ABEM Certifying Exam Prep: How to Get Ready for the New Exam

The ABEM Certifying Exam replaced the Oral Certification Exam in 2026, and it is a different test — closer to an actual ED shift than to the structured role-play you may remember from older prep materials. This guide covers what the exam actually tests, how each case type works, and how to structure your preparation, based on our experience building practice cases mapped to ABEM's published criteria.

What the Certifying Exam is (and isn't)

The Certifying Exam is an in-person, simulation-based assessment administered at the AIME Center in Raleigh, NC. During a half-day session you'll complete a series of cases spanning two broad formats: Clinical Care cases (~15 minutes each) — tabletop discussions that evaluate clinical decision-making, prioritization, reassessment, and adaptability — and Communication & Procedure (OSCE-style) cases (10–15 minutes) with standardized patients or procedural setups assessing communication, professionalism, procedural skill, and conflict management — not medical knowledge or clinical competency.

It is not the old oral boards. There is no "What do I see, hear and smell?" role play. The cases are not designed to be tricky or zebra hunts — it's bread-and-butter emergency medicine, and what's being scored is how you think, communicate, and lead.

The case types, and what each one is really testing

Clinical Decision-Making (CDM)

CDM cases are structured discussions — no role-playing. It's just you and the examiner, speaking directly. You'll review a task sheet (you get a full five minutes — use them to read every detail, take notes, and make a game plan), then the examiner presents a one-liner and vitals and asks targeted questions: focused history, physical exam elements, differential and your reasoning, diagnostics, and management.

Two things surprise people. First, the examiner may ask questions only tangentially related to the scenario — that's the design, not a sign you're off track. Second, answers need to be case-specific: not "I'd examine the head and neck" but "on head and neck exam, I'm looking for JVD." Of the current formats, CDM is the closest to the structured-interview portion of the old oral boards. Anything on ABEM's EM Model is fair game. Deep dive: CDM vs. the old Oral Exam: what's different.

Prioritization

Prioritization cases are the most unfamiliar format. You're shown a trackboard of patients — chief complaints and vitals — and asked to run the board: request one or two pieces of triage-relevant information per patient (history, exam findings, or immediately available diagnostics like an EKG or point-of-care glucose), identify the sickest patient, articulate stabilization measures, and delegate to your resources (nurse, resident, tech). One rule worth internalizing: delegation offloads tasks, but stabilizing a patient requires you to personally evaluate and treat them at some point. Expect patients to decompensate and new arrivals mid-case.

Mass Casualty Incident (MCI) variants add a layer: clear the board first (stabilize anyone you're moving upstairs or discharging — they can deteriorate later), gather information from EMS, inventory hospital resources (beds, nurses, ORs, blood), then triage the incoming wave using a familiar triage system — including recognizing expectant patients and moving on. Some MCI cases might even place you outside the ED in a prehospital setting. Deep dive: How to prepare for Prioritization cases.

Communications

Four case types — Difficult Conversations, Managing Conflict, Patient-Centered Communication, and Reassessment — and these do involve role-play with standardized patients. They are not testing medical knowledge; they're testing empathy, communication, and conflict management skills. Each scenario has its own theme, and often a hidden catch the case wants you to uncover (the "UTI going home" who is actually developing sepsis, for example). Practical habits that score: introduce yourself, acknowledge concerns, explain the change in plan in plain language, and invite questions. Patients and consultants will push back — that's intentional. Don't react negatively; stay calm and keep guiding the conversation toward uncovering the hidden "catch." Deep dive: What to know for Communications cases.

Procedures & Ultrasound

Review ABEM's published procedure and ultrasound lists. For each procedure know indications, risks, consent, technique, and post-procedural care; expect to articulate these and perform on a mannequin. For ultrasound, practice describing probe placement, expected views, and interpretation of normal anatomy and pathology. Deep dive: Procedures on the Certifying Exam.

How to structure your prep

1. Start with ABEM's own materials. The case summaries, sample videos, and debrief videos on abem.org are the closest thing to an official blueprint. Watch them first.
2. Learn the formats before the content. Most candidates' anxiety comes from format unfamiliarity, not knowledge gaps. Prioritization and CDM deserve the most reps because they're the least like anything you've practiced before.
3. Practice out loud, with feedback. The exam is spoken. Reading about cases is not the same skill as talking through them under time pressure. Whatever tool you use — a study partner, your program's mock exams, or BoardED's AI cases — the loop that matters is: attempt → specific feedback → re-attempt. While you can type your answers into BoardED's text boxes, you'll gain much more comfort if you get used to speaking your thoughts aloud.
4. Rehearse the logistics. Five minutes with a task sheet, then a timed case. Practice using the full five minutes deliberately: read everything, note the task statement, take a breath.
5. Don't cram facts. In ABEM's words, the best preparation for the Certifying Exam is being a practicing emergency physician. The exam rewards clear thinking, communication, and decisive leadership in simulated chaos — practice those specifically. The medicine, truly, is not the hard part.

How BoardED fits in

We built BoardED because nothing existed to practice the new formats interactively. Our case library covers CDM, Prioritization (including MCI), and all four Communications types — AI-driven, physician-verified cases with task sheets that mirror ABEM's, voice interaction, and a score report with specific, constructive feedback matched to ABEM's published criteria. If you complete 80% of our cases and don't pass on your first attempt, we refund you in full.

Frequently asked questions

About the authors

Naseem Moridzadeh, MD — Board-certified emergency physician; Clinical Assistant Professor of Emergency Medicine at Olive View UCLA Medical Center. Co-founder of BoardED.

Nathan A. Friedman, MD — Board-certified in Emergency Medicine and Medical Toxicology; emergency physician at Eisenhower Health. Co-founder of BoardED.