Procedures on the Certifying Exam

The ABEM Certifying Exam reshapes how procedural skills are tested. Gone are the days of purely verbal descriptions in the old Oral Exam. Now, in dedicated Procedures cases, you step into a simulation room and show what you can actually do—while explaining your reasoning, risks, and next steps to an examiner.

These cases sit within the broader Communication & Procedure Cases category and focus on skills integral to emergency medicine. You will be asked to prepare for and perform a procedure from the official ABEM Procedures List. Examiners score you on preparation (indications, contraindications, complications), technique, and post-procedure management, including any necessary patient or team communication.

Here is the core list published by ABEM in May 2025, grouped by category:

Airway Techniques

• Intubation (direct laryngoscopy and video-assisted)
• Airway adjuncts (e.g., LMA use)
• Surgical airway
• Non-invasive ventilatory management (CPAP/BiPAP, high-flow oxygen)
• Pediatric and adult bag-valve-mask ventilation

Vascular Access

• Arterial line placement
• Central venous access
• Intraosseous line placement (children and adults)
• Umbilical vessel catheterization

Anesthesia and Acute Pain Management

• Regional anesthesia (hematoma block, femoral nerve block, digital block, dental block)
• Procedural sedation (children and adults)

Diagnostic and Therapeutic Procedures

• Paracentesis
• Cardiac pacing, cardioversion, defibrillation
• Pericardiocentesis
• Thoracostomy (including small-bore catheters)
• Wound closure
• Control of epistaxis
• Laryngoscopy
• Slit-lamp examination
• Arthrocentesis
• Fracture/dislocation immobilization techniques
• Spine immobilization techniques
• Lumbar puncture
• Delivery of newborn

Resuscitation

• Medical, trauma, neonatal, and pediatric resuscitation

These represent the procedures most likely to appear. The exam does not expect mastery of every one in every possible variation, but you must show solid command of the fundamentals: why you choose it, how you mitigate risks, step-by-step execution, and what happens afterward.

What sets these cases apart is the integration of communication. You will need to explain the procedure's indications and contraindications, describe equipment you'll need and the steps involved, and discuss post-procedure expectations. Technical skill alone is not enough; you need to blend expertise with the patient-centered approach that runs through the entire Communication & Procedure Cases block.

The Procedures cases test whether you can safely and effectively intervene when a patient needs it most. They reward preparation, precision, and the ability to explain your actions in real time. Build that confidence now—your performance in the sim bay will carry straight into the AIME Center.

BoardED is hard at work adding in procedural practice cases where you'll practice all of the procedure case except the cutting. Stay tuned!