Development and Pilot Evaluation of Mock American Board of Emergency Medicine Ultrasound Cases for Emergency Medicine Residents

Background: The maturation of point-of-care ultrasound (POCUS) within the specialty of Emergency Medicine (EM) has led to its incorporation into the newest iteration of the American Board of Emergency Medicine (ABEM) Certifying Examination.The new iteration of the exam will consist of ultrasound cases that will include at least two image acquisition and two interpretation components.Examinees will be asked to acquire and interpret ultrasound images on a standardized patient.The objective of this study was to evaluate resident performance and confidence during a two-case mock ultrasound curriculum designed to familiarize trainees with the ultrasound component of the ABEM Certifying Examination.Methods: This is a single blinded, cross-over study at the University of Arizona College of Medicine (Tucson, Arizona, United States).The study participants were EM resident physicians.A panel of POCUS experts developed two mock cases modeled after the ABEM certification ultrasound case.Residents were randomly assigned to a cardiac or thoracic-based case.Prior to participation, they were asked to independently watch the ABEM instructional video.They underwent an examination with a standardized patient, proctored by POCUS experts.After a one-month interval, participants were assessed on the alternate case.Data were collected from January 1, 2025 to May 1, 2026.Results: 64 EM residents participated in the study.48 completed the cross-over design, and 16 completed one day of the examination.Those that did review the material scored higher with a median score of 14 compared to 13, however, this was not statistically significant (p-value of 0.36).On Day 1, the mean overall score (out of 15) was 11.96 ± 2.49 for the Cardiac group and 11.62 ± 1.92 for the Pulmonary group.On Day 2, the mean overall scores increased to 12.55 ± 2.45 and 12.75 ± 2.24, respectively.There was no significant difference in mean scores between the Cardiac and Pulmonary cases on either Day 1 (p=0.57)or Day 2 (p=0.74).When comparing performance across days within each case type, Pulmonary case scores demonstrated a statistically significant increase from Day 1 to Day 2 (p=0.05).Across all participants on Day 1, post-graduate year (PGY) level was moderately correlated with total score (r=0.45,p=0.0007), with more senior residents tending to achieve higher examination scores.Conclusion: A focused, two-case preparatory curriculum was feasible across multiple residency programs and associated with differences in performance across testing days, particularly in the pulmonary ultrasound scenarios.Early exposure to mock examination cases may help residents develop familiarity with the observed structured clinical examination (OSCE)-style interface, strengthen technical and communication skills, and improve readiness for board certification.