1. How will I be notified when a new question is available?

  • An email notice is sent to the email account associated with your ASA profile.

2. Is the question embedded within the email to answer?

  • No, you are emailed a link to each question which will direct you to the PULSE course hosted on the ASA Education Center. You must be logged in to the ASA Education Center to access the question from MY LEARNING>MY ENROLLMENTS.

3. How do I access the question?

  • PULSE questions are hosted on your ASA Education Center account. There are two options to access weekly questions:
  1. Log in to the ASA Education Center with your ASA account credentials, and then copy and paste the question link from your email in the web browser to be taken directly to that question.  
  2. Log in to the ASA Education Center and locate the course from the MY LEARNING>MY ENROLLMENTS>PULSE 

4. How many questions will I receive over the six-month subscription?

  • A total of 30 questions. Questions are packaged as two quarterly (three month) courses:
    • Quarter 1 – 13 questions plus two bonus questions (15 total). Bonus questions are delivered together during the last week of the quarter.
    • Quarter 2 – 13 questions plus two bonus questions (15 total). Bonus questions are delivered together during the last week of the quarter.

5. How many CME credits are available to claim?

  • A total of 10 CME credits. Credit is claimed every quarter (three months); 5 CME credits are available after the first quarter and 5 CME are credits available after the second quarter.

6. How much time do I have to answer each question?

  • Learners have up to three minutes to submit their answer.

7. What happens if the three-minute time elapses before I submit my answer?

  • Learners will be locked out of re-attempting to answer the question for 90 seconds to review and reflect on the content. After 90 seconds the question will become available to re-attempt.

8. What happens if I answer incorrectly?

  • Learners will be locked out of re-attempting to answer the question for 90 seconds to review and reflect on the content. After 90 seconds the question will become available to re-attempt.

9. Do I have to answer the question within the week of its posting?

  • No, you can wait to answer the question at any time prior to course expiration. Unanswered weekly questions will accumulate in your PULSE course.

10. What is certainty-based marking*?

  • Certainty-based marking (CBM) is a tool used to encourage thinking more carefully prior to selecting an adequate response. It encourages reflection on reasoning prior to decision making, because the answers also require an indicator of level of confidence in one’s response. The process is thought to enhance deeper levels of learning at the expense of commonly utilized rote learning practices. Asking learners to select a level of certainty of their answer will encourage careful processing of information and feedback on what content areas need to be further developed.

The use of CBM in health care training has important implications, particularly in clinical situations, where any risk of error should be recognized and acted on accordingly. It is likely to be far more detrimental to possess a confident belief in an erroneous judgment than the ability to recognize a lack of knowledge in that area.1 

11. How is each question graded?

  • Questions are graded according to the CBM schema presented in the table below. A passing score is obtained automatically for correct responses. Points are added to your correct score based on your level of certainty. 

    Incorrect answers deduct points based on your level of certainty. You have unlimited opportunities to re-attempt questions. Learners are encouraged to reflect on question feedback and join the discussion board to see the latest postings relevant to each question.

    This grading schema is used:

Certainty level




No Response
or 'No Idea'

Mark if correct




( 0 )

Mark if wrong




( 0 )

Probability correct

< 67%







Quite sure


12. What is the passing score criteria?

  • Learners must correctly answer all questions. Correct answers are scored by certainty levels per the CBM grading schema. If the learner selects an incorrect answer, points are deducted per the CBM grading schema. Learners have unlimited attempts to answer each question correctly with a 90 second lock out time to review the question feedback before starting a new attempt. 
    Learners are encouraged to use this time to reflect on the question feedback and join the discussion board.

13. How are questions selected?

  • An ASA Physician-Chaired Review Committee selects questions mined from content throughout ASA’s curriculum.

14. What content is covered in PULSE questions?

  • PULSE questions cover a variety of anesthesia topics. Questions are extracted from several of ASA educational activities including ACE, JCME, A-ACLS, Ethics, RCA and Patient Safety Highlights. More questions will be added as ASA’s curriculum expands. 

15. How will PULSE help me improve my knowledge and skills?

  • PULSE questions represent diverse areas of medical knowledge. The delivery of a one-question activity minimizes the required learning time to three minutes or less with the opportunity to review question feedback and participate in the discussion board.  Attention is focused on one digestible topic. Questions are designed to encourage reflection about justification and soundness of relevant knowledge and skills, and probes weaknesses more deeply. You decide on your level of engagement with an opportunity to focus, review, reflect and participate in the discussion board.  

16. How do I participate in the Discussion?

  • To better support collaborative and reflective learning this course is enhanced with two discussion boards. These discussion boards serve different purposes and therefore function differently. 

    The News discussion board is designed primary to deliver information to participants. Participants can reply to posts but cannot start new discussions. This discussion board is monitored and moderated by the PULSE Planning Committee and ASA staff. Participants can manage subscriptions to each discussion board here. 

    All participants are automatically subscribed to the PULSE News discussion board. If a participant opts out of the News discussion board they will no longer receive the PULSE question of the week email notice.

    The PULSE Virtual Cafe discussion board is designated for open discussion among all PULSE course participants. Subscription is optional. Course participants can start new threads and respond to existing ones. While you are submitting your posts you can decide if you want to subscribe. This discussion board is monitored by ASA staff. Participants can tag posts they like with comments: “Marvelous post”, “Very insightful”, “Tell me more.” 

    Discussion board etiquette – Discussion boards are available to support education. All education-focused posts are encouraged. Inappropriate comments or criticism will be monitored and removed from the discussion board.

17. Who will benefit from participating in PULSE?

  • Physician Anesthesiologists, Residents, Anesthesiologist Assistants and Care Team Members will benefit from the diverse content covered in PULSE.

18. Can I renew my subscription?

  • ASA offers a six-month and 12-month subscription. An opportunity to subscribe will be posted on the PULSE course page with links to purchase from Shop ASA.


1) Schoendorfer N, Emmett D. Use of certainty-based marking in a second-year medical student cohort: a pilot study. Advances in Medical Education and Practice. 2012;3:139-143. doi:10.2147/AMEP.S35972.



Last modified: Tuesday, July 26, 2016, 9:14 AM