Number 27: The Answer is C

(Or: Give Me The Right Answers, ABEM!)

courtesy Wikimedia Commons

Today we residents are post-inservice exam, put together by The American Board of Emergency Medicine, and I can say this about the test: I’m glad I’m not an intern anymore. I’ve obviously still got a lot to learn, but it’s nothing like the feeling of overwhelmth (yes, just made that up) you feel halfway through your internship thinking, “I’m supposed to know the answer to this?”

But today I’m not writing about those mushy-gushy feelings and experiences. No no. Today, I want answers.

I was always annoyed with standardized medical tests (primarily the USMLE) where you left the exam with a) no idea how you performed and b) no real feedback for several months. At this point, I don’t really care if I missed a question about cyclic GMP on USMLE Step I, but for the inservice exam, it’s a different story. This is stuff that I apparently need to know. And so, please, ABEM: I want to know the right answers.

If the point of the inservice and the boards is knowledge and learning and requiring a certain level of competency of emergency physicians, then why not give us feedback so we don’t actually screw something up with an actual patient? What, the answer wasn’t ceftriaxone? Why not? What is it that I’m not understanding about the case that you thought it so important a concept as to test it? If a resident answers that he or she wants to use an ABG to rule out a pulmonary embolism, or decide to get abdominal films as the test of choice for right lower quadrant pain, shouldn’t we be telling that resident (or his or her program) that there’s some serious educating that needs to happen?

ABEM: I want an email with feedback on the questions I missed, or wasn’t sure about. Have me optionally fill out my email address in bubble format, and when you scan through my answers and calculate my percentage, email me the answers. Or, if you don’t want to share the questions because you recycle them, email me the specific topic. Not just “management of status epilepticus,” but “second and third line agents for status epilepticus.” Not just “tick borne disease,” but “treatment of pediatric lyme disease.”

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  1. #1 by Nick - February 25th, 2010 at 13:08


    When I got my written board score back, about two months after the exam, ABEM attached a “candidate keyword report” sheet for questions I missed. I imagine this was once a progressive innovation, many years ago, but I can’t imagine this helping with anyone’s education today.

    For instance, apparently I missed a question on “trauma TI” (I checked the attached key — perhaps they’re trying to save ink — TI stands for therapeutic intervention) and “toxicology PT” (pharmacotherapy). So, I’ve got oral boards coming up, and this document doesn’t help focus my review in any meaningful way. They might as well just say, “you missed a few questions on emergency medicine.”

  2. #2 by JR - February 25th, 2010 at 14:32


    Somehow, I have a feeling if they actually sent you that email it would be very short indeed. Looking forward to working a shift with you again!

  3. #3 by Carey - February 25th, 2010 at 19:39

    I second Nick’s amen, and I’m glad to know I’m not the only one who found ABEM’s report sheet useless.

    Anyone care to speculate about why the answers and explanations aren’t released?

    I’ll start: ABEM might believe that releasing the answers will limit their ability to recycle the questions (with suitable tweaking) for subsequent inservice exams, or for the actual qualifying exam.

    Anyone else a better speculator than I am?

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