Certifying Exam Scoring
Introduction
The new Certifying Examination (CE) is designed to provide the certified physician a more valuable credential. The new CE assesses competencies that the specialty, healthcare systems, and the public have identified as essential to determining that a physician has demonstrated the capacity to practice in a safe, high-quality manner.
There are several cases that assess explicit skills (e.g., difficult conversations). The various case types and references are described here. Because the skills that are being tested are often unique to the case type, the scoring criteria can also be unique to the case type.
The following scoring criteria show the types of parameters upon which candidates will be scored. ABEM will update the general scoring criteria as needed.
General Scoring Criteria by Case Type
Below are the general criteria that will be used to evaluate candidate performance in each case type.
Clinical Care Cases
Clinical Decision Making
This case is a structured discussion with an examiner where a physician will describe the steps necessary to diagnose and treat a patient with an undifferentiated presentation.
The successful physician will:
- identify the focused historical information a physician would ask
- describe physical exam findings and their significance to the presentation
- develop an appropriate differential diagnosis
- order appropriate tests and interpret them accurately
- stabilize and treat the patient
- reassess the patient as care evolves and modify care as needed
- provide anticipatory guidance at time of disposition
- discuss clinical decision-making rationales
- demonstrate comprehension of pathophysiology
Prioritization
This case is a structured discussion with an examiner. This case will assess the ability to prioritize multiple patients in the emergency department or prehospital setting and provide stabilizing care.
The successful physician will:
- Determine acuity of patient(s)
- Provide appropriate and immediate stabilizing care
- Respond to changes in patient acuity and triage new cases as presented
- Use team resources appropriately
Communication and Procedures Cases
Difficult Conversations
This case involves disclosing sensitive, unwanted, or unexpected information to a patient or family member.
The successful physician will:
- Establish rapport
- Determine baseline knowledge
- Disclose information
- Respond and react appropriately
- Provide closure
Managing Conflict
This case requires a physician to negotiate patient care when there are differing opinions about what is best for the patient.
The successful physician will:
- Establish rapport
- Understand the other person’s position
- Explain their own position
- Acknowledge divergent positions
- Identify shared interests
- Propose a path forward
Patient-Centered Communications
This case assesses a candidate’s ability to effectively communicate with patients, families, or advocates to create a patient-center encounter.
The successful physician will:
- Establish rapport
- Acknowledge and respect the patient’s perspectives
- Communicate information effectively to facilitate mutual understanding
- Share results of relevant diagnostic studies and other information
- Support shared decision-making to optimize outcomes.
Procedures
For this case, the physician must demonstrate an understanding of procedures integral to the practice of emergency medicine as well as demonstrate the proper technique for performing the procedure.
The successful physician will:
- Describe the indications, contraindications, and potential complications associated with performing the procedure
- Prepare for the procedure
- Demonstrate technical proficiency while performing the procedure
- Provide post-procedure management
Reassessment
This case requires a reassessment of the patient that integrates new information.
The successful physician will:
- Obtain additional information after an unexpected change in a case that is in progress
- Analyze impact of new information
- Modify the patient’s care as appropriate
- Reassess case
- Describe next steps in patient’s care
- Articulate any change in treatment
- Consider system-based factors
Ultrasound
For this case, physicians must demonstrate the ability to acquire and interpret multiple ultrasound videos. Candidates will obtain ultrasound images on a standardized patient with the aid of the examiner who is able to change the settings of the machine to acquire the images. The physician does not need to be familiar with the specific ultrasound machine being used, but should be able to troubleshoot a suboptimal image with respect to mode, gain, depth, etc.
The successful physician will:
- Demonstrate proficiency at obtaining ultrasound images
- Interpret ultrasound videos accurately
- Provide patient-centered care