In-Training Examination

Dates and Fees

ABEM develops and administers an In-training Examination (ITE) annually to Emergency Medicine residency programs for a small fee. Programs are not required to participate in this exam.

The In-training Exam targets the expected knowledge and experience of an EM3 resident. The exam is not designed for program evaluation, and the results should not be used to compare programs or residents across programs.

Requirements and Process

The ABEM ITE is available to:

See the Policy on ITE Accessibility for more information.

The ACGME accreditation decision must be made on or before November 1 of the year prior to the exam administration in order to be eligible to take the ITE. ABEM mails ITE registration information to all residency programs in early December. Participating residency programs pay the examination fee for each resident registered to take the ITE. ABEM does not communicate directly with residents in this process.

The ITE is an exclusively online format administered over a five-day testing window that begins on the last Tuesday of February. Programs have the option to administer the ITE on any single day during the five-day testing window or on more than one day (e.g., across any or all of the five designated testing days). Programs that have the ability to handle simultaneous online testing of all their residents on a single day of testing may choose to administer the examination on a single day. Programs that have limited capacity for online testing may choose to administer the ITE on more than one day.

Exam Content

The In-training Exam is a comprehensive examination covering the breadth of Emergency Medicine. The exam contains 225 multiple choice questions and takes about 4.5 hours to complete.

Questions are drawn from EM Model (EM Model). All questions are written by a group of emergency physicians with special training in question writing. New questions pass through an extensive series of reviews, followed by field testing.

Sample Exam Questions

EM Multiple Choice Question Content Blueprint

The lists below describe the relative weight given to different elements of the EM Model in constructing the examination.

EM Blueprint Revisions

A revised EM MCQ Exam Blueprint will be used to construct exams beginning in the fall of 2020. 
View Revised Blueprint

Medical Knowledge, Patient Care, and Procedural Skills

  • 1.0 Signs, Symptoms and Presentations: 9%
  • 2.0 Abdominal & Gastrointestinal Disorders: 8%
  • 3.0 Cardiovascular Disorders: 10%
  • 4.0 Cutaneous Disorders: 1%
  • 5.0 Endocrine, Metabolic & Nutritional Disorders: 2%
  • 6.0 Environmental Disorders: 3%
  • 7.0 Head, Ear, Eye, Nose & Throat Disorders: 5%
  • 8.0 Hematologic Disorders: 2%
  • 9.0 Immune System Disorders: 2%
  • 10.0 Systemic Infectious Disorders: 5%
  • 11.0 Musculoskeletal Disorders (Non-traumatic): 3%
  • 12.0 Nervous System Disorders: 5%
  • 13.0 Obstetrics and Gynecology: 4%
  • 14.0 Psychobehavioral Disorders: 4%
  • 15.0 Renal and Urogenital Disorders: 3%
  • 16.0 Thoracic-Respiratory Disorders: 8%
  • 17.0 Toxicologic Disorders: 5%
  • 18.0 Traumatic Disorders: 10%
  • 19.0 Procedures & Skills: 8%
  • 20.0 Other Components: 3%
  • Total: 100%

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

Exam Results

Programs that administer the ITE will receive detailed examination results for all of their residents who took the examination. The exam does not have a passing score. There is a strong relationship between the ITE and Qualifying Exam scores. Physicians with higher ITE scores have a higher likelihood of passing the Qualifying Exam and those with lower scores have a lower likelihood of passing the Qualifying Exam.

The exam is not designed for program evaluation, and the results should not be used to compare programs or residents across programs.

Contact or call 517.332.4800 ext. 388 with any questions.