The ABEM In Training Exam lands every February: about 225 questions, four and a half hours, and a score your program director sees before you do. Most residents know the date. Far fewer have a plan beyond a vague promise to do more questions after this rotation.
That is where an emergency medicine question bank earns its place. It looks like the exam, scores like the exam, and tells you which organ system is going to hurt you. This guide covers how to pick one, how to use it, and what to do when the score comes back low.
A large set of single best answer questions written in the ABEM style: a clinical vignette, one decision, and an explanation that covers every option. Textbooks show what you are supposed to know. A bank shows whether you can use it with a patient in front of you and the clock running.
A good emergency medicine board review question bank tests five things on every item:
According to ABEM, the ITE has about 225 multiple choice questions and no passing score, but residents who score higher are more likely to pass the Qualifying Exam. The Qualifying Exam itself is around 305 questions at a Pearson VUE center, as EMRA summarized when the process changed.
ABEM retired the oral exam in 2026 and replaced it with an in person Certifying Exam: a half day, 10 case session at the AIME Center in Raleigh, North Carolina, that tests communication and procedural skills as well as clinical decisions. The written Qualifying Exam did not change. It is still the single best answer, and the only way to get good at that format is to sit through thousands of questions, the same discipline that got you through USMLE Step 1.
A bank does three things reading cannot. It finds your gaps before the exam does, builds recall under time pressure, and trains the pattern recognition the exam rewards. If your ITE score dipped, it is also the fastest way back; a full recovery plan is later in this article.
Counts vary by product and subscription tier, and most vendors sell a resident ITE bank separately from a larger Qualifying Exam bank. As of October 2026, Rosh Review lists a 2,000 question Resident Qbank and Qualifying Exam Qbanks of roughly 3,000 and 5,000; TrueLearn a 1,000+ question ITE bank and a 1,500+ question Qualifying Exam bank; ACEP 2,800+ questions in PEERprep for Physicians and 3,300+ in PEER for Programs; and AMBOSS Knowledge+ 2,000+ in a single bank covering both exams. Vendors add and retire questions through the year, so verify counts on the product page before you pay, and match the product to the exam in front of you.
Suggested targets, not requirements. ABEM publishes no required volume. As a planning figure, 20 to 40 questions a day on clinical months and more on lighter rotations puts most residents at 1,500 to 3,000 questions over a prep cycle, enough to cover the blueprint once and run a second pass on weak areas. Let review quality, time to the exam, rotation load, and baseline knowledge set your actual number. Twenty questions fully reviewed beat sixty skimmed.
Every ABEM exam follows the Model of the Clinical Practice of Emergency Medicine, which fixes how much weight each organ system and task carries. The better banks tag every question to that model, so you can sort practice by category and see your performance the way ABEM will. Check that your bank maps to the current model; older banks sometimes lag a revision behind.
The right choice depends on your training year, your budget, and what your program already pays for.
The one most residents name first. Rosh Review, now part of Blueprint Prep, sells separate products: a 2,000 question Resident Qbank for the ITE (the premium tier adds a 225 question mock ITE) and Qualifying Exam Qbanks of about 3,000 and 5,000 questions with a pass guarantee. Residents mention its teaching images and a dashboard that reports projected score and pass probability. Many programs provide it, but that is convenience, not evidence that it outperforms the others.
If you have searched for a peer question bank for emergency medicine, this is it. PEER (Physician’s Evaluation and Educational Review) is ACEP’s own bank, written and reviewed by practicing emergency physicians. ACEP lists 2,800+ questions in PEERprep for Physicians and 3,300+ in PEER for Programs, with ITE and Qualifying Exam modes and simulated versions of both. Many residents get it through their program or ACEP membership.
TrueLearn sells a 1,000+ question ITE SmartBank and a 1,500+ question Qualifying Exam SmartBank, both with timed mode, peer tracking, and predictive scoring. It licenses to institutions, so it is a sound primary choice if your program provides it and a good second bank for unseen stems if not.
NEJM Knowledge+ never had an emergency medicine product. After AMBOSS acquired it, an ABEM bank appeared: AMBOSS lists 2,000+ questions in one adaptive bank for both exams, with a five day free trial. Worth a look if you already use AMBOSS on shift, since each explanation links to the clinical article.
Hippo EM is video driven board review with questions attached, suited to people who learn on the drive home. BoardVitals offers volume at a lower price. Both are supplements, not a headline bank.
A note on UWorld: as of 2026 UWorld sells internal medicine and family medicine board banks but no dedicated emergency medicine bank, so do not plan ABEM prep around it.
Question counts as each vendor reports them in October 2026. Verify before you buy; they change.
| Question bank | Size and style | Best use |
|---|---|---|
| Rosh Review (Blueprint Prep) | 2,000 question Resident Qbank; 3,000 or 5,000 question Qualifying Exam Qbanks; teaching images; pass probability dashboard; pass guarantee on board banks | Primary bank for either exam. Often program provided |
| PEER (ACEP) | 2,800+ (PEERprep for Physicians) or 3,300+ (PEER for Programs); ITE and Qualifying Exam modes; simulated exams | Primary or second bank. Often through ACEP membership or your program |
| TrueLearn | Separate 1,000+ ITE bank and 1,500+ Qualifying Exam bank; timed mode; peer tracking; predictive scoring | Primary if your program provides it, otherwise a second bank for unseen stems |
| AMBOSS Knowledge+ | 2,000+ questions in one adaptive bank for both exams, tied to the AMBOSS library | Primary for daily AMBOSS users; reference tool for everyone else |
| Hippo EM | Video board review with attached questions | Audio and video learners, supplement only |
| BoardVitals | High volume at a lower price | Extra practice, supplement only |
Start with whichever bank your program provides, then compare it against the others on a free trial before paying for a second subscription. The criterion by criterion comparison is two sections below.
Pediatric emergencies carry real weight on both exams and are the category residents most often avoid. For a general EM resident, the pediatric questions inside your main bank usually cover the exam share, and PEER lets you build a pediatrics only block. A dedicated pediatric emergency medicine question bank is a different purchase: Rosh Review sells a PEM Qbank built around the American Board of Pediatrics subspecialty outline, and Hippo Education offers a PEM bank and bootcamp. Buy one if you are heading into a PEM fellowship or your pediatric scores stay low after two passes. Otherwise, use the filter in your main bank.
A full emergency medicine question bank free of charge does not exist, but every major vendor offers a trial or sample questions, FOAM sites such as ALiEM publish case based board review, and your program may already pay for Rosh, PEER, or TrueLearn. Ask your chief residents before you spend a cent, use the free material to choose, then commit to one.
Key Tip: One bank you finish and review properly beats three you half finish.
Most residents who underperform picked a fine bank and stopped at 40 percent. Our board-prep coaching builds a block-by-block schedule around your rotations, and holds you to it.
Most residents who underperform on the ITE did not pick the wrong bank. They picked a fine one and stopped at 40 percent. Our board prep coaching builds a block by block schedule around your rotations and holds you to it.
Six criteria you can act on. Figures are vendor reported as of October 2026, so verify on the vendor’s site before purchase. Hippo EM and BoardVitals are left out because they are supplements, not candidates for a primary bank.
| Criterion | Rosh Review | PEER (ACEP) | TrueLearn | AMBOSS Knowledge+ |
|---|---|---|---|---|
| Intended exam and stage | Separate products: Resident Qbank for the ITE, Qualifying Exam Qbank for boards | One bank with ITE and Qualifying Exam modes, intern year through boards | Separate products: ITE SmartBank and Qualifying Exam SmartBank | One bank marketed for both the ITE and the Qualifying Exam |
| Questions and overlap | 2,000 (Resident); about 3,000 or 5,000 (Qualifying). Sold separately; confirm overlap before buying both | 2,800+ (Physicians) or 3,300+ (Programs), more added continually. One pool, no overlap | 1,000+ (ITE); 1,500+ (Qualifying). Sold separately; ask about overlap | 2,000+ in a single pool |
| Explanations and images | Every option explained; teaching images are its signature | Textbook style explanations by practicing EM physicians; image and multimedia items | Right and wrong answers explained; illustrations; flashcards from your misses | Explanations link to the AMBOSS clinical article, which doubles as the image source |
| Analytics and weak area targeting | Category dashboard with projected score and pass probability; custom quizzes | Scores by content area, comparison with other PEER users; custom quizzes | Peer tracking, predictive scoring, quizzes built from misses, spaced re exposure | Adaptive engine that reweights toward weak areas; analytics by content area |
| Cost, duration, trial, institutional access | Resident Qbank $279 (Basic) or $339 (Premium with mock ITE); Qualifying Exam Qbanks roughly $600 to $800. Free trial. Widely licensed to programs | PEERprep for Physicians $379 a year at the member rate; PEER for Programs licensed to residencies. Sample questions free | Sold by length, 30 days to one year; price varies. Sample questions free. Institutional licensing | Bundled with the AMBOSS library; five day free trial. Institutional licenses |
| Best use case | Primary bank at any stage, especially if program provided | Primary or second bank; the specialty society’s own questions | Primary if program provided, otherwise a second bank for unseen stems | Primary for daily AMBOSS users; reference tool for everyone else |
Start with the bank your program provides, then compare its question explanations, analytics, and content coverage with the other options before purchasing a second subscription. No published study shows that one of these four produces better ITE or Qualifying Exam results than the rest.
You can usually tell within ten questions. Strong vignettes read like real patients, with vital signs, a time course, and a detail that matters: a stem describing hypotension, a narrow pulse pressure, and distended neck veins teaches tamponade whether you get it right or not. Strong banks explain every answer choice, because the wrong options are where the differential gets sharpened. They match the exam format, include ECGs and imaging because the exam will, and track you by category so you never wonder what needs work.
Forty random, timed questions before you review anything. The score will hurt. That is the point: it gives you a true map of your gaps instead of the one you imagine.
One category a week for the first few weeks (cardiac and ECGs, toxicology, shock and sepsis, trauma), then mixed blocks. The exam never tells you which system is coming, so your practice should not either.
Give the explanation more time than the question, including the ones you got right. A right answer for the wrong reason is a miss the exam has not caught yet. Write recurring concepts down in your own words.
The ITE gives you a little over a minute per question. Tutor mode is fine for a first pass through a weak category; move to timed blocks within the first month, because pacing only improves when you practice it.
Check category trends weekly, not daily, and schedule a second pass on your bottom three. Flag questions you got right for the wrong reason and treat them as misses.
In the last six weeks, sit at least two full length practice tests at exam length, with the same breaks and, if you can, the same time of day. The goal is to make the real exam feel like one more block.
| Time before the ITE | What to do | Suggested daily target |
|---|---|---|
| 6 months or more | Baseline block, then one category per week in tutor mode. Build the habit before the volume. | 15 to 20 questions |
| 3 to 6 months | Mixed timed blocks. Weekly category review. Second pass on your bottom three. | 20 to 40 questions |
| 6 weeks | Two full length practice tests. Redo every flagged question. Add a second bank only if your reviewed and unseen scores have split. | 40 to 60 questions |
| Final 2 weeks | Short mixed blocks, mnemonics, ECG and imaging drills. No new resources. | 20 questions and rest |
These are suggestions, not a quota. Adjust them to your rotation and your baseline, but keep the order: habit first, volume second, simulation last.
Two questions can test the same topic and teach in completely different ways. The gap is detail.
A 45 year old man presents with chest pain. Which of the following is the most likely diagnosis? A. Myocardial infarction. B. Gastroesophageal reflux. C. Pulmonary embolism. D. Pneumonia.
A 62 year old woman with diabetes and hypertension presents 40 minutes after sudden substernal chest pressure radiating to the jaw. She is diaphoretic. Blood pressure is 88/54 mm Hg, heart rate 48, oxygen saturation 95% on room air. ECG shows ST elevation in leads II, III, and aVF with ST depression in leads I and aVL. Which of the following is the most appropriate next step? A. Intravenous nitroglycerin. B. Aspirin and immediate catheterization lab activation. C. CT pulmonary angiography. D. Intravenous metoprolol.
Key Takeaway: A bank is only as good as its vignettes. If the stems do not read like your last shift, find a different bank.
Most of these show up during a free trial:
Doing questions without reading the explanations is the worst: your percentage climbs and your knowledge does not. Starting too late is close behind, since the ITE arrives every February whether you are ready or not. Staying in tutor mode means you never learn to pace, and grinding one category to perfection fails because the exam is mixed.
Two more slip past people: chasing a high bank percentage by redoing questions you have already seen, which inflates the number and teaches nothing, and treating your bank score as your exam score when it is really a coverage map and a trend line.
A disappointing score is information, not a verdict. ABEM’s results guidance describes what the report gives you: an equated score, a percentile against residents at your training level, and an estimated chance of passing the Qualifying Exam on the first attempt. That is exactly the data a question bank is built to act on.
Open your report next to the Model of the Clinical Practice of Emergency Medicine. The percentile and pass probability tell you how far you have to travel. Then take the content area breakdown, from your report or your program director, mark every area clearly below your overall performance, and check its weight in the Model. A weak area worth 2 percent of the exam is a footnote. One worth 10 percent is where recovery starts.
On a 225 question exam, one low category can rest on a handful of items, and a handful of items is noise. Look for clusters instead. If cardiovascular, resuscitation, and procedures are all low, the real gap is probably ECG reading and resuscitation decisions under pressure, not three separate topics. Cross check against your bank’s category data from before the exam; where the two agree, the gap is real.
The fix depends on the type of miss. Sort your last 100 to 200 bank questions into three bins:
| Type of miss | What it looks like | What fixes it |
|---|---|---|
| Knowledge gap | The explanation is news to you. The fact was never there to reason from | Read the explanation, write the point in one line, check a quick reference, then retest with new questions on the topic one to two weeks later |
| Reasoning error | You knew the facts and still picked the wrong next step: mis weighted a finding, anchored early, or chose the test when the exam wanted the treatment | Redo the stem in tutor mode and say your reasoning out loud before reading the explanation. Then drill mixed timed blocks that force prioritization |
| Time pressure | Right in tutor mode, wrong in timed mode. Running out of time or changing correct answers | Timed blocks only. Track seconds per question, commit to your first well reasoned answer, and sit full length tests under exam conditions |
Most residents with a low score expect knowledge gaps and find that a third or more of their misses are reasoning or timing errors. That is good news: those are the fastest to fix.
Set the target per rotation, not per year. As a suggestion only, plan on 15 to 20 questions a day on a heavy ED or ICU month and 30 to 40 on a lighter one, drawn from the areas you flagged. On a string of nights, set a weekly floor instead. The number that matters is the one you actually hit six days out of seven.
Redoing the same question tests recognition, not knowledge. For each flagged concept, reread your note, review the topic briefly, then build a custom quiz of unseen questions from that category; Rosh, PEER, and TrueLearn all allow it. Retest at one week and again at three weeks. A concept you get right on unseen questions at three weeks is fixed. One you keep missing goes back to Step 3, because you may have classified it wrong.
At three to four weeks, compare first attempt accuracy in the flagged areas with where you started. If an area has moved, shift time to the next one. If it has not, change how you review before you change how much you do. If your bank offers a mock ITE, sit it under timed conditions at the halfway point and treat the result as a new score report.
Does volume itself help? Modestly. A single program analysis presented at SAEM 2026 found each additional 100 Rosh Review questions was associated with a 0.17 point gain in ITE score, and the authors concluded a bank should be one adjunct among several strategies. Targeted review and retesting on unseen questions are what move a low score.
Key Takeaway: A low ITE score is usually a review problem, not a volume problem. Classify the misses, retest with new questions, and bring your program director the plan.
The ITE is often the first standardized comparison between you and your US trained co residents, and a strong score answers the question some programs quietly ask: can this person handle our exam?
If you trained under different guidelines, drug names, or resuscitation protocols, the bank is where you reset to US practice. Pay close attention to toxicology, where drugs and antidotes differ by country, and to airway and resuscitation algorithms. None of this discards your clinical instincts; your home training gave you volume many US graduates never had. The bank translates it into the language ABEM speaks, the way the IMG roadmap to the US residency Match translated your application into the language programs speak.
Still working through the ERAS application timeline? Bookmark this for intern year. A strong first ITE score is also something to raise with confidence at fellowship interviews, the way you learned to handle tough questions in residency interview preparation. If your budget is thin, one bank finished with every explanation read does more than three subscriptions you barely open.
IMGs often arrive with stronger clinical volume and weaker exam habits. We build the study schedule, the resource list, and the weekly accountability so the score matches the clinician.
IMGs who match into emergency medicine often arrive with stronger clinical volume and weaker exam habits than their peers. We build the study schedule, the resource list, and the weekly accountability so the score matches the clinician.
There is no single best one. Start with the bank your program provides, then compare its explanations, analytics, and content coverage with the others on a free trial before paying for a second subscription. Rosh Review and PEER are the two most residents name; TrueLearn and AMBOSS Knowledge+ are credible alternatives. The comparison table above lays out the differences by criterion.
ABEM publishes no required number. As a planning suggestion, 1,500 to 3,000 in the months before February, with every explanation read, covers the blueprint once and leaves room for a second pass. Time left, rotation load, baseline knowledge, and review quality should set your actual volume.
Not a complete one. Free trials, sample questions, and FOAM sites get you started, but a full bank with performance tracking costs money or comes through your program. Ask your chief residents what is already paid for.
Usually not for the general boards. The pediatric questions inside Rosh or PEER cover the exam share. A dedicated bank makes sense if you are heading into PEM or your pediatric scores stay low after two passes.
Finish one first. Add a second only when your reviewed score and your unseen score start to separate, which means you are recognizing questions rather than reasoning through them. For most residents that happens in the last six weeks, if at all.
Not on its own. ABEM describes the 2026 Certifying Exam as an in person, half day session of 10 cases at the AIME Center in Raleigh: clinical care cases plus OSCE style cases that assess communication, professionalism, and procedural skills with standardized patients. A multiple choice bank builds the clinical knowledge those cases draw on, but it does not prepare you for the communication, procedural, and live performance elements; those need case based verbal practice, simulation, and procedure labs. Banks prepare you for the ITE and the written Qualifying Exam, which is still multiple choice and is the gate you must pass first.
Of everything in your training, the question bank is the part that most closely mirrors the exam. Aim for depth, not volume: one emergency medicine question bank, every explanation read, timed from the first month, weak categories revisited on purpose. Start early, and if you are an IMG, treat the bank as the place where your training meets the US exam.
Follow IMG Helping Hands for more residency and board prep guides, and visit our website if you are facing trouble choosing resources or building a study plan. Board prep is a demanding part of residency. Do not hustle alone; take expert advice, and we aim to help you pass your boards and thrive in your dream residency program.
The bank mirrors the exam, but a plan is what turns questions into a score. IMG Helping Hands builds the whole system around you:
Articles published by IMG Helping Hands are prepared by our team using information from direct experience, publicly available resources, and educational references. AI tools may be used to assist with drafting, proofreading, and formatting; however, all content undergoes review and approval before publication. The information provided is intended for educational purposes only. Requirements, policies, and processes may change over time. Readers should consult official sources for the most current information.
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