don’t think too hard.  This isn’t journal club and the examiners aren’t looking for you to impress them with the latest literature.  Focus on the basics. You're expected to do what a reasonable emergency physician would do.

- In “real life,” ED nurses are generally pretty good and able to handle just about anything.  During boards, you have to presume they won’t do anything unless asked.  You need to explicitly order things like an IV, oxygen, a finger stick glucose, etc.

- Have a mantra--this is somewhat of a generic scenario, so you need to embrace that.  For every case, be able to rattle off the things you take for granted in “real life.”  Obviously, if the simulated patient presents with an ankle sprain, use your judgement and do what you would do in the ED.

Make sure to ask “what do I see, hear, and smell” to get a sense of the gestalt your normally take for granted in the ED.

For the more complicated cases, I go with:

1. IV

2. O2

3. "Place the patient on a continuous monitor with a rhythm strip"

4. "Draw a rainbow of labs"

5. "Obtain a full set of vitals, including pulse ox"

6. "Make me aware immediately when labs/imaging results return or when the patient’s condition changes.”


- You have to be nice.  Just like in real life, you have to speak to the patient and demonstrate some degree of compassion.

- Have a framework.  The best way to do this is with a standardized sheet that you write on before the case starts.  You’ll be provided with a piece of paper with a crime-scene cutout type of body on it and blank space.  It’s best to write out each step and give yourself room for notes.  Important headings are:

  1. HPI
  2. Review of Systems/Past Medical & Social History/Medications/Allergies/Immunizations
  3. Labs
  4. Imaging
  5. Interventions
  6. Consults & Disposition


- Be thorough: even if the patient presents for a stubbed big toe, do a complete physical exam.  I’d recommend writing the steps that are easy to overlook--elements like the back, skin, rectal, genitourinary, and neuro exams.  Cross off each section on the "crime scene body" as you complete it and mark any abnormalities.

- Be aggressive: If there's peaked T waves, treat hyperkalemia.  If breath sounds are absent in a trauma case, decompress the chest.  If even mild anaphylaxis, treat with epinephrine.  If someone's drunk, get them a sandwich.

- Get there the day before and bring business attire.  They’ll have places to store your things securely, but plan on not having access to your phone (or really anything at all for that matter) for the duration of the test.


The Bottom Line:

- Take the test seriously

- Prepare for the specifics of an oral exam

- Do, say, and order the things that would be customary during any of your regular attending shifts


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