Passing the emergency medicine written certiﬁcation examination is an important milestone in the process of becoming a board certiﬁed emergency physician. The written exam, formerly called the Written Certiﬁcation Examination and now referred to by the American Board of Emergency Medicine (ABEM) as the “Qualifying Examination,” is used to identify candidates who are ready to take the oral exam, the ﬁnal step in becoming board certiﬁed. The Qualifying Examination measures core knowledge, and, to many who must take it, it is an intimidating hurdle. Every year approximately ten percent of examinees fail the test and must retake it the following year. Given that many test takers are completing their residency and may be moving to start a new job in the months leading up to the test, it is clear that there is a need for a focused, easy-to-use review book to help them prepare.
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First Aid for the Emergency Medicine Boards is such a book. The First Aid series is based on the idea that people who have recently prepared for and taken the test know best how to teach others to study for it. We have drawn on the experience of 31 individual chapter authors and nearly as many senior reviewers, integrating clinical experience, information from existing review books, and the ABEM practice questions to create a book designed to improve your score on the Qualifying Examination. First Aid for theEmergency Medicine Boards contains dozens of challenging cases (“minicases”) and reinforces important information in highlighted “key facts” and “mnemonics.” Filled with tables and ﬁgures, it presents key ﬁndings and must-know information in a clear, concise, and highly accessible format that makes it easy to recall both on test day and in the emergency department.
Knowing the right answers is the most obvious way to pass the test, but studying is not the only way to prepare. Knowing how to take a multiple choice test can also help. There are ﬁve key components.
First, anticipate the answer as you read the question. With most questions, you should already have an answer in mind before you look at the choices. For example, a question might describe a young lady who presents with odd neurologic complaints. She is not obviously sick, and she reports that she had a different neurologic problem two months ago. Just as when you listen to real patients describe their symptoms, a differential should form in your mind. At the top of the list for the test patient should be multiple sclerosis. If you are conﬁdent in your answer, you can avoid wasting the time it takes to carefully consider the merits of each answer choice. Instead, you can scan for the one you know is right, check the alternatives to make sure they don’t compete with your anticipated answer, and move on.
Second, when you cannot anticipate the answer, use the following guidelines to help you make your choice:
1. Opposites attract. If two of the answers are the opposites of each other, one of them is usually the right answer.
2. Similars attract. If two answers are similar, one of them is usually the right answer. Test writers don’t usually create two similar wrong answers.
3. Grammar is a guide. Sometimes wrong answers can be identiﬁed through minor grammatical inconsistencies between the question and the answer choice. The right answer should link to the question without grammatical errors, as if it is part of a sentence that was cut neatly in half.
4. Avoid “always” and “never.” Answers that include always and never are almost never correct. This fact has become so well known that you will probably not see these words on the test. If you do, be wary.
5. Worst-case answers are often right. One of the goals of emergency medicine training is to teach you to consider life-threatening illnesses ﬁrst. Be always on the look out for the pulmonary embolus or the ectopic pregnancy, and anticipate the need for immediate surgical consultation and early intubation. The diagnoses of GERD, gastroenteritis, or musculoskeletal lowback pain should be made only after you have ruled out more serious diseases with similar presentations.
Third, don’t be ﬂustered if you have difﬁculty interpreting a ﬁgure on the test. Like diagnostic tests in the emergency department, images on the written exam should be used to conﬁrm or refute a clinical suspicion. The question will often guide you to the answer without the image. Use the picture to strengthen your conﬁdence in your answer choice. For example, a 72-year-old male presents with hip pain and difﬁculty walking after a ground-level fall at home. What is his diagnosis? If you were seeing this patient in the emergency department, you would put hip fracture at the top of the differential. The purpose of the radiograph would be to exclude a hip dislocation (although your exam will usually do this) and to identify the location of the fracture. If the radiograph is negative and the patient really cannot walk without a lot of pain, you will probably proceed to a CT or an MRI to ﬁnd the fracture that you cannot see on radiograph. Take the same approach to this patient on the test as you would in the emergency department. Determine the answer from the story, and look to the image to conﬁrm your diagnosis. If you can’t interpret the image, answer the question without it.
Fourth, read the question carefully. As in the emergency department, there is a danger in being overly conﬁdent in a diagnosis. It is good to anticipate an answer as you read, but be sure to read the entire question. Don’t be so certain about your diagnosis of glaucoma that you miss the sulfa allergy, the history of sickle cell disease, or COPD. Paying attention to such details can mean the difference between choosing the right answer and a wrong one.
Fifth, be aware that test writers like to mislead test takers. It has been said that writing good test questions is easy—it is writing good test answers that is difﬁcult. A good test answer choice captures the imagination of unprepared test takers, and lures them down the wrong path. Here, again, knowledge is your friend. In this book, we include information about unusual problems to help you hone in on the correct diagnosis and alert you when you are being led astray. For example, strychnine causes muscle convulsions leading to asphyxia two hours after ingestion and is therefore unlikely to be the right answer to any question, but if you don’t know that, you might end up choosing it. Of course, good foils sometimes are right answers; knowing the key information covered by each question should help you tell the difference.
Finally, good luck and enjoy your time studying. There are few careers that offer as much opportunity to positively impact the lives of others as that of the emergency physician. The investment you make in yourself by studying will make you a stronger test taker and a more competent emergency physician.
Best Medical Books: First Aid for the Emergency Medicine Boards