It's been 10 years since you passed the ABEM exam. You did fine the first time. You should be OK the second time around, right? Truth is, you've kept up with your reading about as well as you've remembered to floss. Maybe you do need to go over a few things just to be sure. The boards are only a few months away. How is the best way to prepare?

There are two issues. The first is whether you need to reacquaint yourself with the test format and atmosphere. Do you get test jitters enough to effect your score? If you do, you need to take practice tests administered by a third party. I think the only way to do this is to attend a course that concentrates on recreating the test environment. There are many good ones put on by both specialty societies, state chapters, universities and private vendors. They can be expensive and usually require a week of your vacation time, but they're the only way to truly simulate the testing environment. You can argue that a home test is just as good, but if you need to simulate the pressure of the timed test, I think there is no substitute for a third party to keep you honest.

What the week long course will not do is substitute for a serious re-examination of all the knowledge that you accumulated in your residency or the years of practice track preparation for the first boards. Take a hard look at your current practice and how it has stimulated your continued learning. If you practice at an academic center where you are constantly being peppered with questions by residents trying to show off their knowledge, you probably don't need to review much. More likely, however, your practice setting has a bias toward certain types of problems. You may not see much peds, for instance, or you may see very little trauma. EPs in the southwest know all about snake bites while urban EPs have never seen one in their lives. And the test will examine all the potential problems, in every area. What you need is a systematic review of all of emergency medicine. The thought may seem overwhelming, but there are several good study aids that break the material down into bite sized chunks. Which one is best for you?

I used several and each had their own strengths and weaknesses. While Tintinelli's textbook has achieved something of the 'gold standard' in EM textbooks, I found it a little overwhelming. After spending several evenings that ended up with glazed eyes and wondering what I had just read, I tried Carol River's review of EM. It was a little more manageable in size and its approach was clearly more test prep oriented. For several weeks I virtually lived with that book, taking it wherever I went. I studied while waiting in the carpool line. I studied on the back deck waiting for the burgers to burn. I studied at night before drifting off to sleep. But the portability of the material was both good and bad. It was good time management, but it didn't encourage me to spend dedicated study/test time. I eventually decided that, since the exam was taken on a computer, I needed to study using a computer test format.

The two computer based study/test formats that I tried were Rosen's and Challenger. Both were quite good. And as the test date approached I felt that I was getting a pretty good feel for the actual test material. (In fact, when I took the exam I thought I saw some questions that had appeared in the Rosen material.) However, Rosen's had some technical glitches that made me wonder if the answer key was correctly matched to the test questions. The Challenger material was, in my opinion, the best by far. It took a little more comprehensive approach to the review with materials that encouraged me to learn from my mistakes. And the extensive library of test materials gave me a palatable way to continue my learning. Both formats require that I spend time in front of the computer screen, but I do that everyday anyway.

In the end I successfully passed the test. In fact, it seemed a little anticlimactic after all my study. I guess that's the way it's supposed to be when you really are prepared.