Emergency Medicine Residency Survival Guide

How to survive Emergency Medicine Residency.


Written Boards. ABEM offers an Inservice Training Exam (ITE) annually for EM residents during the last week of February, typically on a Wednesday. The ITE is closely representative of the written board that must be completed after residency to obtain board certification. The ITE is standardized nationwide, and is a great tool for each resident and program director to gauge how well their preparation for written boards is progressing. Do not dismiss this test. The ITE itself does not officially mean anything professionally, but it is a litmus test. If you perform poorly, your residency leadership may require you to participate in remediation and extra study sessions. If you perform well, they will leave you alone. While scoring well on the ITE does not necessarily correlate with shift performance, it is a necessary step you must take, and you must pass your written boards eventually after graduation.

The ITE itself does not officially mean anything professionally, but it is a litmus test.

Our residency program provides a Rosh Review subscription with approximately 1300 practice questions, and also purchases a simulated ITE exam each year. This is an incredible resource, do not waste it. Each year, I completed most of the available practice questions before the ITE. Start AT LEAST a few months before the ITE and set a goal to complete a certain number of questions per day or per week. I found that studying in tutor mode worked best for me. In this mode, you answer a question and then get immediate feedback via the answer and a concisely crafted explanation. You progress more slowly through questions this way, but it works by providing immediate learning and feedback. Question banks are great study tools because of the active learning involved. Answering well crafted questions recruits additional brainpower and cements pertinent facts more completely. Rosh Review maintains a mobile app, so you can easily study when only moments are available – while resting, while waiting for an appointment, or while sitting on the toilet, etc. With purposeful effort, you will rock your inservice. Other residents choose to study board review books as well, or complete additional question banks. Find what works for you. Our residency website contains multiple resources, also below are a few extra resources:

  • Comprehensive Rapid Board Review. This podcast (with slides) is available via the linked website and also via Itunes under the Emergency Board Review show. It is one hour and 43 minutes, but is super high yield. I usually watch this a few times during the last week before boards. It will help you remember multiple simple recall questions on the exam.
  • Emergency Board Review. This Itunes channel has multiple other board review podcasts. Some are helpful, others not so much. But they are free, and can be digested passively while driving or performing other duties.
  • EMRAP Crunch Time: If you have an EMRAP subscription, this is a phenomenal resource. These are EMRAP’s high yield podcasts for each board topic.
NMCP EM Residents working the Ambuscope

Oral Boards. After graduation, you must also pass oral boards to become board certified. To prepare us adequately, our residency hosts Mock Oral Boards multiple times per year in place of conference. These are great opportunities to learn more about this exam. Oral boards are essentially a game, and you must learn to play that game well. During these sessions, you will learn how to prepare and organize your thoughts. Some residents write prompts on the provided scrap paper, or follow a systematized approach to each vignette. The mock oral boards allow you to practice, modify, and solidify your system. Below are a few helpful documents with exam tips from our staff.

NMCP EM Resident presenting research.

Promotion Boards. Promotion boards are military specific. For our program, your promotion board will occur before you progress to the next year group. This annual board lasts one hour, during which you will sit in your Service Dress Blues across from three staff attendings while they question you on a variety of specific topics that you are required to master at that point in your training. You MUST study specifically for this board, you can flail or shine, you choose. There are many different resources, some residents create their own tools, others use what is already available. This board requires rote memorization, which takes time. So don’t procrastinate. My poor wife was often my study partner. She would randomly question me on the testable topics, and I would reply in as much of a cogent manner as possible. Do this at least a few times with other residents, or someone who loves you very much. You can often recall these facts in your head, but things fall apart when you are forced to verbalize your thoughts. Don’t fall apart in front of the board. There are multiple resources available on our residency website. Below is the list of required topics from a year ago, which should be similar to the current list of topics.

The PGY-2 page is missing from this Primer, but for this year you must demonstrate proficiency in all 27 procedures detailed in our EM procedure manual which is available on the residency website. The PGY-2 board is different from the other promotion boards in that it is conducted in the procedure lab.

NMCP EM interns and EM2s practicing TCCC on the beach.

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