Board with emergency medicine?

I passed my American Board of Emergency Medicine (ABEM) written board exam! This was a necessary step in the process of becoming a board certified emergency physician in America. To be eligible for the exam, one has to complete an EM residency and be a licensed doc. I completed the three-year EM residency at Johns Hopkins in June of 2005. By passing the three steps of the USMLE examination process, and graduating from medical school, you can apply to a state for a license to practice medicine. You also have to sign-off on forms that establish that you have not ‘screwed the pooch’ (i.e. felons and despots and vampires need not apply). Once the written ABEM exam has been hurdled, there is an oral exam. Mine will be in either the spring or the autumn of 2006.

The exam was on a dreary Sunday morning in November last year. I took it in Chicago at some hotel out by O’Hare. There were several hundred shiny new, fresh faced EM docs in a massive room. About 4 nervous souls with foreign accents were the only smokers huddled outside in the rain huffing butts. The exam was a few hours in the morning and a few hours in the afternoon, punctuated by a lunch break. Lunch was not one of the benefits the extortionate fee entitled us to. My wife sent me with a turkey sandwich and a Vitamin Water. The format was multiple choice. We were handed out booklets of questions and illustrations, and we penciled-in bubble-sheets with our answers. I have taken about a thousand of these exams over the years, so it was all pretty familiar.

The exam was hard as hell. I passed by the skin of my teeth. It wasn’t enough to recognize the disease or even the diagnostic test or the treatment as almost every question went one step beyond. If the set-up suggested a disorder, and the standard of care treatment was assumed, the question would ask what the most likely complication of the treatment was. Time was also a factor. You have to work pretty fast, and although I didn’t run out of time, I was glad I had practiced with one eye on the clock.

We are sworn to secrecy about the exam. So I cannot mention anything specific. But there were lots of questions from pediatrics, cardiology, and orthopedics. Lots of radiology along the lines of ‘what is the best study for…’. I was surprised at the dearth of surgery and OB/Gyne questions. But, of course, each test is probably a different mix of subjects. Past performance is no indicator of future flavors of pain.

I always recommend that students and residents prepare for these standardized exams by doing practice questions. I would reiterate that advice after taking the ABEM written exam. In particular, ACEP (American College of Emergency Physicians) sells a book of 600 practice questions that I found extremely helpful (Emergency Medicine Examination & Board Review by Susan B. Promes, MD, FACEP). The broad scope of emergency medicine coupled with the specificity of the questions means that unless you have a photographic memory and have committed Tintinalli and Rosen to it, it would be difficult to study from those to good effect.

BTW, there is a competing ‘board’ of emergency medicine that is for folks who haven’t done a residency in EM. I admit to being biased: completing a residency in the specialty is important to being a good EM doc in my opinion. Certainly, there may be docs out there who are working in an ED (emergency department) but trained in another specialty and who do good work. But, if you aspire to be a new EM doc, an accredited residency and ABEM is the only way to go.