A method trusted for decades — ABEM’s practice
Worth watching: Seon Yoon Chung’s talk.
From 1980 through 2025, the American Board of Emergency Medicine (ABEM) used an oral examination as the final step in board certification for emergency physicians. Examiners walked candidates through simulated patient cases that unfolded based on each decision. In 2026, ABEM replaced it with a new Certifying Exam that adds standardized patient actors and procedural and ultrasound cases.
This kind of case — talk to the patient, make the call, see what happens — is one of the best ways we have to assess clinical reasoning. Simulation is already widely used in training, but giving every learner repeated, high-quality, branching reasoning cases is still resource-intensive: each case takes expert faculty time to write, and live delivery needs trained examiners or standardized patients, simulation space, and protected time.
AI with guardrails and source provenance can lower that cost. Imagine AI, with these guardrails, bringing case-authoring time down to about 30 minutes rather than days, followed by clinical review from the author, with a human in the loop. Learners would work through cases in natural language, just as in a real clinical encounter, see the consequences of their decisions unfold, and receive feedback that shows the sources it draws on.
I believe this is where medical education is heading: making a method emergency medicine has trusted for decades available to every learner, every day, in every domain of clinical education.
— Wesley Jin, MD · Sources: ABEM history · ABEM Certifying Exam launch (2026) · Video: TEDx Talks on YouTube.
The practice gaps VOC helps with →
From method to requirement
The method is decades old, and the tools are changing. Residency requirements already include it.
Here is what ACGME’s own documents say about simulation in residency training.
they permit examinees to make life-threatening errors without hurting a real patientACGME Assessment Guidebook (Holmboe & Iobst, 2020), Section III, “Simulation,” p. 26.
The program, in partnership with its Sponsoring institution, must provide residents with access to training using simulation to support resident education and patient safety.ACGME Program Requirements for Graduate Medical Education in Internal Medicine (2026), §1.7.b, p. 8.
The Review Committee does not expect each program to own a simulator or to have a simulation center.ACGME Internal Medicine Program Requirements (2026), §1.7.b, Specialty-Specific Background and Intent, p. 8.
Quoted from public ACGME documents; ACGME has not reviewed or endorsed VOC.