[Music] [Music] [Music] [Music] [Music] [Music] [Music] [Music] [Music] [Music] do [Music] [Music] [Music] [Music] [Music] [Music] good morning um welcome to abem's webinar uh to provide information on our new virtual oral exam my name is carl chanovsky and i'm the chair of the test administration committee and i'm happy to be here this morning to update everyone on on our progress um i'd also like to thank you all for taking the time to be here we know that everyone has a busy schedule particularly now as as the pandemic seems to be surging across the country again and i'm sure all of you are working very hard and we appreciate your service and for you being here today and i'd also like to thank you for your patience during this this process um the pandemic has you know been difficult for all of us and certainly um it's created a um our inability to provide the oral exam as you know in person um and um so we appreciate your patience as abrams work through the process of developing this new oral exam uh so without any further ado um let's move on and let's talk about our new exam so the purpose of the webinar this morning is to provide all of you with an update on the development of our virtual oral exam examination um i'm going to provide an overview to start uh discuss the format of the exam because i know you all have questions about that and we're going to show you a demonstration of one of the new case types that you will be seeing during the administration we often get questioned about why abam still has an oral exam and there are some very good reasons for that the oral exam measures different elements than the qe or the written exam as you all know our exam content comes 100 from the em model the building blocks of the exam is something we call ksas which stand for knowledge skills and activities and we we assess the most important knowledge skills and activities that emergency physicians must have when we look at our exams we find that 36 percent of those knowledge skills and activities are not tested on the qualifying exam we are unable to test them in a written exam format and and that's why we have the oral exam the oral exam test things like empathy decision making complex reasoning data acquisition problem solving clinical judgment a variety of things that we just cannot test on the on the written exam that are very important to the practice of emergency medicine so that's why we continue to have an oral examination so let's talk a little bit about our new exam as you all know the spring and fall in person examinations in chicago were canceled that's left a backlog of approximately 2300 board eligible physicians i.e all of you on the call today who have passed the qe uh but are waiting to take the oral exam but as you know we've run into a number of challenges our e-oral platform that's our platform that we use uh during the in-person exam in chicago does not work remotely so we could not use that and as you might expect remote uh remote exam is much more difficult to administer because of that uh abem uh established a task force called the virtual oral exam task force a number of months ago to develop uh and and implement a new virtual oral exam the task force has been meeting weekly for the last several months and i'm happy to say and the reason we're here this morning is the exam has been developed and is ready for deployment the first exam is going to be taking place in december the dates are set that's december they'll be it'll be december 16th through the 18th we also plan to have three additional exams in the first half of 2021. there'll be one in early march another one in mid-april and a third sometime in either late may or early june we have yet to determine the administrations for the second half of 2021. we are monitoring the state of the pandemic and the and vaccine development and deployment very closely um and so that will help guide us on whether we continue in our current uh virtual format or whether we we switch back to an in-person or even some other type of format the other issue that we have is we don't know what the scalability of this new virtual oral exam is that is how many candidates we can put through at one time and how many times during the course of the year can we do it and much of that is related to the number of examiners we have available to participate nevertheless the virtual oral exam format will be the format we use during the pandemic no decisions have been made about the oral exam format after the pandemic we are we are discussing this and looking at all options and abend will communicate the information to you over how we will proceed as soon as the decision is made something to keep in mind however is even if we are able to return to an in-person exam the prior format that we were using um cannot sustain the number of candidates that we are seeing on a yearly basis now so there'll have to be some changes regardless of which format we decide to proceed with all right i'm sure you're all all thinking about when am i going to get scheduled so let's talk a little bit about the about scheduling for this new virtual oral exam so candidate schedule for the 2020 administrations who were cancelled will be the first scheduled for the new virtual oral exam and as you might expect we're going to try and get the spring candidates in first all of those candidates will be randomly assigned to these next several administrations the december candidates those who have been assigned to take it in december they were already notified and would have received an email with instructions on how to register for the exam if you were not if you were not notified that you were be able to take the exam in december and you would like to do so i strongly recommend that you contact abem and get on the wait list that we've created for that december exam i'm sure that there'll be some candidates who for whatever reason won't be able to take in december and we need to fill those slots and we'll do so from a waiting list so if you'd like to take it in december and you were notified that you didn't get a slot please let us know and we will put you on the wait list candidates for the first three administrations in 2021 will be notified early in january likely sometime during that first week of january notification will consist of an email that will give you all the instructions you need to get registered for that exam all right so more about scheduling let's talk about the exam day itself so we plan to have two exam sessions per day each session will take about three hours we have allotted 25 minutes for each case which is a little longer than our typical in-person exam but we wanted to be sure that our examiners had enough time to administer uh score the exam and move from zoom room to zoom so basically you will have 15 minutes to complete each case that has not changed and the examiners will be allotted five minutes to score and five minutes to transition to the next case for a total of 25 minutes there will be one 10-minute break uh in everyone's session and unlike our in-person exams in chicago where candidates move from uh hotel room to hotel room to take in this uh in the virtual exam uh candidates will remain stationary that is you will be placed in a zoom room and you will stay there and the examiners will go from zoom room to zoom room so a little bit different all right so what kinds of tests are you going to be seeing so there'll be no triples in the virtual oral format um you will get seven total cases there will be six single cases which i will discuss in a moment and one new case again which i will get to called a structured interview case each case will be administered by one examiner and for the virtual oral exam we're going to be using only static stimuli that is there'll be no moving ultrasound images or videos all the stimuli will be static in addition the stimuli will be listed on the screen and what i mean by that is because we're using the zoom platform the examiners will be sharing their screens with the candidates on the screen for the single uh cases there'll be 12 stimuli listed and labeled 1 through 12 and for the structured interview case there'll be six stimuli labeled one through six each case may have 1 5 10 or 12 cases 12 stimuli in the singles you'll have no way of knowing that and this is our way of making sure that we don't inadvertently give anybody any additional information but because the screens need to be shared we have to have them on the on the screen at all times let's talk a little bit about the single cases so these cases are going to be very similar to cases at previous oral exams the content and the format is identical to the pre-oral cases and and so if your residency program provided practice sessions based on our previous exams uh in chicago then they will be right in line with these six uh what we call paper cases that you'll be receiving so identical and you should be uh ready for those if you've been practicing uh using the old format the biggest change in the virtual oral format is that stimuli again will be on the screen we won't be passing you paper stimuli or ekgs everything will be on the screen you will not be able to directly interact with those stimuli in other words you will not be able to click on on a stimuli and open it up they'll be on the screen again labeled either one through twelve or one through six depending on which format you're in and the examiner will click on those stimuli so that you can see them so you can visualize them as the case goes on you will be able to enlarge them if you want to make them bigger like an ekg or an x-ray but you won't be able to open and close them if you want to see a stimuli that you had looked at previously so if you look at an x-ray or an ekg and towards the end of the case you'd like to revisit all you need to do is ask the examiner and they will bring it up on screen for you to relook at let's talk a little bit about this new case a structured interview case abam is using this opportunity to innovate and leverage uh new types of cases the structured interview case is basically a structured discussion between you and the examiner and it follows the approach to workups that you perform in the emergency department every day the idea behind the structured interview case is to really assess uh your your thought process to understand why you did something and so in the structured interview format you're going to get a lot of dr brown why did you order that ct scan on this patient or dr smith you order the cbc how is that helpful to you it'll give you an ability to explain your thought process um really kind of showing your work verbally so to speak and we believe it's going to be the first time that we've been able to directly assess how you think about a case and i think it's going to be very very helpful in assessing uh your abilities i think the best way to understand the structured interview case is to see one online um so we have a demonstration that i'm going to ask shelby to tee up next but i also want to remind all of you that that this demo that you're going to look at today is available on the abem website along with a demo of one of the the uh um paper cases uh that will be on our type that will be on the the virtual oral exam and you can log on to the abam website and and watch either of these or both of these at your leisure after this so let's go ahead and start the video and you can take a look at the structured format good afternoon doctor this is a structured interview case you will have 15 minutes to complete the case before we begin do you have any questions no i don't all right you're asked to see mr parker a 42 year old man without the gastric pain and vomiting for the past six hours when you walk in the room you see a middle aged man who is uncomfortable in vomiting the nurse hands you this admitting form almost six hours uncomfortable no history of gi disease pain and nausea quickly sharp under emitting a radius to the back and no history of surgery or chronomorphic medical conditions he's a little hypertensive tachycardic but otherwise unremarkable based on this presentation what additional historical information would you want to ask the patient well i i want to confirm that in fact he's never had any symptoms like this before he has no history of gastrointestinal disease but but never anything like this before i'd want to know about his past medical history particularly a history of hypertension since he's a little hypertensive here and if he truly takes any medications um i'd want to know what he was doing when the pain started if he finds that anything makes the pain better or makes the pain worse um sharp abdominal pain i would want to know if he's um now he's vomiting i'd want to know what that vomitus looks like i'd want to know his last bowel movement and what color the last bowel movement was um i'd like to know a social history if he's a smoker or a drinker or if he uses any illicit drugs um i'd like to get a family history and i'd also um like to get a history of um unintentional weight loss um over the last number of months all right doctor thank you you asked about previous episodes or past medical history um why well i think the best predictor of the his diagnosis today would be previous diagnosis of the same or similar all right you also asked about alcohol use how is that helpful to you uh i think they all the alcohol use is important because it can affect the gi system in a number of different ways it can be a direct irritant to the stomach it can be associated with nausea and vomiting and that can give even erosive esophageal problems and it can exacerbate other types of hepatic dysfunction if he's a long time drinker it can really cause liver dysfunction and increase the risk of gi bleeding and it can also cause inflammation of the pancreas all right thank you the patient does drink alcohol infrequently but drank heavily for him last evening he had six beers and two shots of tequila he has no known history of gallbladder disease based on what you now know what specific physical exam findings would you be looking for well i'd clearly start with how he looks in general um does he does he look sick is he pale are his mucous membranes pale or is mucous membranes dry is his mental status okay um i do a heart and lung exam i'd certainly do an exam of his abdomen i'd look at the abdomen first then i'd auscultate and i would palpate the abdomen i do a rectal exam and check for occult blood i um i do a gu exam as well and i just make sure that he was moving all extremities normally all right doctor you indicated that you would uh auscultate the abdomen um how is that helpful [Music] well i think a sudden onset of uh nausea and vomiting um can be a sign of a bowel obstructions um so i would want to make sure that he had bowel sounds if they were high-pitched bowel sounds i'd be more worried about a mechanical obstruction if he uh bow sounds were absent i'd worry about an ilias whether that was from medication or from some other cause right doctor you indicated that you would want to palpate the abdomen again how is that helpful uh well i want to make sure given hopefully i would be able to tell given his body habitus if he had a pulsatile abdominal mass if this was doesn't sound like a triple a but clearly thinking worst first i would think about a vascular emergency i would also want to see how tender he is and exactly where he's tender so looking for parent needle signs i'd also check and make sure that there wasn't specific tenderness despite him complaining of tenderness in the middle of a gas stream in the right upper quadrant or that he had a murphy sign all right doctor um the patient is slightly diaphoretic and appears to be uncomfortable and nauseated oral mucosa is dry there is moderate epigastric tenderness without rebound bowel sounds are normal stool is negative for a cold blood and the vascular exam is normal based on what you now know what are the top three items on your differential diagnosis based on the most likely conditions so we see this pretty sick with an epic gastric pain i i think i'm gonna focus on the um gosh it could be it still could be a lot of things so um could be peptic ulcer disease could be gallbladder disease could be as pancreas not typical for mesenteric ischemia but it could still be mesenteric ischemia um could be gastritis not typical for primary hepatitis with a sudden onset but that's still a possibility um how many more would you like me to get we'll ask you doctor if you would i'd like your top three only please um okay um i think this could be peptic ulcer disease pancreatitis um with or without a gallstone or i'm still going to leave mesenteric ischemia on right doctor thank you based on what you now know and the working differential diagnosis that you just provided what if any diagnostic studies would you order um i'd like to get a cbc and a bmp i'd like to get liver function tests in a ua [Music] i'd like an ekg and a troponin and i i'd like to get either a red upper quadrant ultrasound or a ct abdomen and pelvis i guess given the location of his pain i'd like to go with the ct [Music] abdomen and pelvis i don't think a right upper quadrant ultrasound yeah ct ct abdomen and pelvis all right doctor thank you um you ordered a bmp um why well his um i think that he's volume contracted given his tachycardia and the oral mucosa findings on his physical exam so i i would want to make sure that he doesn't have an acute kidney injury associated with the volume contraction all right and uh similarly you ordered a cat scan how would that help you i i think given the two diagnoses that are at the top i i guess i could have gotten a chest x-ray to make sure that he didn't have free air but he doesn't really apparent neil signs so i think a ct would tell me more about gastric as well as pancreas and biliary disease than just a right upper quadrant ultrasound so um it would it would definitely show me freer it would show me um gallstones i might get a an estimation of the common bile duct and it would give me a general look at the pancreas as well as a look at the vasculature all right doctor um here are the results of the lab and imaging studies okay a little bit of a white count when hemoglobin looks normal well like pace and amylase it's very pancreatic that's true okay right doctor um based on what you know now what treatment if any would you order i would um start iv fluids i'd give a liter bolus reassess after the leader for a second leader i would give him some anti-medics some medication for pain and i would make sure that nursing is aware that uh he needs to be kept npo at this time all right doctor you ordered uh iv fluids um why um well his physical exam with the tachycardia and the dry mucous membranes is consistent with volume contraction and those are really born out in his labs with a bicarb of 17 mildly elevated lactates and a bu and the creatinine ratio over 20 to 1 and so um i think he would benefit from iv hydration that and i'm going to be keeping an mpo so he's going to need maintenance fluids anyway all right and why would you reassess the patient i think i need to reassess his vital signs but i also think that um this lactate is elevated and um i think it's going to be important to trend lactates on him to make sure that we're doing adequate resuscitation so reassessment to me means not only vital signs and clinically but i would repeat his labs in a couple hours all right thank you based on everything you know about this case what is your final diagnosis um primarily giving the ct findings in his labs i think it's acute pancreatitis but don't see evidence of common bile duct obstruction all right thank you thank you based on what you you know now what should the disposition of this patient be yeah he needs to be admitted probably admitted to a step down unit or at least a monitored bed someplace where there's um adequate attention to him okay why would you admit him um for a number of reasons um and he needs to say mpo um for pancreatic rest um he's gonna get iv fluids um probably he has gonna have a continued need for parenteral pain medication as well as antibiotics and um i think most importantly he's going to need serial abdominal exams he doesn't seem to have any surgical complications of pancreatitis uh yet but we need to trend his labs including his h and um and follow serial abdominal exams along to make sure he doesn't have any uh complications all right thank you based on the disposition that you chose which is to admit this patient how would you hand him off uh well i'd i'd reassess and see how he's doing and and put in labs in a little bit of time um i think though he can be admitted to medicine so i would i would make sure that the um the admitting team or the admitting physician um knows that i have a i have a middle aged gentleman with no significant past medical history um presenting with acute epigastric pain and it's consistent with pancreatitis not associated with gallstones but probably secondary from his acute alcohol use and presentation he was tachycardic and hypertensive but in pain and a febrile but his workup has shown an elevated lipase anomalies um ct consistent with pancreatitis with peri-pancreatic but no evidence of hemorrhage i've treated him with iv pain medication started iv fluids and he needs serial donald exams and i would ask them if they had any questions about his care or needed any clarifications all right doctor thank you very much that ends this structured interview thank you all right so that gives you a good idea of what our new structured interview cases uh will be like again if you'd like to view this again or view a demo of the paper cases this these traditional case uh you can go to the abem website the other thing i'd like to mention now i should have probably said it earlier on it was in the initial slides that you saw while waiting for the webinar to start but if you have questions as we go please feel free to put them in the q a section of the of the webinar the chat room uh as you know is um been turned off for the webinar um some of those questions will be answered by um individuals from abem staff who are monitoring that question in the answer room uh and then i will address what the the number of questions that i have time for at the end um during the webinar so if you have questions please go ahead and and put them in the q a also if you have questions that are very personal to your situation um and you don't feel comfortable putting in the q a um you can notify uh abam either through email or call and we'll try to get those answers for you as quickly as we can all right talk a little bit about some of the security considerations for this new exam again this is still a high stakes exam um and so uh you know we we want to be sure that we have the rights processes in place um candidates will not be allowed any external assistance at all so that means no one else can be in the room um you can't have textbooks cell phones other computers to look at things like up to date no outside assistance we're going to ask you to find a private quiet testing location so that you can take the exam undisturbed uh prior to the exam you'll need to attest to the exam policies uh and basically this exam is being given on the onoco and we're relying on every candidate's personal integrity um just a reminder that violations of the honor code will have consequences as do all of our other exams all right the exam is going to be administered using a zoom platform as you know we will be providing technical support for the zoom meetings and breakout sessions and you'll be receiving information on that prior to the time that you'll be taking the exam each candidate will have uh a tech check ahead of the exam um and we plan on having something we're calling a virtual event center uh kind of like the the elevator lobby at the chicago here marriott hotel where you can park yourselves and where you'll have your session appointments listed and we are planning on recording all sessions so we will be able to go back and look at them um to be sure that they were administered appropriately or answer any questions or concerns that that may come up after the exam all right we plan on having a candidate check-in process and we have an outside vendor that's going to be helping us with that we'll be doing a systems check to be sure that all of your applications are either closed or turned off and of course we need to make sure that we are testing the right person so there will be an authentication uh segment to this we will be taking a virtual scan of your environment using uh your camera on your computer we also plan on having proctors that will circulate through the zoom breakout rooms just to kind of see what's going on keeping an eye on everything and then as we do for all of our exams our abec staff does a really nice job at patrolling the web for exam content all right prior to the exam we are going to provide you with a number of pieces of information all all of you will receive a candidate note sheet um you'll get a list of normal lab values because they will not be on the stimuli that you received during the exam you'll get a list of common abbreviations and we will send you some more information because it is new regarding the si format and information about how you will be scored on the si case we will ask you to destroy rip up shred your notes on camera at the end of the exam session all right again um talk a little bit about uh some of the technical considerations um uh as i mentioned a moment ago we're gonna ask you to find a private quiet distraction-free testing location you will need a laptop or desktop computer you will not be able to take the exam on um on an ipad your laptop with desktop must have a camera and a microphone we recommend if you have one to use headphones that have a microphone so that you have your hands free for taking notes it just makes a little bit easier for you you will need a reliable high-speed internet connection at least one and a half to two megabytes per second for those of you who are planning on taking it in the hospital we strongly recommend that you test uh your hospital firewall first many institutions uh have very thick firewalls and it may make it difficult to actually take the exam from the institution so if you're planning on doing that please be sure that that your firewall or the firewall from your institution does not negatively impact your ability to to take the exam remember that examiners will be sharing their screens with candidates you will not be able to directly interact with the stimuli all right that's really all i have on the virtual oral exam and um kathleen ruff has been monitoring the q a and um so i'm going to see if i can answer some of those questions that that are burning in your mind now great carl thank you so we've had a number of questions come in about why we're keeping the oral exam why is abem continuing to have the oral exam um and then also why are they continuing to require us potentially to go back to an in-person format if that's what we're gonna do all right so let me start with the first question which is why abam continues to have an oral exam and i mentioned this at the very very beginning of the talk you know we we need to assess every candidate's ability to practice emergency medicine to be a competent emergency physician and as i mentioned earlier the qualifying exam that is the written exam with multiple choice questions cannot test some of the skills knowledge and ability that are required for emergency physicians to be competent practitioners again things like data acquisition problem solving clinical judgment interpersonal skills your ability to manage multiple patients simultaneously that just can't be tested well those things can't be tested on the written exam but yet are very important uh to the practice of emergency medicine so because of that um that's that that's really the reasons we have the the oral exam again 36 of the knowledge skills and activity that that are important for emergency physicians to possess cannot be tested on the on the written exam so that's the answer to the first one the second one is we have not made any decisions yet as i mentioned earlier um we may continue with a virtual format um we may want to go back and have an exam in chicago there may be the ability to do both no decisions have been made as of right now we will continue the virtual format at least until the pandemic allows us to do otherwise we will take a look at how the results of the virtual exam come out um we'll get feedback from you from our examiners uh and then make a determination about what is the best way to continue on with the oral exam so right now we don't really know um and when we do we will we will bring this back to to our candidates we will have discussions and allow you to ask questions and try to provide you with as much information as we can there are also a number of call questions about the cost of the exam the cost of the exam is remains what it was and so the question is why do we continue uh to have this cost given the fact that uh it is now a virtual format recognizing of course that this is the cost is really attributed to the value of the cert of the certificate and as part of the contribution of um the overall uh certificate itself in terms of that value so can you speak a little bit about uh the cost issues associated with the oral sure so um the cost is the same that is correct um but but you know abam does not get any any financial support other than through the tuition for our for our exams uh to develop the virtual oral exam um to uh have an outside vendor working with us to have uh the correct platform all of those things are expensive to create um and we still have of course our our entire staff at abend uh helping us do that uh and they're they're paid individuals so things like uh test development uh test administration research um staff costs all of those things are still present regardless of whether we have an in-person exam or not and so we we still need to have have that to happen um recall or remember that as at least for these exams for the virtual exams you don't have to travel to chicago and so there will be uh cost savings for travel and hotel and things like that so it should be less for all of you um but but to continue to have a a good oral exam does cost money the only money that abram gets is through through the cost of the exams and so for now that's the way we are proceeding so carl we've had a number of questions on the structured interview uh so one of the questions is is the structured case supposed to be a back and forth or should you give a list of questions up front no the the the idea of this case is to be a discussion between the examiner and the candidate um the examiner will lead you through that discussion they are all well trained on how to do that there are very specific items that we are looking for in that discussion but it needs to be back and forth we want it to be more of a kind of the workups you do every day in the ed and how you do them but but really we are getting at with this interview um we are trying to get at your thought process your rationale why you do things that you do uh and we think that's going to be very helpful in making a great assessment of your abilities as an emergency physician so for the structured interview it seems that you can answer the questions as if you're speaking to another physician and is using medical jargon okay is it expected absolutely yes you are not talking to the patient during the structured interview you are talking to another seasoned emergency physician and so you can use and should use you know medical jargon we we want to know your thought process so again um you're going to get a lot of whys uh you know why did you order that test how will that helpful be helpful to you you'll get a lot of those uh we are looking for your rationale but you're talking to an emergency physician uh and so you can use medical jargon um when you're when they ask you about how you would transition a case um you're talking to a physician so feel free to to use the jargon that works for you so in um these types of cases i mean normally in the emergency department you're contacting a pharmacist or using up to date why wouldn't an up-to-date resource or other resources be available to you for this type of exam so again for the structured cases we are really looking at your thought process which shouldn't be affected by um textbooks are up to date during the exam if you if you feel like hey i think the patient has disease a i really don't remember what the treatment for disease a is but i'm sure that's what he has and i would look it up you can say that i would look up the treatment for disease a or i know i want to give this particular medication i can't remember the dose i would look it up you can tell that to the examiner that's fine but you just can't have external assistance in moving through the discussion so is it recommended that we verbalize the things we note on the stem for a structured interview case um you can if you want some candidates like to repeat the stem and and say it out loud that's fine but you don't have to as i said the examiners will guide you through this discussion um and as you notice there's some uh discussion back and forth on history on physical exam you're going to be asked for a differential diagnosis what tests you would order what treatments you would give a final diagnosis and then you know your disposition and then based on what that disposition is whether it's admitting or sending the patient home you'll kind of be asked about how that transition will occur um you don't have to repeat the stems you can just be make this a natural discussion between you and the examiner so will there be reference ranges for labs results given in the structured interviews so as i mentioned earlier before you take your exam abem will be sending you normal values for all laboratories so you'll have that in front of you along with um uh abbreviations uh list as well so you'll have the you'll have all the information you need to know whether a lab is positive or high or negative or low can you speak to scoring what is the criteria for scoring for cases and the structured interview case so scoring for the six single patient encounters are identical to the scoring that we used uh prior to the virtual oral exam that's unchanged the uh scoring on the structure in a few cases um well first let me just by saying we will be sending you information regarding scoring so we're going to send that to you in writing so that you'll be able to see how you're being assessed but basically there are elements in each of those sections that i just mentioned that we feel it's important that an emergency physician verbalizes to us it may be a particular historical piece of information based on the case that you have or a particular part of the physical exam um it may be the final diagnosis etc so um if you hit those individual points for each section you'll get a point in addition we are going to be asking you uh your rationale your thought process behind those answers um and as long as that thought process process or rationale is appropriate to those correct answers and you get the majority of those rationales correct you'll also receive a point for your thought process and at the end of the exam your points get added up and the passing score will be determined based on the results of everybody's exam so are any of the stimuli going to be a bedside point of care ultrasound as part of our physical exam are all ultrasounds uh an ordered test uh in essence like a ct versus an official ultrasound so there may be cases particularly with the uh single uh patient encounters where you may be shown a single ultrasound image to interpret or you may be seeing a written result from like a radiologist it could be one or both of those there will not be dynamic images for you to interpret on the simula simulated structured interview case there were several more stimuli that were not shown during the interview uh during the single cases or the structured interview will it show the list of stimuli and see that there are several stimuli that we never got to i mean how's that going to work all right so remember unlike the in-person exam in chicago we're sharing screens the examiners are sharing screens with the candidates which puts a little damper on what we can and cannot do with our stimuli because of that every single single case encounter will have 12 stimuli listed on the screen you don't know whether there's actually one stimuli five stimuli h stimuli you won't know that every single one will have and the examiner will open the ones that you request you there may not be 12 on on all of them you just won't know that similarly for the structured interview there'll be six stimuli listed for each case there may only be one or two for that case but all will have six and by doing this um it it avoids inadvertent cueing uh uh for any particular case that oh boy this is a bunch of more than i i must have asked the wrong questions or i need to i need to do more tests because there's more stimuli that is not correct and that that is not something that you should think you should order the tests uh and the imaging studies um that you that you want on that patient regardless of the number of stimuli listed on the screen that number is irrelevant there may not be that actual number of stimuli and i hope that's clear and if you if it's not um again i recommend going to the to the website uh and and there's more explanation on that uh for each of those case demos so in the particular demonstration i would not have pursued a ct abdomen um pelvis in the pancreatic pancreatis example would i be penalized for this not necessarily again there are there are certain parameters uh in each of those sections that the case developer feels that is most important for an emergency physician to ask do or order in that particular case ct may not have been on there um but yet that's what the candidate wanted to do so um i can say not necessarily and remember there's multiple sections and multiple scoring points within each section so missing one particular uh answer or giving one wrong answer doesn't necessarily mean you're going to fail that that encounter so how can you fail the structured interview well as i mentioned you'll be getting points for each of the correct answers and correct rationales um and while i don't have the scoring yet because we haven't done this you'll have to get a certain number of points on each case in order to pass that structure interview case and then of course that's just one of seven total cases that you will be getting during the virtual oral exam um and so if you pass all of the single encounter paper cases and you potentially don't pass the structured interview um you still could pass the exam uh so it has to do with the your entire score uh and that is yet to be determined uh our our psychometricians are working on that right now and it will we will have a scoring paradigm in place prior to the december exam so there are a number of questions uh on uh technical issues one of which was how soon and how much in advance are we gonna email uh information to candidates uh and that information will go to candidates uh substantially in advance of their administration so that they will be able to print out the documentation there is concern uh that people do not have access uh readily access to printers and so we will take that into account uh to help them in that process um but there are some questions related to the browser what kind of browser can be used uh for uh for the exam all right so um we recommend uh using chrome um for this however there's really no um no mandate for any particular browser firefox would work explorer would work so any of those are fine we've we have found that uh that chrome does work the best but you can use any of those and how would they approach if there is a technical issue uh a wi-fi issue um a problem with the computer all right well i'm sure all of you by now have done many zoom meetings and you know that no matter how much you prepare in advance um there's always the possibility of a technical uh problem or even things like a brief interruption because someone walks in the room even though you think you're in a private quiet place i mean we anticipate things like that happening and we are prepared to manage those we will be getting your cell phone numbers and we have all the examiner cell phones cell phone numbers so that we can communicate immediately during any exam session if the if the session has a brief you know a small um interruption we will likely just continue that case on if there's a significant interruption either because of a technical problem or other uh issue that really either stops or or prolongs our ability to administer that session the chief examiners will be available immediately to to make a determination of what to do next we have a number of things that we can go to so we have backup examiners who will be immediately available and can go right into the candidates room and and provide the exam for them we also have exam sessions we call them makeup sessions that are scheduled at the end of the main session so if you were to miss an entire session for whatever reason our entire exam we can actually make that up on that day at the end of the session and certainly if there's major issues with multiple exams we may have to have you do a totally different day we're hoping that doesn't become a reality but for simple things we're going to continue for more significant things you might get a backup examiner we might ask you to stay a little later and have a makeup session but we do have a variety of fixes in place should that happen there were a number of questions about and concerns about being able to find that private quiet testing uh type of location uh for some folks they were wondering if is it gonna be a problem if for instance a co-worker walks into a room or a roommate walks into a room um and then leaves is that gonna be disruptive will that end their exam how how will that work i'm going to strongly recommend to all of you that you find a place that you can take this exam undisturbed i am sure that if you talk to your residency director or department chair they can help find that place for you um if you live in a place where you have roommates if you have a room that you can lock the door in so that you are not disturbed uh that's going to be my strongest recommendation to all of you if you absolutely can't find a place um i'm going to suggest that you contact abe and let's talk about it individually um we don't want people to walk in and disturb the exam session we think that's really important so you know do your best to find a private secure location and if you absolutely can't after exploring all possibilities let us know and we'll talk about some of the alternatives that we may be able to help you with uh there are a number of questions uh coming in about scoring again um and related to the single cases and the structured interview there's questions of whether the structured interview is going to be basically weighted the same as the single cases is one going to count more than the other is one worth more than the other so as of right now uh and uh for the for the foreseeable future and i say that because we haven't we haven't provided this exam yet and we haven't gotten any results yet but for right now um it has not weighted any differently than the other uh cases that that you will be taking so all cases are weighted the same uh and will be graded as i mentioned earlier great and can you uh just go over um also there was a question related to um providing enough time during the exam for a candidate to be able to look at the stimuli like magnify it uh if it's too small uh that kind of thing will that be you know will candidates be able to do that kind of uh interactive with the stimuli um during the exam if they need to see something that's really small sure um so you will be given 15 minutes for the case and and no longer however to to magnify stimuli takes literally a second or two um there is a magnification uh function on the zoom platform you can make things bigger or smaller at your leisure that is that is probably the only aspect of the stimuli that you will personally be able to interact with and again if you want to see a stimuli that was previously put on the screen by your examiner all you need to do is ask them hey i'd like to see that admitting form again please or you know can you put up the