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Preparing for the Examination of Added Competence in Emergency Medicine

Overview

Written and oral examination

The Examination of Added Competence in Emergency Medicine is comprised of two components: a written examination and an oral examination. The content to be assessed in this examination is drawn from the Priority Topics in Emergency Medicine and the CAEP Ultrasound guidelines.

To help prepare for the exam:

  • Examination of Special Competence in Emergency Medicine Short-Answer Management Problems (SAMPs): The Committee on Examinations – Emergency Medicine authorized the release of short-answer management problems (SAMPs) used on previous examinations to help candidates prepare for the written Candidates should be aware that these SAMPs are from previous examinations and may not reflect current clinical practice.
  • Structure orals video: The Committee on Examinations – Emergency Medicine has produced a video demonstration of a structured oral, along with detailed instructions about what to expect and how to proceed in the oral examination.
  • The Canadian Library of Family Medicine (CLFM) has compiled a list of resources including conference, books, journals and Internet sites that help candidates keep up-to-date with developments in emergency medicine and to create a home study plan.

Home study

Study aids

It’s easy to study for the examination at home. Candidates can create an individual program of continuing medical education (CME) to fit into their schedule. There are many convenient ways of keeping up-to-date with developments in emergency medicine. A few of the most popular options are listed here.

Candidate Guide

  • Conferences

    A number of annual scientific meetings take place in Canada and abroad where related examination issues are discussed. Mainpro+® certified courses are listed on the continuing professional development (CPD) events calendar.

  • Books, manuals, multimedia

    Several comprehensive emergency medicine textbooks, board examination guides, and manuals are available. Prices listed are approximate.

    • Advanced Cardiovascular Life Support Provider (ACLS) and Pediatric Advanced Life Support (PALS) textbooks and eLearning courses available at courses, from Channing Bete Company (distributor of American Heart Association Products), and at selected bookstores.
    • Advanced Trauma Life Support (ATLS) manuals available at courses, and from the American College of Surgeons Committee on Trauma.
    • Howes DS, Gupta R, Waples-Trefil F, Pillow T, Tupesis J. First Aid for the Emergency Medicine Oral Boards: Emergency medicine oral board preparation and review. McGraw-Hill Professional; 2010.
    • Marx J, Adams J, Walls R, Rosen P, Hockberger R. Rosen's Emergency Medicine: Expert Consult Premium Edition. 2 vols. 7th ed. Mosby; 2009. Includes access to complete contents online.
    • Naderi S, Park R. Intensive Review for the Emergency Medicine Qualifying Examination. McGraw-Hill Professional; 2009. Includes CD-ROM.
    • Paul Olszynski, MD, MEd; Daniel J Kim, MD; Jordan Chenkin, MD; Louise Rang, MD, The CAEP Emergency Ultrasound Curriculum – Objectives and Recommendations for Implementation in Postgraduate Training
    • PEPID Emergency Physician Suite: point-of-care solutions that enable healthcare professionals to efficiently pinpoint diagnoses, treat diseases and medical conditions, detect harmful drug interactions and allergy sensitivities, accurately dose patients, and provide quality patient education; includes specialized clinical content, drug database, calculators, evidence-based medicine (EBM) resources. Available for various platforms.
    • Rivers C, ed. Preparing for the Written Board Exam in Emergency Medicine. 8th ed. Ohio: American College of Emergency Physicians; 2017. Other formats available include flashcards, PDAs, audiotape, CD-ROM, and combination packages. Available from Ohio American College of Emergency Physicians.
    • Schaider J, Barkin R, Hayden S, Wolfe R, Barkin AZ, Shayne P, et al. Rosen and Barkin’s 5-Minute Emergency Medicine Consult. 4th ed. Lippincott Williams & Wilkins; 2010.
    • Strange GR, et al. Pediatric emergency medicine: a comprehensive study guide. 3rd ed. McGraw-Hill; 2009.
    • Strange GR. Pediatric emergency medicine: just the facts. 2nd New York: McGraw-Hill Education; 2011.
    • Tintinalli JE. Emergency medicine: a comprehensive study guide. 8th ed. New York: McGraw-Hill Professional; 2010.
  • Journals

    • Academic Emergency Medicine (AEM), official monthly publication of the Society for Academic Emergency Medicine (SAEM) (online and print available). Wiley-Blackwell.
    • Annals of Emergency Medicine, an International Journal, on behalf  of the American College of Emergency Physicians (online and print available). Elsevier.
    • Canadian Journal of Emergency Medicine (CJEM/JCMU), official journal of the Canadian Association of Emergency Physicians (published six times/year; articles less than one year old restricted to Canadian Association of Emergency Physicians (CAEP) members and subscribers).
    • Emergency Medicine Clinics of North America, quarterly from Elsevier Health Sciences Division (online and print available).
  • Online resources

    Here are emergency medicine sites that offer continuing professional development (CPD) listings and content, news, and other information:

    Canadian Association of Emergency Physicians (CAEP)

    American College of Emergency Physicians

    BestBETs: emergency medicine reviews developed in the Emergency Department of Manchester Royal Infirmary, United Kingdom, with rapid evidence-based answers to real-life clinical questions.

    Medscape: articles on emergency medicine, published by WebMD.

    Canadian Library of Family Medicine: the College of Family Physicians of Canada’s (CFPC’s) library services; CFPC members can request free literature searches and full text articles. For more information, contact the library:

    Canadian Library of Family Medicine 
    The College of Family Physicians of Canada 
    2630 Skymark Avenue 
    Mississauga, ON L4W 5A4 
    [email protected]

Structured orals

Timing

The oral component of the Examination of Added Competence in Emergency Medicine consists of three stations, each delivered by a single examiner, for a total of three independent stations; one 25-minute (triple case) and two 12-minute (single case) stations. The triple case station involves three sequential cases, delivered one after another. There is no triage component tested in that station.

At the beginning of each oral, the examiner will give you a written clinical scenario containing information about the patient presented as if you are just about to go see that patient. You should read the written scenario carefully out loud, after which the timer will be started. After that time, you may start writing out memory aids or patient assessment rubrics. The examiner will conduct your oral exam and score simultaneously as you proceed through the case. The examiner will prompt you through the exam to allow for efficient use of time.

Examiner Role

This examination is different from the Simulated Office Oral component of the Certification Examination in Family Medicine where the examiner plays the role of the patient. You do not need to act as you would in a regular doctor-patient interaction. The examiner will facilitate your progress through the case. Ask the examiner for the information you feel is important to determine how to care for this patient.

The examiner will provide you with answers to all questions about history, physical exams, investigations, consults, or any other relevant inquiry. The examiner will occasionally direct or redirect you to cover certain essential aspects of the case. Should the examiner say a certain aspect of the case is normal or non-contributory, you should accept this and move on to the next steps of your evaluation or management.

Marks for PROCESS of caring for patients

This is an examination of your medical PROCESS of caring for patients who present to the Emergency Department. You are being assessed on how you manage the patient, not just if you get the right diagnosis at the end. There are many points for identifying various facts that are used to arrive at a sound differential diagnosis and management plan, and much less for the specific diagnosis itself.

Try to verbalize as much of your thought process as possible. Summarize periodically. You may take notes as you proceed, perhaps to remember an item to follow up, but since time is limited, consider using your time to verbally communicate with the examiner about the patient scenario. There are no points given for notes written on your paper. Carefully describe the actions you are taking. Remember, the examiner can only score you on the things you actually verbalize.

Avoid a cookbook approach and instead follow lines of questioning, physical assessments and investigations that are tailored to the case at hand. In this examination, a good history is most essential, and the relevant physical exam and logical differential diagnosis are also paramount. Any further investigations and management are secondary to a solid assessment that reflects a good foundation in the overall process of care for emergency medicine. There are no negative points for wrong answers.

Interventions

In the cases presented to you, there will usually be nurses to assist you in the emergency department (ED), as well as the services of your hospital. You may delegate certain activities to other members of your team. Be very specific in the orders and interventions you require (e.g., “CT scan of the chest” is not the same as “CT pulmonary angiogram”). Monitor the ABCs and vital signs in an ongoing fashion as necessary to get a feel for the progression of each case. Ask for the results of your interventions and investigations when appropriate.

Interpretations

You may be shown some actual copies of test results of your investigations and then be asked for your interpretation of what is presented to do. Please do so carefully, but succinctly. Certain results may be normal. Most scenarios are practice-based and don’t focus on extremely rare or occult problems. If the final diagnosis is uncommon or rare, the key points are for how you get to the diagnosis, not necessarily for the management of the specific diagnosis. When listing your differential diagnoses, be complete but concise; mention the things you should be considering in this patient, at this time.
Be decisive in the way you conduct your evaluations and establish your setting so that you can gather the best information in the most efficient manner.

Disposition

Make certain to be direct and clear in your disposition of each case, ensuring each patient has a clearly articulated and transparent care plan that covers all the essentials and is well presented to your examiner. Ensure that each patient has a comprehensive plan that provides continuity of care, be it in-patient or as an out-patient. Remember to include family members or caretakers as well as primary care health professionals.

Interaction with others during the exam

The examiner is not allowed to give you any feedback on your performance. However, he or she will work with you during the exam to provide all the information necessary to manage each situation optimally.

You will be expected to be silent during the intervals between the oral examinations. Do not discuss the content of the oral examinations with other candidates, before, after or during the examination. Experience has shown that prior knowledge of the clinical content or case diagnoses of oral examinations has resulted in poorer performances than might otherwise have been expected. You will be best served in preparing for this oral examination by exploring a case-based approach with practice scenarios that reflect a similar process and structure.

Disclaimer: This video is only an example of an oral examination and is intended to help candidates better understand the nature and purpose of the oral exam. The candidate's performance reveals diverse interviewing skills, the patient-centered clinical method of evaluation, as well as skills assessed. It is not representative of a candidate who meets the level or performance required to meet Certificate of Added Competence in Emergency Medicine [CAC(EM)].

Short-answer management problems (SAMPs)

The SAMP component will be delivered on computers and will be held at Prometric Testing sites in Greater Toronto Area locations. Once the applications have been approved, candidates will be directed to a website where they will select the time and location for their testing appointment. Each testing appointment is seven hours in length; this includes two 3-hour testing windows and a 1-hour break.  Candidates should plan to arrive at their testing site 30 minutes prior to their appointment to allow for the check-in process. Follow the link entitled “What to expect” for a description of the registration process that occurs in all Prometric administered testing centers.

This short-answer management problem (SAMP) examination is intended to measure a candidate’s knowledge and problem-solving skills in the context of a clinical situation.

Candidates will receive basic information about the presentation of the patient and a series of questions will follow each scenario.

The video demonstration is designed to provide an orientation to the functionality and features of the Prometric testing interface candidates will use on exam day. 

For the most part, each question will require a single word, short phrase or short list as a response. Where appropriate, the number of desired responses will be indicated for each question. No credit will be given for responses which exceed the number of requested responses.

The Committee on Examinations – Emergency Medicine has authorized the release of some SAMPs from previous examinations to help candidates understand the format and prepare for the exam. The sample questions available here are from previous examinations and may not reflect current clinical practice.

As they work through the problems, it is imperative that candidates follow the directions carefully so that they receive full credit for responses. The examination is very clear about the manner in which candidates are expected to list or write responses. Deviation from instructions can result in lower scores.

Candidates should:

  • Note that for each case, the setting of practice will be described if relevant
  • Understand most questions can be answered in 10 words or less
  • Submit only the number of answers required (i.e., if asked to provide three responses and five are submitted, only the first three will be scored)
  • If directed to mention drugs, include dosages
  • Give details about procedures only if directed to do so

Candidate Instructions:

For each SAMP, the setting is an Emergency Department with tertiary-care capability, unless the setting is otherwise described.

When answering questions in this examination please read the question carefully and provide only the information that is requested.

You can answer most questions in ten words or less.

Where appropriate, the number of desired responses will be indicated for each question. The corresponding number of answer fields will be provided. 

Write only one answer in each field. Subsequent answers in the same field will not be considered. No credit will be given for responses which exceed the number of requested responses.

When listing medications, the use of generic names or trade names will be accepted

When providing values or measures only Systeme Internationale (SI) units will be accepted

Avoid abbreviations which are not commonly used and which may not be clear to an examiner

If your answer to a question is “none”, please type “none”. Do not leave the answer box empty

When the phrase “Be Specific” is added to the end of a question, include ample detail. Provide pertinent descriptions of tests or investigations (e.g. CT with contrast re: pulmonary embolism is different from CT with contrast re: aortic dissection; abdominal ultrasound is different from ultrasound guided paracentesis), and include medication doses and routes

Sample SAMPs

While there may be other acceptable answers, these sample answers demonstrate the correct way to answer SAMPs. Candidates should use these cases to become familiar with the examination format. Contact the College of Family Physicians of Canada (CFCP) with any questions or concerns about SAMPs.

What to expect

Examination of Added Competence in Emergency Medicine Short Answer Management Problems (SAMPs): an example of sample answers acceptable to the Committee on Examinations – Emergency Medicine

Video Demonstration

SAMP Software Tutorial

Resources

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