APPLIED

The APPLIED exam is taken after completion of residency and passing the ADVANCED exam. It includes the Standardized Oral Examination and the Objective Structured Clinical Examination. The OSCE assesses communication, professionalism, and technical skills. Browse the content outline below.

  1. A. Communication & Professionalism
    1. 1. Discussion of Treatment Options and Informed Consent (Obtain informed consent from a patient or authorized health care proxy)
      1. • Demonstrates understanding of, and concern for, the situation of the patient
      2. • Explains the indications for the proposed treatment options
      3. • Explains conduct of proposed treatment options in lay terms
      4. • Explains benefits and risks of treatment options, including both less severe/more common and more severe/less common relevant risks
      5. • Discusses strategies for minimizing risks of the treatment options
      6. • Elicits questions and responds appropriately in lay terms
      7. • Confirms a final decision with the patient or authorized health care proxy regarding the treatment options and obtains affirmative consent without coercion
    2. 2. Peri-procedural complications (Conduct a focused evaluation of a peri-procedural complication, formulate an action plan, and discuss this plan with the patient or designee)
      1. • Elicits history relevant to the complication and current symptoms
      2. • Performs focused physical evaluation
      3. • Discusses potential causes and contributing factors
      4. • Discusses anticipated, likely, and potential outcomes
      5. • Presents plan for further evaluation and/or treatment
      6. • Elicits questions and responds in lay terms
      7. • Demonstrates understanding of, and concern for, the situation of the patient
    3. 3. Ethical issues (Frame and discuss appropriate plans to address common ethical dilemmas in clinical care settings)
      1. • Identify and address ethical issues by obtaining relevant information, clarifying options, determining preferences, negotiating differences, and arriving at a decision with patients, families, and other stakeholders.
      2. • Allocation of resources
      3. • Barriers to access to healthcare
      4. • Care decisions involving family members or surrogate decision makers
      5. • Confidentiality and privacy
      6. • Decision-making capacity, informed consent, informed refusal, and voluntariness
      7. • Ethical obligations toward fellow clinicians
      8. • Treatment of patients receiving investigational therapies or research protocols
      9. • Life-sustaining medical treatment (e.g. end-of-life management)
      10. • Procurement and allocation of organs
      11. • Potentially inappropriate treatment
      12. • Recognized or potential conflicts of interest
    4. 4. Communication with other professionals (Effectively communicate with other healthcare team members in a professional manner)
      1. • Communicate in a clear and professional manner
      2. • Prioritize communication of information most relevant to patient care
      3. • Demonstrate understanding of the concerns and perspective of other health care professionals through active listening
      4. • Recognize the potential for conflict and initiate conflict resolution
    5. 5. Practice-based Learning and Improvement (Articulate and apply principles of patient safety and quality improvement to a clinical scenario)
      1. • Measure current outcomes and benchmarks
      2. • Devise change in practice in collaboration with stakeholders
      3. • Educate and train clinicians regarding change in practice
      4. • Implement change in practice
      5. • Measure outcomes after change in practice
  2. B. Technical Skills
    1. • Accurately identify clinical conditions, identify relevant anatomy, make qualitative diagnostic assessments, and provide treatment recommendations.
      1. • Interpret data presented on monitors
      2. • Interpret echocardiograms and ultrasound images
      3. • Use an ultrasound probe to obtain indicated images and demonstrate simulated needle placement techniques
      4. • Identify clinical conditions, relevant anatomy, make qualitative diagnostic assessments, and provide treatment recommendations
      5. • Perform and interpret airway assessment and management including physical exam and related information
    2. 1. Interpretation of Monitors
      1. a. Monitor parameters
        1. • Electrocardiogram
        2. • Arterial blood pressure: non-invasive (value) or invasive (waveform and value)
        3. • Central venous pressure – waveform and value
        4. • Pulmonary arterial pressure – waveform and value
        5. • Pulmonary artery occlusion pressure – value
        6. • Cardiac output – value
        7. • Mixed venous oxygen saturation – value
        8. • Pulse oximetry – waveform and value
        9. • Capnography – waveform and end tidal value
        10. • Qualitative and quantitative neuromuscular blockade – value (testing to start in 2026)
        11. • Fetal heart rate monitor – waveform and value (testing to start in 2026)
        12. • Airway pressure – waveform and peak, PEEP values
        13. • Airway flow – waveform
        14. • Tidal volume – waveform and end-tidal values
        15. • Respiratory rate, inspiratory and expiratory times
        16. • Flow-volume loops – waveform
        17. • Temperature – value
      2. b. Clinical conditions to identify
        1. • Perioperative cardiac events
        2. • Perioperative respiratory events
        3. • Other perioperative/peripartum events
        4. • Ventilatory modes used in normal and critically ill patients
    3. 2. Interpretation of Echocardiography and Ultrasonography
      1. a. Clinical findings and diagnoses
        1. • Biventricular function and wall motion assessment
        2. • Presence or absence of an atrial septal defect
        3. • Volume status assessment – hypovolemia and response to volume therapy
        4. • Pulmonary emboli
        5. • Air emboli
        6. • Basic valvular lesions
        7. • Pericardial effusions
        8. • Aortic dissection
        9. • Pleural effusion
        10. • Pneumothorax
        11. • Pulmonary edema
      2. b. Point-of-care ultrasound images
        1. • Heart
          1. • Parasternal Long Axis
          2. • Parasternal Short Axis (Left Ventricle Midpapillary)
          3. • Apical Four Chamber
          4. • Subcostal Four Chamber
          5. • Subcostal IVC View
        2. • Lung and diaphragm
          1. • Lung
          2. • Pleura
          3. • Diaphragm
          4. • Artifacts (A-lines, B-lines)
        3. • Abdomen
          1. • Right upper quadrant (assessment for free fluid)
          2. • Left upper quadrant (assessment for free fluid)
          3. • Pelvis (assessment for free fluid and bladder volume; bladder volume testing to start in 2027)
          4. • Gastric (assessment of content and volume)
        4. • Airway-related structures (testing to start in 2027)
          1. • Trachea
          2. • Tracheal rings
          3. • Cricoid cartilage
          4. • Cricothyroid membrane
          5. • Thyroid cartilage
          6. • Vocal cords
          7. • Hyoid bone
          8. • Epiglottis
          9. • Tongue
          10. • Esophagus
      3. c. Transesophageal echocardiography: 11 standard views
        1. • Midesophageal Four Chamber
        2. • Midesophageal Two Chamber
        3. • Midesophageal Long Axis
        4. • Midesophageal Ascending Aortic Long Axis
        5. • Midesophageal Ascending Aortic Short Axis
        6. • Midesophageal Aortic Valve Short Axis
        7. • Midesophageal Right Ventricular Inflow-Outflow
        8. • Midesophageal Bicaval
        9. • Transgastric Midpapillary Short Axis
        10. • Descending Aortic Short Axis
        11. • Descending Aortic Long Axis
    4. 3. Application of Ultrasonography
      1. a. Vascular cannulation
        1. • Internal jugular vein
        2. • Cubital fossa vessels
        3. • Radial artery
        4. • Femoral vessels
      2. b. Nerve blocks
        1. • Interscalene brachial plexus
        2. • Supraclavicular brachial plexus
        3. • Infraclavicular brachial plexus
        4. • Axillary brachial plexus
        5. • Transversus abdominis plane (TAP)
        6. • Femoral
        7. • Adductor canal (saphenous)
        8. • Popliteal sciatic
        9. • Airway (superior laryngeal, transtracheal) (testing to start in 2027)
        10. • Erector spinae plane (ESP) block (testing to start in 2028)
        11. • Pectoral nerve (PECS I and II) block (testing to start in 2028)
        12. • Fascia Iliaca block (testing to start in 2028)
        13. • Quadratus lumborum block (testing to start in 2028)
      3. c. Point-of-care ultrasound image acquisition
        1. • Heart
          1. • Parasternal Long Axis
          2. • Parasternal Short Axis (Left Ventricle Midpapillary)
          3. • Apical Four Chamber
          4. • Subcostal Four Chamber
          5. • Subcostal IVC View
        2. • Lung and diaphragm
          1. • Lung
          2. • Pleura
          3. • Diaphragm
          4. • Artifacts (A-lines, B-lines)
        3. • Abdomen
          1. • Right upper quadrant (assessment for free fluid)
          2. • Left upper quadrant (assessment for free fluid)
          3. • Pelvis (assessment for free fluid and bladder volume; bladder volume testing to start in 2027)
          4. • Gastric (assessment of content and volume)
        4. • Airway-related structures (testing to start in 2027)
          1. • Trachea
          2. • Tracheal rings
          3. • Cricoid cartilage
          4. • Cricothyroid membrane
          5. • Thyroid cartilage
          6. • Vocal cords
          7. • Hyoid bone
          8. • Epiglottis
          9. • Tongue
          10. • Esophagus
    5. 4. Airway Management (testing to start in 2027)
      1. • Airway examination including identification of normal anatomical structures and markers of anticipated difficult mask ventilation and/or difficult intubation
      2. • Identification of landmarks for airway blocks (e.g. superior laryngeal nerve, transtracheal) and emergency surgical airway placement
      3. • Navigation of the American Society of Anesthesiologists Difficult Airway Algorithm
      4. • Demonstrate choice and use of airway management techniques
        1. • Laryngoscopy
        2. • Video laryngoscopy
        3. • Supraglottic airway placement
        4. • Intubation through a supraglottic airway
        5. • Flexible scope (fiberoptic) bronchoscopy and intubation
        6. • Lung isolation with devices including bronchial blockers and double-lumen endotracheal tubes
        7. • Cricothyroidotomy
        8. • Airway exchange catheter placement
        9. • Jet ventilation

Study Resources

Oral Board and APPLIED blog posts

Jed Wolpaw's ACCRAC Oral Board Episodes

Oral board review books

ABA Successful Candidate and Improper Candidate behavior videos

Smarter Anesthesia oral board YouTube channel

Discussion of APPLIED Exam Prep from Residents in a Room (2024)

Jessica Lovich-Sapola's The Things I Do For the Residents (2008)

John Doyle's Hints for Mastering the Orals (2005)

Niels Jensen's Outlining-Attacking the Stem Question: The Knockout Blow (1999)

Commercial Board Review Courses

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