Emergency Medicine Examination Description
When and Where the Examinations are Offered
The American Board of Physician Specialties (ABPS), the official certifying body of the American Association of Physician Specialists, Inc. (AAPS), offers computer-based (written) certification examinations for the Board of Certification in Emergency Medicine (BCEM) twice a year and oral examinations once a year.
The examination process in Emergency Medicine requires candidates to pass both a computer-based (written) examination and an oral examination. The computer-based Emergency Medicine examination is offered twice each year at computer-based testing centers throughout the United States, Puerto Rico and Canada. Candidates who pass the written examination are then eligible to take the oral examination during the next available administration. ABPS administers BCEM oral examinations in Tampa, Florida once a year.
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Examination Day Schedule
The written exam is administered in two four-hour sessions, with a break between the sessions, but the two sessions must be taken in the same day. Candidates are advised to schedule the exams as early in the day as possible. A typical schedule would be to begin the first session at 8:00 a.m. and conclude no later than noon, take a one hour lunch break, and begin the second session at 1:00 p.m. and conclude no later than 5:00 p.m. Oral examination administrations begin at 8:00 a.m. on their respective days, although each candidate for the oral examinations is scheduled for one two-hour block.
The Written Examination—What to Expect
The written examination consists of approximately 350 multiple-choice questions of four choices. (Experimental or non-scorable items may also appear on an examination. These questions will not necessarily be identified as non-scorable.) Each scorable question has only one correct answer. For each session candidates are provided online access to approximately half the questions. A tutorial is provided to help the candidate understand the online process. ABPS also provides a formal comment form on which a candidate can enter comments regarding any question. All comments are read to determine if a question may be flawed. Upon review of the comments and item analysis (statistical data), if an item is considered flawed, it is removed from the scoring of the examination. The passing score on forms of the examinations varies depending upon the expected performance values of the individual questions on the examination. Currently the minimum score for passing, depending upon the form of the examination, ranges from approximately 75% to 82%, with each response to a question being scored correct or not correct, with no penalty for guessing. Candidates receive score reports indicating their pass/fail status on the examination. Candidates who fail receive a breakdown of their performance by subject content domains and if their performance on each domain met an expected minimum level of performance.
The following table lists the approximate number of items in each domain included on each form of the written examination. Cases for the oral exam are also drawn from these domains and use the same reference materials.
|Domain||Number of Questions|
|1||Administrative and Legal Aspects, Disaster Medicine, and Emergency Medical Services||9|
|4||Ear, Nose & Throat||18|
|5||Endocrine, Metabolic, & Nutritional Disorders||8|
|6||Gastrointestinal and Abdominal Disorders||24|
|7||Hematologic, Oncologic, and Immunologic Disorders||7|
|11||Obstetrics and Gynecology||21|
|16||Procedures & Skills||8|
|17||Pulmonary & Respiratory Disorders||21|
|18||Psychiatric and Behavioral Disorders||10|
|19||Toxicology and Environmental Disorders||22|
Emergency Medicine Examination Study References
You may wish to use the study references to prepare for the written certification or recertification examinations. The Examinations Committee uses these references to create questions for the examinations.
The Oral Examination-Cases, Procedures, and Scoring
An oral examination in Emergency Medicine consists of five case studies–two simulated single-patient encounters and one triple-encounter in which the candidate is required to manage three patients simultaneously. The Board’s philosophy is that the candidate must address items deemed important in patient history; physical examination; labs and tests; management; diagnosis; disposition; and pathophysiology to successfully manage a case and must successfully manage all the assigned patient simulations in order to pass the examination.
Cases reflect typical types of cases seen by Emergency physicians, and utilize the same reference materials and domains as used for the written exams. The Examinations Committee developing the cases reflect a range of experience in terms of types of hospitals at which they practice and geographical location in the country. Therefore, the types of cases selected and the expected minimally satisfactory responses by candidates are those that are considered appropriate by the diverse array of members of the Examinations Committee.
For each case, two examiners (ABPS Diplomates in Emergency Medicine) independently mark evaluation forms composed of items pre-identified by the Examinations Committees, composed of ABPS-certified physicians in Emergency Medicine, as important or applicable to the case. Each case typically requires candidates to address details in each of the following categories: patient history; physical examination; labs and tests; management; diagnosis; disposition; and pathophysiology. Candidates are provided a brief introductory statement regarding a patient’s general condition, symptoms, complaints, or reason for coming to the Emergency Department. The candidate is then asked how he or she would like to proceed. Although most cases contain each of the categories, some may not. The pathophysiology area, if applicable to the case, is a question asked of the candidate at the end of the period. Candidates are allowed 15 minutes for each single-case scenario and 30 minutes for the three triple-case scenarios (administered simultaneously). The underlying assumption for the examination is that successful management of each case requires a candidate to identify for him or herself each of these categories and the appropriate items in each category to address.
The examiners also record notes documenting what is said by the candidate. Upon completion of a round of cases, the two examiners and the physician presenting the case review the ratings provided by each examiner. A final joint evaluation form is compiled, with the presenter serving as the arbiter in those situations in which there may be a disagreement in the ratings of the two examiners. Results are compiled for each candidate. Each candidate who potentially may fail the examination, candidates committing a dangerous action on any case, and situations flagged by the examining committee are then reviewed the Board of Emergency Medicine to verify the results or make a judgment regarding credit or deductions that should be made for each candidate’s responses.
Each of the areas for a case is weighted. The candidate’s score on a case is the result of the jointly compiled evaluation (the two examiners and the presenter) with review of the results by the Board. Each case is assigned a threshold (acceptable performance) value prior to the administration, based upon the independent judgments of several Emergency Medicine Diplomates, taking into account the difficulty and complexity of the case. The thresholds typically range from 65% to 75% of the points for a case, although it is possible for the threshold to be higher or lower. Each examinee receives a mixture of easier and more difficult cases among the five he or she is assigned. In order to pass the examination, a candidate must meet all of the following criteria, thereby demonstrating successful management of all the assigned cases:
- The examinee’s total score (the sum of the percent scores attained on all five cases) equals or exceeds the sum of the five threshold values.
- The candidate’s case scores must equal or exceed the threshold values for at least three of the cases.
- For each case in which the examinee has not attained the threshold value, the candidate must attain a score of at least 85% of the threshold value set for that case.
- If the examinee meets the above three criteria but scores below the threshold value on each of two cases, the score on each of the two cases must be at least 90% of the respective threshold values for the two cases.
For each case, candidates receive details of their performance. Indicators of performance are provided in the areas of patient history; physical examination; labs and tests; management; diagnosis; disposition; and pathophysiology. An “NA” indicates that the category is not applicable for that case or there is an insufficient number of items in the category to provide information. These indicators are not precise. Candidates are advised to look at patterns in a category across cases. For example, an indicator of less than minimally expected performance in the “physical examination” category in only one case does not indicate that the examinee typically performs less than satisfactorily in this category. If less than minimally satisfactory performance is indicated for the same category in three or more cases, an examinee is well advised to consider this, particularly if he or she will be taking the oral examinations again.
Candidates are also advised whether they performed a dangerous action during the course of managing the case. Dangerous actions are categorized into two levels—the first being one that is likely to result in untoward outcome that is non-lethal (resulting in a deduction of 12.5 points, based on 100) and the second being an action that is either life-threatening or lethal (resulting in a deduction of 25 points, based on 100). Performing a dangerous action does not result in an automatic failure on a case but does substantially reduce the candidate’s total score on the case.
A candidate may take the written examination as many as three times to attain a passing score, upon which the physician is eligible to take the oral examination. A candidate may take the oral examination as many as three times in order to pass. Candidates who are successful in passing both the written and oral examinations are then certified and attain Diplomate status within ABPS and AAPS. Candidates who are not successful in passing both examinations within the number of allowable attempts may reapply for certification by completing a new application and meeting all the requirements in effect at the time the new application is submitted.