If you want the ABEM Certifying Exam format in plain English, it is a half-day, in-person exam in Raleigh with 10 cases: four longer Clinical Care Cases and six shorter Communication & Procedure Cases. ABEM's candidate-facing materials use the term Communication & Procedure Cases; the exam validity paper describes those six stations as OSCEs, which is why many candidates think of them as the OSCE-style half of the exam.
That format matters because the exam does not reward a rambling textbook answer. In the longer clinical cases, examiners are judging how you assess and treat an undifferentiated emergency patient, prioritize risk, reassess, and dispose safely. In the shorter stations, they are judging communication, negotiation, procedural thinking, ultrasound performance, and your ability to adapt when the case changes.
ABEM Certifying Exam format at a glance
- The current exam is in person at the AIME Center in Raleigh, North Carolina.
- You complete 10 cases in a half-day session.
- ABEM assigns eligible physicians to an administration window, and you then register for an available half-day appointment within that window.
- The blueprint is 10 components: four Clinical Care Cases and six Communication & Procedure Cases.
- The four Clinical Care Cases are 15 minutes each, and the six shorter stations are 10 minutes each.
ABEM's published morning and afternoon schedules show two possible sequences. If you start with Clinical Care Cases, you do four 15-minute cases, take a fixed 30-minute break, then do six 10-minute Communication & Procedure Cases. If you start with the shorter stations, the order reverses, but the total structure is the same.
This is also the current replacement for ABEM's former Oral Exam. ABEM states that the former Oral Exam retired in 2025, and the inaugural Certifying Exam was administered in March 2026.
Practical takeaway: you should train in two different gears. One gear is longer, analytical, and management-focused. The other is shorter, behavior-heavy, and much less forgiving of wasted words.
Clinical Care Cases: how the four longer stations work
ABEM's blueprint groups the longer stations under Clinical Care Cases, covering clinical decision-making and prioritization. These are structured discussions with an examiner, and the core marks sit in safe emergency management, clear reasoning, reassessment, and disposition planning.
Clinical decision-making
ABEM describes Clinical Decision-Making as a structured discussion about diagnosing and treating a patient with an undifferentiated presentation. Successful candidates identify focused history and exam findings, build an appropriate differential, order and interpret tests, stabilize and treat the patient, reassess as care evolves, and explain the rationale behind their decisions.
A good answer spine is simple:
- Open with sick or not sick.
- State immediate actions before you drift into detail.
- Give your leading differential and the dangerous alternatives.
- Ask only the focused history and exam questions that change management.
- Reassess out loud when new data arrive.
- End with disposition and anticipatory guidance.
For example, if the stem is a 67-year-old with crushing chest pain and diaphoresis, do not start with a long list of causes of chest pain. Start like an attending: monitored bed, IV access, ECG, assess hemodynamics, treat immediate threats, then explain what findings would push you toward STEMI, dissection, PE, or another shock state.
Prioritization
ABEM's Prioritization case tests your ability to triage multiple patients, give immediate stabilizing care, respond to changing acuity, and use team resources appropriately. The case description specifically notes realistic workflow interruptions, arriving patients, and deterioration of existing patients.
The mistake here is trying to manage every patient in sequence as if you were on a ward round. Examiners want to hear that you can spot who will die first, delegate, protect bottlenecks, and keep revisiting the whole department rather than tunnel-visioning on one bed.
A useful structure is:
- Name the highest-acuity patient first.
- Delegate immediate actions to the team.
- Briefly justify why the others can wait, or cannot.
- Re-triage when the stem changes.
- State what you would escalate to senior, specialty, or system support.
Think of a realistic ED board: an elderly septic patient with hypotension, a trauma arrival two minutes out, and a child whose asthma is tiring. If you sound calm, explicit, and team-based, you sound like someone safe to credential.
OSCE-style stations: Communication & Procedure Cases
ABEM's content page divides the shorter half of the exam into Communication & Procedure Cases, while the 2026 validity paper describes these six shorter stations as OSCEs. For candidates, the important point is not the label. It is that these stations are shorter, more behaviorally specific, and usually reward concise, deliberate performance rather than broad medical discussion.
The six station types are:
- Difficult conversations: establish rapport, find out the other person's baseline understanding, disclose the information clearly, respond appropriately, and provide closure.
- Managing conflict: understand the other person's position, explain your own, acknowledge disagreement, identify shared interests, and propose a way forward.
- Patient-centered communications: build rapport, respect the patient's perspective, share information clearly, discuss results, and support shared decision-making.
- Procedures: cover indications, contraindications, and complications, then show preparation, technical performance, and post-procedure management.
- Reassessment: take in new information, analyse its impact, change management, and describe the next steps.
- Ultrasound: explain the study, obtain images on a standardized patient with examiner assistance on machine settings, interpret the images, and keep the encounter patient-centered.
This is where many strong clinicians lose marks. They know the medicine, but they do not show the examiner the behavior being tested.
In a difficult-conversation case, for instance, a brisk, technically accurate speech can still underperform if you never check what the family understands, never pause after the headline, and never respond to emotion. In a procedure station, a slick description of how to place a chest tube can still underperform if you skip consent issues, equipment setup, complication avoidance, or what happens after the tube is in.
How to pace each station
The published ABEM schedule leaves little spare time: 15 minutes for each Clinical Care Case and 10 minutes for each Communication & Procedure Case. That means pacing is part of the test.
For a 15-minute Clinical Care Case
Use the first minute to orient the room. Name immediate threats. State first actions. Then move into focused history, focused exam, differential, investigations, treatment, reassessment, and disposition.
If the examiner gives you new data, treat that as a cue to pivot. Say so. Short phrases help: 'That changes my concern'; 'I would now reassess airway and perfusion'; 'My working diagnosis is shifting'; 'This patient now needs ICU-level care.'
For a 10-minute Communication & Procedure Case
Think in loops, not essays:
- Introduce yourself and set the agenda.
- Show the key behavior early.
- Keep your language short and plain.
- Close the loop before the station ends.
In ultrasound, tell the patient what you are doing before you touch the probe. In conflict stations, show that you heard the other person's concern before defending your own position. In reassessment, make the turning point explicit.
Short station, short sentences. That is often the difference between sounding polished and sounding flustered.
Scoring, resources, and what to practice
ABEM states that the Certifying Exam is criterion-referenced, not graded on a curve. Results are released within 90 days of the last day of the administration, and candidates who do not pass must wait 9 months before reattempting the exam.
That matters for preparation. You are not trying to sound cleverer than the next candidate. You are trying to meet a published standard of safe, independent emergency medicine practice.
ABEM has also made the official prep resources much clearer than they used to be. The board provides case summaries, sample case videos, debrief videos, scoring guidance, and separate procedures and ultrasound lists. ABEM announced the debrief videos and the dedicated procedures and ultrasound lists in May 2025, and the content page still points candidates to those resources.
Use those resources with intent. For the procedure list, practice saying the indication, setup, key safety steps, complications, and aftercare in one smooth run. For ultrasound, rehearse probe positioning, image goals, anatomy, pathology, and next-step management aloud rather than silently scanning. The cases are built from the EM Model and are reviewed for relevance and fairness, so your prep should feel like real emergency medicine, not trivia collection.
Common mistakes
These are inferred failure patterns from ABEM's published case descriptions and scoring domains.
- Leading with a long differential before addressing immediate threats.
- Forgetting to say what you are doing right now for the patient in front of you.
- Failing to reassess when the case changes.
- Treating prioritization like three separate mini-cases instead of one dynamic ED system problem.
- Using scripted empathy lines without actually responding to what the patient or family just said.
- Arguing in a conflict station rather than negotiating toward a patient-centered outcome.
- Describing a procedure without preparation, contraindications, complication management, or post-procedure care.
- In ultrasound, talking vaguely about images without clearly stating what is normal, abnormal, or management-changing.
Practice workflow
Build your practice around the official case types, not random oral-board folklore. ABEM gives you enough structure to rehearse the real tasks: case summaries, sample videos, debrief videos, scoring criteria, and the procedures and ultrasound lists.
A workable weekly routine looks like this:
- Run one full Clinical Care Case and two or three short stations in a sitting.
- Rotate the short stations so you see communication, conflict, procedure, ultrasound, and reassessment every week.
- Debrief in three layers: content, structure, and examiner-facing behavior.
- Record yourself at least once a week. You will hear your filler words faster than you will feel them.
- Every couple of weeks, do a mini-circuit under time pressure.
- In the final stretch, rehearse a full 10-case sequence with the break left in place.
If you use a study partner, give them a marking brief before you start. If you use AI for mock viva practice, ask it to score you against the station's behavior and structure, not just factual completeness.
Summary
- The current ABEM Certifying Exam format is a half-day, in-person assessment in Raleigh with 10 cases.
- The blueprint is four 15-minute Clinical Care Cases and six 10-minute Communication & Procedure Cases.
- The longer cases test clinical decision-making and prioritization; the shorter OSCE-style stations test difficult conversations, conflict management, patient-centered communication, procedures, reassessment, and ultrasound.
- Strong candidates sound like safe attendings: they identify threat, act early, reassess, explain clearly, and close the case.
- The best revision is case-based, timed, and mapped to ABEM's published scoring domains and official resource lists.
References
- https://www.abem.org/get-certified/certifying-exam/
- https://www.abem.org/get-certified/certifying-exam/certifying-exam-content/
- https://www.abem.org/get-certified/certifying-exam/certifying-exam-scoring/
- https://www.abem.org/wp-content/uploads/2026/02/Certifying-Exam-Morning-Session-Schedule.pdf
- https://www.abem.org/wp-content/uploads/2026/02/Certifying-Exam-Afternoon-Session-Schedule.pdf
- https://www.abem.org/wp-content/uploads/2026/01/Certifying-Exam-Candidate-Packet.pdf
- https://www.abem.org/wp-content/uploads/2024/09/certifying-exam-case-summaries.pdf
- https://www.abem.org/get-certified/certifying-exam/how-are-certifying-exam-cases-developed/
- https://www.abem.org/news/american-board-of-emergency-medicine-launches-inaugural-certifying-exam/
- https://www.abem.org/news/new-certifying-exam-resources-available/
- https://www.abem.org/about/become-a-volunteer/become-a-certifying-exam-examiner/
- https://www.abem.org/wp-content/uploads/2026/04/Validity-Evidence-for-the-New-American-Board-ofEmergency-Medicine-Certifying-Examination.pdf