The virtual Oral Exam is a half-day session held virtually via Zoom. It consists of seven cases: five single-patient scenarios and two structured interview cases that you must manage. You are expected to handle each simulated case as though these are real patients in the emergency department.
Exam Session
Typically, only you and the examiner will be in the virtual exam breakout room. Other people may enter the virtual room as well to verify that the examiner is delivering and scoring the exam according to Board standards. Others entering the room will not interact with you. Only the examiner’s scores will count toward your final score.
It's important to ABEM that you receive an unbiased examiner. All ABEM examiners are clinically active, ABEM-certified emergency physicians who have gone through extensive training on the examination process.
Starting the Case
Before starting the case, you will need to verify your identity. The examiner will then answer any of your administration questions. You may begin the case once you have received the introductory materials from the examiner.
Time Limits
Because of the dynamic nature of the cases, the examiner cannot give you a time warning, but will keep track of the time. Instead, you should listen for cues from the examiner that tell you whether you should slow down or speed up. For example, “The nurse is asking what you would like to do next,” is a cue that you should move a little more quickly. “The nurse asks you to repeat your orders,” is a cue that the examiner needs more time to record your actions. It's important to demonstrate effective time management during each case. Cases are designed to be manageable within the time limits, and the examiners help by guiding the pace of each encounter, so you have enough time to finish. You are not scored on speed, so be responsive to examiners' efforts to either slow down or move the case along.
Technical Issues
If you encounter technical issues during your scheduled exam session such as Wi-Fi connectivity, power loss, or computer issues, please contact ABEM immediately so we can troubleshoot or reschedule your examination immediately.
Single Patient Cases
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.
Review Sample Cases
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 candidates prior to their exam.
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.
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.
Structured Interview
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.
View standard interview materials and watch a demonstration video
Ending the Case
Once you have finished managing the patient, the examiner will end the case. Usually, the examiner will say something like, “This ends the case.” The examiner will ask you to shred your case notes on-screen. You may not need the full testing time, which is not a reflection of your performance. The examiner will then leave your virtual exam room. Please wait for your next examiner. After your last case, an ABEM staff member will let you know when you have completed the exam administration and can log off.