In-Service Exams, E-Orals, and a New Emergency Medicine Dual Specialty

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Updates from the American Board of Emergency Medicine

Today’s emergency medicine residents are more tech-savvy than ever, and the American Board of Emergency Medicine (ABEM) is taking note. ABEM is one of 24 medical specialty certification boards recognized by the American Board of Medical Specialties. ABEM certifies emergency physicians who meet its educational, professional standing, and examination standards. The organization is not a membership association like ACEP; rather, its certification is sought and earned by emergency physicians on a voluntary basis.

ABEM’s mission and activities directly affect residents. Among other responsibilities, the organization administers the annual in-training (in-service) exam to help residents prepare for the qualifying (written) board exam after graduation, manages and administers the oral and qualifying board exams, manages maintenance of certification, and can approve new dual training opportunities.

The EMRA and ABEM boards meet at least biannually, keeping up a stellar working relationship. During this year’s SAEM conference, ABEM solicited feedback from the EMRA Board to get the resident perspective on the transition to a computerized in-training exam, eOrals, and the resident page of their website. They also provided updates affecting residents.

In-training Exam Goes Futuristic

The 2016 in-training (in-service) exam was held Feb. 24 across the U.S., Canada, and Singapore. For the first time in history, ABEM piloted an online version of the exam among 56 EM residency programs, with few technical glitches. Notably, ABEM reports no significant differences in scores between those who took the online and paper versions of the exam. Also of note, ABEM was able to release results of the 2016 in-service exam in just 37 days, faster than ever. According to ABEM, the in-training exam may go entirely online by 2018, as this change would be more eco-friendly and more closely simulate the real qualifying (written) board exam.

Appropriate Use of In-training Exam Results

Recently, ABEM has noted that in-training exam results have been used in unintended ways. For example, some fellowship programs have used resident in-training exam scores to gauge competitiveness of applicants. ABEM emphasized that the in-training exam is a tool to gauge progress toward passing the qualifying certification exam at the end of residency. The exam has not been validated to be used by a residency or fellowship program, or by potential employers, as a measure to gauge the success of a resident or to make decisions about whether to pass, hold back, or hire a resident. A resident’s performance on the exam should be confidential, primarily known only to the program director and the resident, and the resident must give written consent if his/her results are to be shared outside of the program’s Clinical Competency Committee (CCC).

eOral Exam Gets High-Tech

Historically, oral board exams have been administered without electronic or auditory stimuli, using old-fashioned X-rays and light boxes, and paper and pencils. The advent of eOral cases came about in 2015. These are single-patient cases where some information is presented electronically. As part of a case, you may receive, for example, audio of an EMS call, a transfer sheet, or a video of the patient; stimuli can include video and audio presentations.

From the start, eOral cases were positively received by test takers, and the technology is improving rapidly. In the inaugural administration of its implementation, 1 in 40 eOral cases were unable to be scored due to technical glitches. In spring 2016, 3 out of 7 oral board cases were in the eOral format, and only 1 in 990 could not be scored. ABEM is busy developing additional eOral cases and expects to move to all single cases being in the eOral format in the next few years, with the ultimate goal being 100% integrated electronic cases for the oral board exams.

Emergency Medicine and Anesthesiology — Now You Can Do Both

Did you have a difficult time choosing between anesthesiology and EM as a specialty? If so, you may be interested in ABEM’s newest approved dual certification program. Until now, it has been possible for emergency physicians to complete a combined training program to obtain dual certification in pediatrics, family medicine, and internal medicine. In collaboration with the American Board of Anesthesiology, ABEM is now accepting applications from residency programs who wish to start a dual EM-Anesthesiology combined training program. Candidates must meet all primary requirements of both specialties, which will require a 5-year residency (6 years if the EM program is a 4-year program). A link to the list of combined programs will be available on the ABEM website as they become approved.

Osteopathic Residents to Become ACGME Board Certified

In a nutshell, the Accreditation Council for Graduate Medical Education (ACGME) has given American Osteopathic Association (AOA)–approved EM residency programs 5 years to become ACGME-accredited and create a single EM accreditation system in the U.S. Historically, osteopathic residency programs have fallen under the umbrella of the AOA for approval. Today, 56 EM osteopathic programs exist, and 6 of these were already dually accredited by both the ACGME and AOA, versus 182 ACGME-accredited (allopathic) EM residency programs. This spring, the Review Committee for Emergency Medicine (RC-EM) accredited another 7 osteopathic programs; currently, 12 osteopathic programs have applied to be accredited and are awaiting approval.

Another recent change is that AOA-certified physicians who complete an ACGME-accredited fellowship can now apply for certification in certain ABEM co-sponsored subspecialties.

It is expected that as many as 1,600 residents in osteopathic EM residency programs will eventually be absorbed into the ACGME system as their residency programs become ACGME accredited. This will allow osteopathic residents to become board certified by the American Board of Emergency Medicine, which will increase the number of residents that ABEM will assess for certification each year, and ultimately, the number of ABEM diplomates. Graduates of EM osteopathic programs retain the choice of being certified by the American Osteopathic Board of Emergency Medicine and/or ABEM.

The ABEM, ACGME, and the AOA regularly update information related to this change on their websites. Check regularly for the most up-to-date information.

Stop by the ABEM Booth at ACEP2016

If you will be attending the 2016 ACEP Scientific Assembly, stop by the Exhibit Hall and visit booth 654, where ABEM directors and staff will be available to answer your questions.

ABEM strives to improve the quality of emergency medical care, establish and maintain high standards of excellence in EM, enhance medical education, and evaluate and certify physicians who have demonstrated special knowledge and skills in EM. By continuing to update their testing methods and paying attention to what residents need and how we learn best, ABEM will contribute to the advancement of emergency medicine for decades to come. Check out the ABEM resident page at abem.org/residents for more information or to provide feedback on any of these issues.

Alison Smith, MD, MPH

Alison Smith, MD, MPH

EMRA ACEP Representative, University of Utah, Salt Lake City, UT
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