Emergency Medicine · ABEM Certifying Exam practice

Emergency Medicine boards, practiced out loud.

Run oral-style clinical cases and stations with an AI examiner who plays the room, reveals nothing you didn't ask for, and debriefs you when the case ends.

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Free 7-day trial · practice as much as you want · 65 clinical cases, 26 communication stations, 13 procedure stations and 7 ultrasound stations · physician-reviewed
The exam

What the ABEM Certifying Exam is like

The virtual oral exam is gone. Starting 2026, ABEM’s in-person Certifying Exam pairs discussion-based clinical cases — clinical decision-making and multi-patient prioritization — with procedure, ultrasound, reassessment and communication stations: a format most oral-board prep wasn’t built for.

In a DOME clinical case you run one patient in real time — history, exam, orders, treatment, reassessment and disposition — while the examiner plays the patient, the nurse and the consultants.

  • Covers ABEM’s decision-making, communication, procedure and ultrasound case types, plus multi-patient prioritization in Early Access — not yet reassessment
  • Physician-reviewed cases and stations
  • Not affiliated with ABEM
How to prepare

Practice the way you’ll be examined.

01

Say it out loud

The examiner credits what you actually say — the order, the reassessment, the call to the consultant — not what you meant to do.

02

Ask for everything

Findings and results appear only when you ask or order. Nothing is volunteered, so build the habit of asking.

03

Mix in the stations

Rotate communication, procedure and ultrasound stations in with the clinical cases, so no station type is new on the day.

04

Read the debrief every time

Every run ends with a full debrief of what you did and what you missed. The next rep is where it sticks.

Sample walkthroughs

Three free sample cases.

Short excerpts from physician-reviewed DOME cases: the opening stem, a few of the examiner’s questions, and the teaching points from the debrief. In the full version you run it live, out loud, and the examiner only reveals what you ask for.

Sample 1 · Clinical case

The stem

You are working an evening shift in an ABEM-capable tertiary hospital emergency department — CT, ultrasound, and the full laboratory are in-house. Consultants, blood bank, OR, and ICU pathways are available when requested or activated. Your next patient is Chloe Bennett, a 16-year-old girl brought in by her mother with vomiting, tiredness, and 'breathing funny.' Her vitals are on the monitor. She is slumped in the chair and answers you slowly. How would you like to begin?

The examiner asks

  • Why must you know the potassium before starting insulin, and what do you do if it is low-normal?
  • How do you sequence fluids and insulin in this adolescent, and what cerebral-edema warning signs stop you?

Key teaching points

  • Check the potassium before you start insulin, every time. Total-body potassium is depleted in every DKA even when the serum level looks normal, and insulin drives it down further. If K is below ~3.3, hold insulin and replace potassium first — this is the single most dangerous timing error in the case.
  • DKA is fluids and insulin, not bicarbonate. Reserve bicarbonate for pH < 6.9 at most; it worsens hypokalemia and causes paradoxical CSF acidosis, and the gap closes on fluids and insulin alone.
  • Kussmaul breathing and a fruity breath in a thirsty, polyuric teenager is new-onset type 1 until proven otherwise. Do not mistake the tachypnea for a primary respiratory problem.

Excerpt only. The full clinical case runs live with the AI examiner and ends with a full debrief.

Sample 2 · Clinical case

The stem

You are working an evening shift in an ABEM-capable community hospital emergency department — CT, ultrasound, and the full laboratory are in-house. Consultants, blood bank, OR, and ICU pathways are available when requested or activated; some specialty services are reached by transfer. Your next patient is Mr. Harold Voss, a 58-year-old man brought in by his wife with chest pain. His vitals are on the monitor. He is diaphoretic and appears anxious. How would you like to begin?

The examiner asks

  • Why do you control heart rate before starting a vasodilator in suspected type A dissection?
  • Given your setting, what exactly do you arrange for definitive care, and what do you do while waiting?

Key teaching points

  • Bilateral BPs are cheap and fast, and an important early action rather than a hard critical one. Say it out loud early in every chest pain case.
  • Type A = surgery, not medical management. The disposition action is calling the surgeon and moving the patient, and boards examiners score the phone call.

Excerpt only. The full clinical case runs live with the AI examiner and ends with a full debrief.

Sample 3 · Ultrasound station

The stem

You are the emergency physician in a tertiary emergency department receiving a trauma activation. Mr. Devon Hale, a 34-year-old man, was the restrained driver in a high-speed front-end collision. He arrives diaphoretic and confused, with a seat-belt mark across the abdomen. His pressure is 88 over 58 and his heart rate is 128. The ultrasound machine is at the bedside and I am operating it — you tell me which probe, where it goes and what to change, and I will drive the knobs and tell you what I see. Start by explaining to him what you are about to do, then get me the FAST views you want.

The examiner asks

  • A positive FAST and a systolic of 88 — why is that an operating-room decision rather than a CT decision?
  • Name two reasons a FAST can be negative despite significant intra-abdominal bleeding.

Key teaching points

  • The examiner drives the machine. What is examined is what you SAY: which probe, where it goes, which way the indicator points, and what to change when the picture is bad.
  • A positive FAST in a hypotensive blunt-trauma patient means blood and the operating room — not crystalloid and not CT.
  • Tell the patient. He is awake and frightened; 'free fluid' is not a sentence he can use.

Excerpt only. The full ultrasound station runs live with the AI examiner and ends with a full debrief.

Emergency Medicine (ABEM) questions

About the ABEM Certifying Exam.

111 reviewed cases and stations across 16 content areas — 65 clinical cases with critical-action grading, 26 communication stations, 13 procedure stations and 7 ultrasound stations, rubric-graded. Every Emergency Medicine case and station is authored by hand and physician-reviewed. The clinical cases are a patient who changes, findings you must earn, critical actions on a deadline, and at least one way to fail outright — not topics, cases. The stations are scored on a rubric rather than a kill step: how you carry the conversation, how you walk the procedure, what you find with the probe.

On ABEM's written qualifying exam, the 2024 first-time pass rate was 82%, down from 88% the year before, part of a multi-year decline. The in-person Certifying Exam is new in 2026, so it has no comparable pass-rate history yet.

ABEM retired the virtual oral exam after 2025. Its replacement, the Certifying Exam, is an in-person, half-day exam of 10 cases, offered roughly nine times a year. Four are discussion-based clinical care cases — clinical decision-making and multi-patient prioritization. Six are stations: a hands-on procedure, ultrasound scanning, reassessment, patient-centered communication, a difficult conversation and managing conflict. DOME covers the clinical decision-making cases, multi-patient prioritization (in Early Access), and the communication, procedure-walkthrough and ultrasound stations, by voice. It does not yet cover reassessment, and it is not a substitute for hands-on procedure and scanning practice.

Source: ABEM published statistics and examination announcements.

Pricing

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Free 7-day trial — every case and station, as many reps as you want.

Each exam is its own subscription. Founding price: $49/month, locked for as long as you stay subscribed. The list price will be $99/month later.

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