ABEM procedure cases, explained
A procedure case on the ABEM Certifying Exam gives you a patient who needs a specific procedure and asks you to perform it out loud for an examiner. Here is what it is testing and how to practice it.
What the case looks like
The task sheet names the procedure
You are handed printed case materials — the patient, their vital signs, a physical exam, sometimes an image — and a task statement that names the procedure outright. The case is not asking you to guess what to do; it is asking whether you can do it.
You perform it out loud, not with your hands
There is no manikin and no equipment. You describe the procedure to an examiner: what you ask for, how you position the patient, your landmarks, and each step in the order you would actually do them. What you do not say does not count.
The questions run before, during, and after
A case typically opens with the setup — why this patient needs it now, what equipment and what size, how you anesthetize — then the step-by-step technique, then what happens next: a complication mid-procedure, how you confirm it worked, or what you order afterward.
Landmarks and sizes are the specifics that earn credit
Naming the interspace, the safe triangle, the tube size, the drug and dose is what separates a passing description from a vague one. "I would prep and drape and insert the tube" is not a procedure.
The complication is part of the case
Many procedure cases turn on what you do when it goes wrong or when the result is alarming — the blood that keeps coming, the pressure that does not fall, the needle that hits bone. Have a next move ready rather than stopping at the technique.
Common traps
- Describing the procedure in general terms without naming landmarks, levels, or sizes.
- Skipping the setup — consent, positioning, sterile technique, anesthesia — and starting at the incision.
- Forgetting the analgesia and sedation for a procedure that genuinely hurts.
- Stopping when the procedure is done, with no confirmation step and no post-procedure orders.
- Freezing on the mid-procedure complication instead of naming the escalation.
How to practice it
Say the procedure out loud, start to finish, until the order of the steps is automatic — landmarks, sizes, doses and all. Reading a procedure is not the same as narrating one under a clock. PrepEM’s procedure cases give you a printed task sheet and a timer, ask the examiner questions in order, and then show your answers beside the suggested ones, with a link straight to that procedure’s reference card.
See also the procedure reference, the procedure quiz, and the full exam format guide.