Evidence-based Medicine Questions Logged by Emergency Medicine Residents On Shift in Relation to American Board of Emergency Medicine Content Areas.

The Accreditation Council for Graduate Medical Education (ACGME) has outlined its "Next Accreditation System" (NAS) that will focus on resident and residency outcome measurements. Emergency medicine (EM) is one of seven specialties that will implement the NAS beginning July 2013. All other specialties will follow in July 2014. A key component of the NAS is the development of assessable milestones, which are explicit accomplishments or behaviors that occur during the process of residency education. Milestones describe competencies more specifically and identify specialty-specific knowledge, skills, attitudes, and behaviors (KSABs) that can be used as outcome measures within the general competencies. The ACGME and the American Board of Emergency Medicine (ABEM) convened an EM milestone working group to develop the EM milestones. This article describes the development, use within the NAS, and challenges of the EM milestones.

Emergency medicine (EM) residency programs are increasingly asked to have measurable outcomes of residents' performance. Successful completion of the written and oral American Board of Emergency Medicine (ABEM) examinations is one key outcome. In the clinical practice of EM, emergency physicians (EPs) are often measured by their clinical productivity (patients per hour). This study explored the correlation between these measures of academic and clinical performance and hypothesized that clinical productivity would have a positive association with ABEM performance. A prospective written survey was sent to all EPs completing training at an established Midwest 3-year EM residency program between 1994 and 2005 (53,000 annual visits in 1994 to 65,000 annual visits in 2005). Physicians self-reported their national ABEM written and oral board scores in a blinded fashion. Simulated oral board scores and senior written in-training examination scores were also recorded. Postgraduate Year 3 (PGY3) clinical productivity was calculated as annual patient encounters divided by hours worked. Correlations among these variables were assessed by Pearson's correlation coefficient, with p < 0.05 being considered statistically significant. Multiple regression analysis was performed for ABEM oral and written examination scores. Fifty-six of 85 residents responded to the initial survey. There was no significant correlation between clinical productivity and ABEM scores, either written (r = -0.021, p = 0.881) or oral (r = -0.02, p = 0.879). There was also no significant correlation between productivity and simulated oral board scores (r = 0.065, p = 0.639) of PGY3 in-training scores (r = 0.078, p = 0.57). As previously reported, there were positive and significant correlations between PGY3 in-service scores and ABEM written examination scores (r = 0.60, p < 0.0001), as well as ABEM oral and written examination scores (r = 0.51, p < 0.0001). Multiple regression analysis revealed only the PGY3 in-training examination was a significant predictor of the ABEM oral and written scores (p < 0.001). PGY3 resident clinical productivity, when measured as patients per hour, correlated poorly with academic performance when measured by written and oral ABEM scores. The PGY3 in-training examination was predictive of the ABEM written and oral examination scores.

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Unprecedented Training: Experience of Residents During the COVID-19 Pandemic

Exploring the Relationship Between the American Board of Emergency Medicine In-Training Exam Scores and Mandatory Didactic Attendance for Emergency Medicine Residents

AudienceThis case was specifically designed for senior emergency medicine (EM) resident physicians as a preparatory tool for the American Board of Emergency Medicine (ABEM) Certifying Exam. However, it is applicable for EM residents at all levels of training.Introduction“A hallmark of emergency medicine is the ability to triage or prioritize care. This case will require the physician to evaluate and treat multiple patients while ensuring those who require immediate care receive it quickly. The physician may face the arrival of additional patients, the deterioration of existing patients, and realistic workflow interruptions during the case. A successful candidate will identify and stabilize high acuity patients.”1 With the introduction of the new Certifying Exam by ABEM and the current lack of resources to practice prioritization in an assessment setting, resident physicians will need practice material in order to adequately prepare for their board examination.Educational ObjectivesBy the end of this case learners will be able to: 1) Become familiar with format of a prioritization case (a component of the ABEM Certifying Exam), 2) Practice their ability to prioritize multiple 313 patients and provide stabilizing care, 3) Consider changes in status/patient acuity/new cases as presented, 4) Understand how to utilize team resources appropriately.Educational MethodsThis encounter is a structured, oral simulation case designed as a prioritization exercise for emergency medicine resident trainees. It follows an interview-based format in which an examiner presents evolving patient information in a time-limited scenario, and the examinee responds in real time with clinical reasoning, prioritization of care, and management decisions. The case mimics the structure of the Prioritization Case in the ABEM Certifying Exam, allowing the examinee to verbalize thought processes while receiving updated clinical data from the examiner. This format emphasizes critical thinking, triage under pressure, and the delegation of tasks within a simulated emergency department environment.Research MethodsWe first alpha-tested the case with board-certified emergency medicine physicians, who evaluated both the facilitator and learner aspects of the simulation. Their feedback was used to refine the structure, flow, and clinical realism of the case. Following these edits, the revised case was implemented with emergency medicine residents across varying levels of training. This staged approach allowed us to ensure educational fidelity and enhance realism, while also confirming that the case structure aligned with ABEM exam standards and expectations.ResultsWe conducted multi-site alpha and beta testing of a novel ABEM-style prioritization case with a total of 18 emergency medicine residents (eight individual residents and two 5-person PGY2 teams) and three facilitators. Surveys were completed by two facilitators (Simulation Scenario Evaluation Tool, SSET) and eight resident participants or teams (modified usability survey). Facilitators rated the case highly, with an average global score of 87.5/100, and learners reported strong overall quality (4.4/5) and exceptional educational value (4.9/5), though clarity of instructions was rated lower (3.6/5). Participants were predominantly senior residents (62.5% PGY-3, 25.0% PGY-2, and 12.5% PGY-4). Qualitative comments emphasized the usefulness of practicing the new case format and highlighted a need for clearer explanations of structure and rules.These results suggest the case was well-received across training levels, with iterative revisions improving clarity and usability. Based on preliminary beta testing, a Total Score of 70–75% indicates passing for this case.DiscussionThis oral board-style prioritization case offers learners the opportunity to practice essential but often underemphasized skills, including rapid prioritization, task switching, and real-time decision-making. The case format reinforces critical concepts such as situational awareness and resource management within the dynamic environment of the emergency department. During initial implementation, participants reported strong engagement and found the exercise particularly valuable in preparing for the ABEM Certifying Exam. Many noted that the structure and expectations closely mirrored those of the actual prioritization station based on the example video provided by ABEM.From the instructor perspective, the standardized format promotes consistent delivery and assessment. To minimize examiner cognitive load during this high-complexity simulation, we developed a modular toolkit including a structured script, stimuli slides, and an automated scoring sheet, modeled in part after ABEM’s dual-examiner approach. A suite of Appendices supports both digital and paper-based use, allowing flexibility across educational settings.To further support formative practice, we created a scoring rubric to guide examiner feedback and learner self-assessment. However, as ABEM has not released its internal scoring criteria, this rubric is unofficial and should be interpreted with caution. It is intended for educational use only and is not designed to predict performance on the actual certification exam.TopicsPrioritization, triage, stabilization, delegation, task switching, vaginal bleeding, pediatric injury, altered mental status, septic shock, acute coronary syndrome, headache, abdominal pain, small bowel obstruction, penetrating chest trauma, urinary tract infection.

To assess how emergency medicine (EM) residents perform medical record documentation, and how well they comply with Health Care Financing Administration (HCFA) Medicare charting guidelines. In addition, the study investigated their abilities and confidence with billing and coding of patient care visits and procedures performed in the emergency department (ED). Finally, the study assessed their exposure to both online faculty instruction and formal didactic experience with this component of their curriculum. A survey was conducted consisting of closed-ended questions investigating medical record documentation in the ED. The survey was distributed to all EM residents, EM-internal medicine, and EM-pediatrics residents taking the 1999 American Board of Emergency Medicine (ABEM) In-Training examination. Five EM residents and the Society for Academic Emergency Medicine (SAEM) board of directors prevalidated the survey. Summary statistics were calculated and resident levels were compared for each question using either chi-square or Fisher's exact test. Alpha was 0.05 for all comparisons. Completed surveys were returned from 88.5% of the respondents. A small minority of the residents code their own charts (6%). Patient encounters are most frequently documented on free-form handwritten charts (38%), and a total of 76% of the respondents reported using handwritten forms as a portion of the patient's final chart. Twenty-nine percent reported delays of more than 30 minutes to access medical record information for a patient evaluated in their ED within the previous 72 hours. Twenty-five percent "never" record their supervising faculty's involvement in patient care, and another 25% record that information "1-25%" of the time. Seventy-nine percent are "never" or "rarely" requested by their faculty to clarify or add to medical records for billing purposes. Only 4% of the EM residents were "extremely confident" in their ability to perform billing and coding, and more than 80% reported not knowing the physician charges for services or procedures performed in the ED. The handwritten chart is the most widely used method of patient care documentation, either entirely or as a component of a templated chart. Most EM residents do not document their faculty's participation in the care of patients. This could lead to overestimation of faculty noncompliance with HCFA billing guidelines. Emergency medicine residents are not confident in their knowledge of medical record documentation and coding procedures, nor of charges for services rendered in the ED.

Gulf Coast Hurricane Sinks New Texas Emergency Medicine Residency

AudienceWe administered this case to senior emergency medicine (EM) residents, but it is appropriate for senior medical students and EM residents at all levels of training.IntroductionThe practice of emergency medicine regularly requires navigating challenging conversations and delivering difficult news. The way physicians interact with patients in these cases can significantly influence outcomes, including the patient’s understanding of their diagnosis and treatment plan, satisfaction with care, and willingness to follow medical advice. It is therefore imperative that emergency medicine residency training emphasizes communication skills, which will also be tested on the new American Board of Emergency Medicine (ABEM) Certifying Exam.1Educational ObjectivesThis difficult conversation case is intended to assess the examinee’s ability to disclose sensitive, unexpected information to a patient regarding a missed diagnosis of testicular cancer. By the end of this session, learners should be able to, 1) demonstrate effective communication, including establishing rapport, acknowledging a prior misdiagnosis, and disclosing a revised diagnosis of cancer, 2) elicit and react to the patient’s emotional and informational needs in an empathetic and professional manner, and 3) convey a patient-centered plan of care, including appropriate next steps and coordination with specialist services.Educational MethodsWe created a 10-minute case in the style of an Objective Structured Clinical Exam (OSCE) requiring resident examinees to break bad news. The case was revised after pilot testing on two additional faculty members. Materials included a task sheet for examinees based on example Certifying Exam materials provided by ABEM, a script for examiners with specific attention to eliciting elements of the SPIKES and NURSE frameworks, and a scoring sheet. The faculty who created the case then served as examiners during a Mock Certifying Exam Day for PGY-3 Emergency Medicine residents; alternatively, this case can be run with a standardized patient. For the remainder of this case, we will refer to the person playing the role of patient as “examiner.”Research MethodsResidents were evaluated using a 15-point rubric, with a score of 11/15 (73%) required to pass. The rubric, which was developed based on the objectives for Difficult Conversations Cases published on the ABEM website, included the following categories: establish rapport, determine baseline knowledge, disclose information, respond and react appropriately, and provide closure. Consistent with our program’s usual OSCE workflow, each resident was evaluated by a single faculty examiner. After completing the case, each resident completed an anonymous two-item evaluation: The first item, “This case increased my understanding of the certifying exam format,” was scored on a 5-point Likert scale from “strongly disagree” to “strongly agree.” The second item, “How would you rate the overall quality of this case?” was scored on a 5-point Likert scale from “poor” to “excellent.” The survey and protocol were reviewed by our institutional IRB on 12/3/2024, and this project was determined not to meet the definition of human subjects research.ResultsSeventeen PGY-3 emergency medicine residents completed the case, with a mean score of 13.35/15. Seventeen residents (100%) completed the post-case evaluation. When asked if this case increased understanding of the certifying exam format, 17 (100%) agreed or strongly agreed. When asked about the overall quality of the case, 17 (100%) said either very good or excellent. The case received a score of 4.82/5 for overall quality.DiscussionThis case was effective, as evidenced by the results that all residents agreed or strongly agreed that the case increased their understanding of the certifying exam content, and all residents considered the case quality to be very good or excellent. Residents overall performed well on the case but may benefit from additional instruction on disclosure of sensitive, unwanted, or unexpected information. Specifically, residents should be taught to use the SPIKES (Setting, Perception, Invitation, Knowledge, Emotions/Empathy, Strategy/Summary) or GRIEV_ING (Gather, Resources, Identify, Educate, Verify, Give Space, Inquire, Nuts and Bolts, Give) frameworks for breaking bad news and NURSE (Naming, Understanding, Respecting, Supporting, Exploring) statements for responding to emotions.2–4 This case and its grading rubric could easily be adapted to other difficult conversation scenarios to prepare emergency medicine residents or graduates for their certifying exam. However, because each resident was evaluated by a single examiner within one residency program, inter-rater reliability could not be assessed, and generalizability may be limited.TopicsDifficult conversations, breaking bad news, communication, certifying exam preparation.

Forget Paris: Emergency Physicians Can Soon Sit for US Critical Care Boards

Audience and type of curriculumThis curriculum is designed for junior and senior emergency medicine (EM) residents who are preparing for the new American Board of Emergency Medicine (ABEM) Certifying Exam.Length of curriculumThis curriculum can be completed over the course of an EM residency program to prepare junior residents for the individual content areas encountered on the new Certifying Exam. Alternatively, it can be implemented during a single session to simulate the actual exam for senior residents.IntroductionWith ABEM transitioning to a new format for its Certifying Exam, there is a critical need for targeted preparatory materials that reflect these changes.Educational GoalsThe goal of this curriculum is to equip residents with the knowledge and skills needed to succeed on the ABEM Certifying Exam. It includes a comprehensive set of case types expected to appear on the Certifying Exam, with a focus on assessing competencies not currently evaluated by the existing written Qualifying Exam and retiring Oral Exam. The curriculum is designed to be delivered to current residents in a single-day exam format to closely replicate the structure and experience of the new Certifying Exam.Educational MethodsThe educational strategy used in this curriculum consists of a set of eight simulation scenarios written in an Observed Structured Clinical Examination (OSCE) format. Each scenario targets a distinct area of the recently introduced ABEM Certifying Exam. These content areas include clinical decision-making, prioritization, reassessment, difficult conversations, managing conflict, ultrasound, procedural skills, and patient-centered communications. The OSCE structure intentionally reflects that of the ABEM Certifying Exam to enhance realism, ensure consistency, and maintain educational relevance.Research MethodsThis eight-case simulation curriculum focuses on core EM competencies, including decision-making, communication, conflict resolution, prioritization, procedural skills, and ultrasound. Initially developed by experts in simulation and medical education, each case was subsequently refined through a structured peer review process. This process involved written evaluations by external reviewers followed by pilot testing across multiple EM residency programs and at the Society for Academic Emergency Medicine Annual Meeting. Faculty facilitators and resident learners provided targeted feedback using the Simulation Scenario Evaluation Tool1 and modified usability surveys, assessing factors such as case realism, scenario flow, clarity of learning objectives, alignment of assessment criteria, and practical feasibility for implementation.ResultsPilot testing across multiple institutions and at a national academic meeting demonstrated the curriculum’s strong educational value, clarity, and usability. Feedback from both facilitators and residents was overwhelmingly positive, highlighting the simulation scenarios’ realism, clinical relevance, and effectiveness in exam preparation.DiscussionThis comprehensive simulation-based curriculum, designed to align with the ABEM Certifying Exam, proved to be feasible, effective, and well-received by both learners and facilitators. Key insights from its implementation emphasized the importance of thorough faculty preparation, flexibility in adapting to available resources, and the use of structured debriefing to support learning. Thoughtfully designed simulation experiences can significantly enhance EM resident preparedness for high-stakes assessments.TopicsCertifying Exam, simulation, board certification, American Board of Emergency Medicine, residency.

AudienceThis practice Certifying Exam Communication case is intended for emergency medicine resident physicians (both junior and senior).IntroductionConflict is the result of two parties who differ in their expectations, agendas, personal needs, backgrounds, and/or communication styles. Emergency medicine physicians are faced with conflict in various forms in the workplace on a regular basis related to task content, interpersonal differences, and processes.1,2 When conflict is not managed appropriately, it can result in subpar patient care and poor team morale.3,4 Thus, conflict management is an important skill for all emergency medicine physicians. With this in mind, ABEM (the American Board of Emergency Medicine) has now chosen to assess candidates’ conflict management proficiency as part of its new Certifying Exam.5 As educators, we must prepare trainees for both the certification exam and the clinical setting by creating opportunities for practice, focused evaluation, and formative feedback. To strengthen our certifying exam preparation curriculum, we designed a certifying exam practice case to help residents learn how to manage conflict.Educational ObjectivesThe following objectives, which align with ABEM’s recommended objectives, address the nuances of managing conflict. By the end of the session, learners should be able to: 1) demonstrate familiarity with the ABEM Managing Conflict case format and structure, 2) establish rapport by developing connection and trust with the admitting physicians, 3) demonstrate understanding of the other party’s position by verbalizing thoughtful and specific questions about his/her concerns, 4) explain his/her own position clearly and insightfully, 5) acknowledge divergent positions with thoughtfulness and insight, 6) identify interests shared by both the psychiatrist and hospitalist as well as what is in the best interest of the patient, and 7) propose a path forward which accounts for the interests of all parties involved.Educational MethodsWe developed a 10-minute OSCE (Objective Structured Clinical Examination)-style case requiring the resident examinee to manage a conflict with consulting physicians. The ABEM certifying exam will utilize standardized patient actors. For our case, the faculty examiner served as the actor who alternated between the two roles required by the case.Research MethodsWe piloted this case with 18 PGY-3 emergency medicine residents. We developed a grading rubric based on ABEM’s six published conflict-management case learning objectives. To pass the case, learners had to score 12 or more of the 18 available points (67%). Each learner was also asked to complete a post-case evaluation associated with a 5-point Likert scale.ResultsWhen asked whether the case increased their understanding of the new ABEM certifying exam format, 18/18 (100%) of the participants replied “agree” or “strongly agree." When asked to assess the overall quality of the case, 16/18 (88.89%) of the participants stated that it was “very good” or “excellent.” The case received a mean score of 4.61/5. The mean critical action completion score was 17.61/18.DiscussionWe sought to create a practice certifying exam case that provided learners with a high-fidelity opportunity to both understand ABEM’s new certifying exam requirements and to be evaluated on how well they managed conflict. Our results reflect that most learners felt we addressed these aims, and that overall, our educational assessment was effective.TopicsConflict management, communication, certifying exam.

Antitrust: Emergency Medicine Physicians Lack Standing to Bring Antitrust Action Against Physician-Certification Organization-Daniel v. American Board of Emergency Medicine, 2005 WL 24705430 (2d Cir. Oct. 7, 2005). Expert Testimony: Expert Witnesses Must be Prepared to Produce Positive Evidence to Establish General Causation in Drug Products Liability Actions-Ruggiero v. Warner-Lambert Co., 424 F.3d 249 (2d Cir. 2005). Antitrust: Emergency Medicine Physicians Lack Standing to Bring Antitrust Action Against Physician-Certification Organization-Daniel v. American Board of Emergency Medicine1-Emergency medicine doctors brought suit against a medical specialty certification board for emergency medicine and hospitals operating residency programs in emergency medicine, alleging that the defendants conspired to unreasonably restrict competition in the market for emergency medicine physicians.2 After establishing that the Clayton Act's3 worldwide service of process provision only applies for cases that satisfy the venue provision, which was not satisfied here, the U.S. Court of Appeals for the Second Circuit held that the plaintiffs did not have antitrust standing.4 In so ruling, the Court of Appeals affirmed the District Court's decision to dismiss the plaintiffs' claims.5 The defendants in this case were the American Board of Emergency Medicine (ABEM), the Council of Emergency Medicine Residency Directors (CORD), and various hospitals.6 ABEM is a Michigan not-for-profit corporation that certifies physicians in emergency medicine.7 All of its daily activities take place in East Lansing, Michigan, where its offices, records and staff are located.8 ABEM is a member of the American Board of Medical Specialties, and is one of twenty-four medical certification boards.9 ABEM establishes educational criteria for emergency medicine and certifies physicians who pass their examination.10 An ABEM certification is not required to practice emergency medicine in any state.11 In 1976, when ABEM first sought to become a specialty board, only thirty emergency medicine residency programs existed in the U.S.12 In order to increase recognition of the specialty, ABEM proposed two eligibility tracks for applicants seeking to take the certification exam: (1) the practice track, requiring 7,000 hours and 60 months of practicing or teaching emergency medicine; and (2) the residency track, requiring completion of an approved residency training program.13 ABEM specifically limited the practice track as an eligibility alternative for the first eight years, from 1980-1988, because it expected additional residency training programs to develop over time, thus making the residency track a practical requirement.14 CORD, another Michigan not-for-profit corporation, is a national association that facilitates communication among the directors of emergency residency training programs.15 The defendant hospitals originally included twenty-eight hospitals that hire ABEM-certified doctors and operate residency training programs, but only nine remained in this action.16 None of these defendant hospitals are incorporated in New York or maintain their principal place of business in New York.17 Dr. Gregory Daniel and 175 other named plaintiffs, along with approximately 14,000 members of the proposed plaintiff class were physicians who currently practice or who have practiced emergency medicine and who would be eligible to take the ABEM exam if the practice track still existed.18 Plaintiffs alleged that by closing the practice track and placing a premium on ABEM certification, ABEM, CORD, numerous hospitals, and various individuals associated with these organizations unlawfully restrained trade and monopolized the market for ABEM-certified and ABEM-eligible physicians.19 Specifically, plaintiffs argued that the defendants conspired to limit the pool of eligible applicants, thus creating an artificial shortage of ABEM-certified and ABEM-eligible physicians, with the end goal of demanding super-competitive pay. …

Currently, the Accreditation Council of Graduate Medical Education requires time-based pediatric experiences for emergency medicine (EM) residents in both pediatric emergency medicine (PEM) and critical care settings. The American Board of Emergency Medicine has published the Model of the Clinical Practice of Emergency Medicine, which is a list of content an EM resident should learn. However, this list is large and without prioritization and therefore can be difficult to incorporate into time-limited curricula. The primary objective of this study was to develop comprehensive categorization of PEM content using an EM lens. The second objective was to suggest a prioritization for the EM learner of the enumerated PEM elements. We first assembled a comprehensive list of PEM concepts, diagnoses, and procedures that might be taught to EM residents. We then convened focus groups composed of key stakeholders to help formulate content and concept themes important for EM resident training. Once the themes were identified, we divided the list of PEM topics into appropriate themes and then carried out a second round of focus groups expanded to include more diverse expert input for prioritizing the elements of the comprehensive list within each theme. We prioritized 168 important PEM concepts from previous standards and emerging PEM literature among 10 identified themes: the pediatric normal, the bottom-line boil-it-down approach, common presentations, high-acuity pediatric cases and procedures, differences between children and adults, same between children and adults, red flags, infrequency of caring for a child compared with an adult, keep breadth but promote self-directed depth, and triage and disposition. Based on input from stakeholders in EM resident education, we identified key themes within PEM education and created a framework for the hierarchical categorization of PEM content for within an EM residency.

Longitudinal Study of Emergency Physicians by the American Board of Emergency Medicine: 1995 Interim Survey Results