In-Training Exam Prep

Commentary: The In-Training Exam (ITE) for emergency medicine is given every year to every resident in EM residency training.  It is designed to help you have an idea for what the EM Written Boards is like.  Most residents who do poorly either underestimate the amount of time or the sheer volume of material needed to review.  You can’t study for it over a weekend – rather it is a multi-week, more often a multi-month process (especially for interns).  Below are several resources you can use to help you prepare, as well as some commentary as to how it may benefit you.



  • In-training Prep Videos
    Commentary: Experience is the best exposure, but no intern/resident will be exposed the wide-range of pathologies of emergency medicine in their first couple months of their training.  Sitting down and reading lengthy textbooks would not be effective time-wise either to study for the test.  Quick review videos like the ones above can give you a flavor of the types of cases you will see on the test and in real-life.  This particular website has been well-received by residents throughout the country over the years, although it does cost a modest $50/year to register.  Other video resources exist but have either varying degrees of applicability/effectiveness (such as the EMRAP Crunch Time) or cost (such as the National EM Board Review Course which approach $1000).


Application (Questions)

  • Peer 8 Questions, Answers 1, Answers 2, Question Breakdown by Subject (Files)
  • Rosh Review (Link)
  • Peer 9 (Link); QuestionsAnswers Part 1, Part 2, Part 3, Part 4
  • 1200 Questions to Help You Pass the Emergency Medicine Boards (Files)
    Commentary: As you begin to learn, you need to be able to apply your knowledge in a test format, and eventually/ultimately in real life.  PEER has been for decades considered the gold-standard source of questions, and has been promoted by ACEP/ABEM (the people who make the ITE and Boards).  In recent years, Rosh Review has gained favorability due to it being the first to develop a computer interface and mobile phone application.  Eventually PEER developed their own software in their latest 9th edition.  Both are well-liked, although some say PEER questions may be a little more representative, whereas Rosh has more questions (PEER ~500q, Rosh ~1200q).  A third favorite is “1200 Qs to Help you Pass the EM Boards.”  Whichever you use, realize you probably realistically can only go through only 1 source per study season.  There is a lot of information and teaching points in the answer explanation sections, so anticipate you’ll have to do some reading/note taking when you sit down each time.  Also, it’s easy to forget later on the points you learned the first time through, so be sure you give yourself time closer to the exam date to review your incorrects (and ideally your correct guesses as well).



  • High Yield PDFs (Files): Cardio, PulmGIGU, Environmental, Toxicology, Heme_ Onc, Metabolic_ Endocrine, Neurology, OB_GYN, ENT MAX FACIAL DENTALOphthomology, Orthopaedics, Trauma, Pediatrics, Procedures, Final Review
    Commentary: After going through the questions and reading the explanations for your incorrects, you still may not understand a particular subject, so you may need to supplement your learning with some texts.  Ideal reading would be textbooks like Tintinalli or Rosen, but for most early learners these textbooks can be too dense for quick test review.  The same company that produced the videos above also has a High-Yield textbook.  You may purchase their book on their website.  Alternatively, we have PDFs copies of the chapters here.  Please do not share these with anyone outside of our residency.  Some people find it useful to have these chapters open while they watch those exposure videos.  The last chapter titled “Final Review” is well-liked by a lot of residents.



  • Board Review Notes All Topics (File)
    Commentary: The sheer amount of new concepts and facts that a new learner will be exposed to is hard to prepare for.  No matter the quality of your learning experience the first time, either through reading or doing questions, inevitably some of those facts you learned will be forgotten a couple of days or weeks later.  Keeping notes of what you learned the first time through can help you quickly review weeks to months after your initial exposure, and will help you refresh on hard-to-memorize differences between certain pathologies (Colles vs. Smiths fracture pattern, Ethylene Glycol vs. Methanol toxicity, etc.).  This file is one example of notes someone would take/keep while studying.  Feel free to use, make edits, reformat, add new concepts, update each year around test time.


Strategy – One commonly employed strategy to go through all of the materials is this: watch a video on a topic (i.e. Cardiology), go over the questions specific to that topic (either PEER or Rosh) while taking notes, go over those notes while glancing through a textbook resource (such as the High-Yield chapters) for clarification/additional notes, review all your notes once you completed all topics, and then finally go over the questions again.  Some people prefer to do questions in a randomized topic assortment.  You’ll have to find what works best for you.

If this is your first time going through, let’s say with PEER, expect about ~1hr per 10 questions including reviewing the answer explanations and writing notes.  10 questions a day is a reasonable amount on a day you’re working a 12-hour shift (i.e. 5 questions when you wake up, 5 questions after you get home).  Five sets of 10 questions (=50 questions) a week is reasonable, as ~2 days a week will be devoted to normal weekly conference preparation.  That means it’ll take you about 10 weeks to go through 500 questions.  It’ll take you one-half to one-third the time to go over all this again a second time, even quicker a third time.  That gives you approximately 3 1/2 months of dedicated studying with this approach.

Some weeks you’ll fall behind, some weeks you’ll get ahead (for example, easier work week or less-time consuming rotation).  Overall, this is going to require a legitimate, time-intensive commitment to study for ~3 1/2 months.

Good luck!