European College of Equine Internal Medicine

Procedures for the Case Management Exam (electronic)

The aim is to test clinical judgement and competency through demonstration of the ability to work up a case in a structured and logical way. A combination of advanced question formats (single best answer, script concordance tests, extended matching questions and single word/phrase answers) will be used to progress through the 5 cases in a uni-directional manner.

The exams tests the ability to integrate and act on new information provided at each stage including: history; clinical and laboratory data; disease pathogenesis; diagnostic tests; differential diagnosis; treatment/ management; prognosis and prevention.

Candidates will be presented with FIVE different cases. These will appear in exemplify as 5 different examinations, although the scores are combined. There are approximately 10 marks for each case

Candidates can undertake the cases in any order, and the examiners will present a short overview of the presenting signs of each case.

Once a candidate enters the password to start a case, they are then committed to finishing that case before they can progress to another case.

Once a case has been started candidates can only progress in a forward direction through questions. They cannot go back and modify previously answered questions.

Candidates will be presented with new information on each screen as well as a summary of the presenting signs.

  • The whole presenting history will be available as an examination notice that can be viewed at any time.
  • Candidates will be presented with conclusions from a previous question to allow candidates to progress – this may not represent the correct answer to the previous question but can be used to change the direction of case progression.
  • It is important not to dwell on previous responses and use the new information without assuming you have not scored correctly.

Question formats

  • Multiple choice questions using a single best answer format
  • Calculations and numeric answers
  • Fill in the blank type questions where candidates write a word or short phrase
    • When answering fill in the blank type questions you must only write a single answer in each box. Often you are being asked to prioritize information and if you give multiple answers you will not score correctly as you have not demonstrated an ability to prioritize
    • When being asked to prioritize (eg a differential list) be aware that there is often no single best answer and responses are marked manually. Examiners will consider multiple possibilities when marking these questions
    • All responses are manually checked but avoid abbreviations
  • Multiple response questions where candidates are asked to select multiple responses from a long list of options. You will be informed how many responses to select. Marks are only awarded proportionate to the number of correct responses given


Script concordance questions. These questions test areas of clinical uncertainty. They are you to consider the impact of new information on a hypothesis that you are given. You then rank how this new information influences your given hypothesis. For example

You are given details of the clinical presentation. Note your are not being asked about how you respond to this clinical presentation, only the question below.

Your hypothesis is: that a horse is dead.
New information: A surface ECG demonstrates normal sinus rhythm.

Question: How does this new information (the ECG finding) influence you decision.

  • Confirms
  • More likely
  • Neither more nor less likely
  • Less likely
  • Excludes

The answers that generate points are determined from a pool of diplomates who rank these questions. Concordance with the answers given by those specialists is therefore being measured.

Timings for the case management examinations

  • The entire exam lasts 3hours 30minutes
  • Each case is estimated to take you 30 minutes. In order to provide flexibility each case has a maximum time of 45 minutes allowed.
  • Each question will upload automatically after 45 minutes – however you should only plan to take 30 minutes on this case.
  • There is not time to spend 45 minutes on each case
  • You are recommended to take any comfort breaks BETWEEN cases