Prep
Review These Materials
Case content, blueprint, and sample cases can be found here. Other resources:
Single Patient Case Structure
Managing the Case
You are in charge of the patient and should take an appropriate patient history, collect physical data, develop a differential diagnosis, provide treatment as appropriate, and communicate your requests, diagnosis, and treatment to the other hospital personnel, patient, and others.
Some information may be withheld to give you a chance to show your skills in a particular area.
Obtaining Physical Examination Information
Some patient information will be provided on the admitting sheet or in other opening statements. Additional physical information you need will be provided by the examiner as you ask for it. Be specific about what information you are seeking. If your question is not specific enough, the examiner may ask, “What you are looking for?”
Available Resources
You can request any resource commonly available in an emergency department. However, ABEM may ask you to manage the patient without certain resources or information to assess a particular skill area. If you would like to request alternative tests, resources, or information, you may do so. You will be given a list of laboratory normal values, common abbreviations, and a note sheet with a body outline to use. These will also be emailed to you prior to their exam. Â
Knowing Drugs and Dosages
You may need to know common drugs and dosage amounts, especially for critical situations. You can look up drug and dosage information without penalty, but the examiner may deny your request. If you are permitted to look up the drug or dose, the examiner will reply, “The correct drug/dose has been given.” But you must specify the drug and dosage amount.
Laboratory Data and Imaging
Order laboratory data and imaging, such as CT scans and X-rays, as you would in the emergency department. Examiners will share their screen to deliver lab and imaging results. Candidates will be able to enlarge their own screen for viewing. Â
Discussing the Case with Other Medical Professionals
Part of your score is based on your interactions with nurses, consultants, and other medical professionals. When the examiner plays the part of the nurse or consultant, remember to use medical language.
Informing the Patient and Family
Part of your score is based on your interactions with the patient and their loved ones. The examiner can only score you on verbal interactions. If you would discuss the patient’s condition with the patient, family, or others in your hospital, you should do so during the exam. Remember to explain information in a way that your patient will understand.
Help from Other Hospital Personnel
If you need help from hospital personnel to manage the patient, you must ask the examiner. This includes a nurse, consultant, security officer, social worker, or other personnel. When you are ready to ask for the patient’s history information, the examiner will play the role of the patient. The examiner will answer the questions you ask, so you may need to ask follow-up questions. Keep in mind that the simulated patient may not understand medical jargon, and they may be hesitant to provide information about sensitive subjects.
Single Patient Case Review Resources
Structured Interview Case Structure
The structured interview is more like a discussion than a standard single case encounter. You will have 15 minutes for the interview. All structured interviews have an admitting form and a stimulus that lists the pertinent positives and negatives of lab results. Additional images, such as X-rays and photographs, may also be included. All candidates will receive the same stimuli at the same point in the case encounter, so you may receive some information that you did not indicate you would obtain.
The examiner will begin the encounter by describing the patient presentation and displaying the admitting form, which contains additional background information about the patient. The examiner will then lead you through the encounter by asking you a series of scripted questions about steps you would take in managing the patient and why you would take certain actions. For example, after asking what physical findings you would be looking for, the examiner might ask what you would be looking for on specific portion of the physical exam. It is important that you listen closely to the questions the examiner is asking and answer each question directly.Â
Structured Interview Case Review Resources
Prepare for Exam Day
Know your rights and responsibilities as an exam candidate, as well as these administrative guidelines:
Complete Your Tech Check
Closer to exam day, ABEM will send you an email with instructions on how to complete a 15-minute tech check with our tech vendor, Markey’s.
General tech needs for this exam:
- Desktop or laptop with camera and microphone.
- Reliable high-speed Internet, i.e., about 1.5-2 Mbps download and upload speed for a quality video call.
- Virtual backgrounds are not allowed
- An examination space that is quiet and free of prohibited items
- Chromebooks are not recommended
Allowed Items
- Health aids, such as glasses and asthma inhalers. These items must not have electronic components.
- Nursing equipment and medical devices contingent upon approval of a courtesy accommodation.
- Tissues (Kleenex) with no writing.
- Cough drops, small candies, granola or protein bars, or other small snacks. These items cannot be moved or unwrapped during a case administration.
All items are subject to inspection.
Prohibited Items
- Watches (smart or analog)
- Beepers or pagers (active or turned off)
- Cell phones
- Additional computers and other electronic information storage devices of any kind
- A second monitor
- Cameras or recording devices of any kind except for the camera on the computer being used to take the exam
- MP3 players, iPods, or any digital recorder or player
- Any electronic storage device, including watches or smartwatches with such functionality
- Notes or study materials (other than those provided by ABEM for the exam)Â
- Purses, briefcases, or backpacks
Dress Code
Your examiners will be dressed in professional business attire. This may include dress slacks and a jacket and tie, dresses, and pantsuits. Exam candidates may choose to dress similarly, but there is no dress code. Attire is not a factor of the evaluation.
Keep in mind that your entire exam administration will be recorded and you are allowed to stand up during breaks.
Candidate Expectations
You will be expected to request any necessary management information, order any tests, and communicate information to hospital staff, the patient, and the patient’s family. If information is not readily apparent—such as who is in the room with the patient—ask your examiner for the information.
- Timing:Â You are expected to be on time for your exam session.
- Video Recording:Â Your camera and microphone will need to remain on for the entirety of the examination and you will need to consent to the recording.
- Artificial Environment:Â While there is artificiality in managing an imaginary patient in a virtual setting, you are expected to manage the patient as though he or she is in the virtual breakout room, and you are solely in charge of the patient.
- Conduct: ABEM will ask you to attest to the ABEM Policy on Examination Irregularities, describing how ABEM defines cheating.
Examiner Expectations
ABEM examiners are extensively trained, and each case is reviewed, discussed, and practiced before being given at the exam. All examiners receive performance feedback during and after the examination to help provide consistent case play and scoring.
- Timing:Â The examiner is expected to keep time during the examination.
- Impartiality:Â For candidates to receive an unbiased assessment of their abilities, let the examiner know that you have interacted with her/him previously and ABEM will assign another examiner to administer the case. This change can happen quickly and will not take time away from your examination.
- No Feedback:Â Examiners are trained to remain neutral during the examination.
- Examiner Roles: The examiner will play different roles, but you may request information from any role in the case. Tell the examiner you would like to “ask the nurse . . .” or “I’d like to speak to the family…”
- Examiner Characteristics:Â All ABEM examiners are clinically active, emergency physicians who have been ABEM certified for at least five years.
Reminders
- Exam content is confidential and copyrighted.
- You cannot ever share or discuss exam content with anyone at any time in any format.
- You cannot access outside information while taking the exam.
- Anyone who violates these policies are subject to sanctions.
- Print your Exam Day Packet (single-sided) and have it with you on exam day.
