The ABEM Board Exam: A Comprehensive Guide  

We're here to help you tackle the ABEM board exam, a crucial milestone in your career as an emergency medicine physician. Think of this exam as more than just a hurdle; it's a reflection of your dedication and skill. We'll walk you through the details of the ABEM exam, providing insights, study tips, and strategies to bolster your preparation. With our support, you'll gain the confidence and knowledge needed to navigate this important challenge successfully.

Your Exam Structure

The ABEM Qualifying Exam contains approximately 305 single-best-answer, standard multiple-choice questions that follow the ABEM Blueprint. Each question is in paragraph form with an answer set containing one correct answer and three or four incorrect answers.

The exam is divided into two sections each lasting 3 hours and 10 minutes, separated by a one-hour, scheduled break. The entire exam appointment takes approximately 8 hours to complete with 6 hours and 20 minutes of total testing time.

Each section of the examination consists of both pictorial and non-pictorial multiple-choice questions. Pictorial questions refer to stimulus images such as photos of X-rays, ECGs, rhythm strips, pictures, etc. These images will be presented in a separate tab along with the relevant test question on the computer screen. You will need to interpret ultrasound images for pictorial questions on the Qualifying Exam. Two reference documents are available to you during the exam: a list of common abbreviations used in the exam, and a list of normal laboratory values.

2024 Exam Dates

You'll select your date and Pearson VUE location when you sign up to take the exam.  

Pearson VUE 2024 ABEM Instructions

ABEM Become Certified Instructions

Exam Features

Let's get the preliminaries out of the way.  

Each section of the examination consists of both pictorial and non-pictorial multiple-choice questions.  Pictorial questions refer to stimulus images such as photos of X-rays, ECGs, rhythm strips, pictures, etc. These images will be presented in a separate tab along with the relevant test question on the computer screen.

You will need to interpret ultrasound images for pictorial questions on the Qualifying Exam.

Two reference documents are available to you during the exam: a list of common abbreviations used in the exam, and a list of normal laboratory values.

While not a huge part of the exam, image interpretation is a sufficiently large part of the score that it can tank you.  Make sure your study resources have plenty of dermatology, x-ray, ECG, strips, ultrasounds and CT's.  The distractors on image questions aren't that difficult - they aren't throwing any ringers at you.

That's true of most of the questions.  Distractor answers are carefully designed to catch you guessing.

What to Study

70% of the test is going to be on acute and emergent conditions, and of that 70%, well over half is clinical presentation, cardiac, and respiratory.  

The short answer to the critical study areas is the common types of incidents that come into an emergency room.  Knock out the basics and then you can play Dr. House.

Here's where your study guides, books, and online programs can help a lot.  A system that pulls together boards level tests, in the same percentages as the EM Model blueprint will give you an accurate measure of how you are going to do on the ABEM boards.

Question Styles

As a medical resident, you probably have horribly hard-won expertise at learning theory, but let's recap question types briefly.

Assessment questions: these are the "boards style questions".  Assessment questions are designed determine your knowledge level, not really teach or remediate.  They normally consist of (a) the correct answer, (b) two or more distractors that you'd guess at if you were vaguely familiar with the topic, and (c) one or more distractors that you'd guess if you were completely unfamiliar with the topic.

Teaching questions: these are the more in-depth case study questions, or complex questions that require thought.  Teaching questions are designed to remediate and drive long term retention of material.  Challenger uses both (and you can select the types you want to use for your tests).

If you're going to do an assessment of your knowledge level, work through it in short exams over topics, not in marathon sessions.  If you've missed questions in the topics, then switch to completing all the questions in a topic, or mix the exams up into assessment and teaching questions.

Content Specifications

ABEM follows the EM Blueprint (officially, The Model of the Clinical Practice of Emergency Medicine, or EM Model for short) for the Qualifying Exam.

While questions can originate from any content area within the model, some areas are routinely selected. The lists below describe the relative weight given to different elements of the EM Model in constructing the examinations:

Medical Knowledge, Patient Care, and Procedural Skills

• 1.0 Signs, Symptoms and Presentations: 10%
• 2.0 Abdominal & Gastrointestinal Disorders: 7%
• 3.0 Cardiovascular Disorders: 10%
• 4.0 Cutaneous Disorders: 3%
• 5.0 Endocrine, Metabolic & Nutritional Disorders: 5%
• 6.0 Environmental Disorders: 2%
• 7.0 Head, Ear, Eye, Nose & Throat Disorders: 4%
• 8.0 Hematologic Disorders: 3%
• 9.0 Immune System Disorders: 2%
• 10.0 Systemic Infectious Disorders: 7%
• 11.0 Musculoskeletal Disorders (Non-traumatic): 3%
• 12.0 Nervous System Disorders: 6%
• 13.0 Obstetrics and Gynecology: 3%
• 14.0 Psychobehavioral Disorders: 2%
• 15.0 Renal and Urogenital Disorders: 3%
• 16.0 Thoracic-Respiratory Disorders: 7%
• 17.0 Toxicologic Disorders: 4%
• 18.0 Traumatic Disorders: 9%
• 19.0 Procedures & Skills: 8%
• 20.0 Other Components: 2%

Acuity Frames: Target (± 5%)

• Critical: 30%
• Emergent: 40%
• Lower Acuity: 21%
• None: 9%

Physician Tasks

For this dimension, the Board has assigned the following specific percentage weights to the Modifying Factor of age:

• Pediatrics: 8% minimum
• Geriatrics: 6% minimum

Pass Rates

Bluntly, pass rates for the ABEM exam are concerning.  In 2023, the pass rate for first-time takers who had completed an EM residency were down to 88%.  That's an unreasonably high failure rate.

The pass rate for first-time test takers is usually several points higher than for repeat test-takers or those requalifying for EM certification after a hiatus.  You'd expect to see normal failure rates for residency-trained first-time test takers to be more in the 1:20 range than the 1:11 range.

Do ITE Scores Indicate Board Exam Scores?

To a degree.  Your ITE scores provide more of a negative indicator of your potential boards exam score.  If you did poorly on ITE's, you have your work cut out for you.  If you did well on ITE's, it doesn't mean you'll score the same on the boards, but it is a positive indicator.

Start preparing early, pick a couple of good resources, and use them.  Frequent short study sessions, done in a methodical manner, are going to do a lot more for you than cramming.

2023 Exam

It wasn't just Challenger that looked questioningly at the 2023 scores.  We didn't have a high failure rate in our audience, but we always fear divergence, where exam test questions start to reflect poorly against the EM Model that we rely on.

There were a lot of suggestions for the cause in publications, and on networks like the Student Doctor Network.  Everything from COVID interfering with teaching, to poorly designed questions and errors on the exam.

It's not a happy thing to tell you, but given what happened in 2023, devote some extra time to studying. 

Strategizing Your Preparation

Comprehensive Study Material

Choose study resources that are aligned with the ABEM Blueprint, ensuring that you cover every topic in depth. Resources like Med-Challenger Emergency Medicine offer tailored preparation with a vast question bank of constantly updated content.

Mock Exams and Simulations

Simulated exams, such as Med-Challenger's Board Exam Simulator, part of the Emergency Medicine Boards Prep Course, are instrumental in gauging your preparation level. They offer insights into your strong areas and those requiring improvement, enabling a focused preparation strategy.

Time Management

The ABEM exam evaluates candidates under timed conditions. Practice with timed mock exams to enhance your time management skills, ensuring that you can navigate through the questions effectively and efficiently during the actual exam.

See also: How I Prepared for and Passed the ABEM Qualifying Exam 

Navigating the Exam Day

Stay Calm

It’s natural to feel anxious. However, staying calm and composed is crucial to think clearly and make informed decisions during the exam. Knowing what to expect by checking out At The Exam can also help put your mind at ease.

Pace Yourself

The exam is structured to evaluate a broad spectrum of your skills and knowledge. Pacing yourself is crucial to ensure that every section of the exam is attempted with equal focus and concentration.

Review Your Work

If time permits, review your answers. Sometimes, a second look can offer new perspectives and insights.

See also: What Emergency Medicine Physicians Say About Med-Challenger