The new ABEM Certifying Exam format, explained
The ABEM Certifying Exam — the emergency-medicine oral boards — is built around two buckets of cases: clinical cases and communication cases. Here is what each bucket contains, how long it runs, and how to prepare.
How the exam is structured
The exam splits into two groups of cases. You are assigned to start with one group or the other, then move to the second.
Clinical cases
Four cases, 15 minutes each. These are the classic single-patient encounters — the medicine and the decisions.
Clinical decision-making (CDM)
You work through a single patient with an examiner: gathering history, ordering and interpreting the workup, and making management decisions out loud. It tests how you reason toward a diagnosis and disposition, not just whether you land on the right answer.
How this case works →Prioritization
You are handed several patients at once and have to decide who to see, treat, and act on first. It tests triage judgment under time pressure — recognizing which patient is sickest and cannot wait.
How this case works →Communication cases
Six cases, 10 minutes each. These shorter encounters test the skills around the medicine — the conversations, the reassessment, and focused procedure and ultrasound cases.
Breaking bad news
A standardized-patient encounter built around delivering difficult news, such as a serious diagnosis or a death notification. It tests how you convey hard information with clarity and compassion.
How this case works →Managing conflict
A standardized-patient encounter with a source of friction — a consultant, a family member, or a patient leaving against medical advice. It tests how you de-escalate and negotiate toward a safe outcome.
How this case works →Patient-centered communication
A standardized-patient encounter that turns on eliciting a patient’s real concern and responding to it. It tests shared decision-making and meeting the patient where they are.
How this case works →Reassessment
You evaluate a patient first seen by another physician, whose clinical picture has changed since that earlier evaluation. It tests whether you catch the change, act on it, and explain it to the patient — without blaming the previous physician.
How this case works →Procedure
A case centered on a procedure — its indications, the key steps, and the complications to anticipate.
Ultrasound
A case centered on point-of-care ultrasound — obtaining or interpreting the images and acting on what they show.
How to prepare
The single most useful thing you can do is practice each format out loud, under time, before exam day — so the mechanics feel familiar and your effort goes into the medicine, not the format. Reading about a communication case is not the same as having to say the words; working a prioritization list on paper is not the same as being handed one and asked who is first.
That is exactly what PrepEM is built for: timed practice cases across both buckets, with examiner prompts and voice dictation, plus AI standardized-patient encounters for the reassessment and communication cases.