ACCS - 2026 Changes
Wondering what's changing with the ACCS (August 2026)?
Here's our breakdown. We use purple to suggest an increased focus in 2026, yellow to suggest a decreased focus (more questions or harder questions), and gray no real change.
| Section | 2018 Questions | 2026 Questions | Thoughts That Have Guided Our Changes |
| Manage Airways | 10 | 24 | Major Increase! We need to be sure we are ready to focus on all the airway assessment and especially tools for being safe (bougie, specialty airways, airway clearance, trachs) |
| Specialty Inhalants | 3 | 4 | Minimal |
| Ventilation/Oxygenation | 36 | 48 | This represents 1/3 of the whole exam. Wow. Things to consider are that ECMO is now more significant, liberation (pain, agitation, paralytics, sedation). |
| Pharmacology Delivery | 10 | 4 | This was a big part of our course with a big drug table. While we may leave most of the drugs (it is hard to determine which will be present), the pressure to learn them all is decreased. |
| Assess Patient | 31 | 21/split | Focus is increased on hemodynamics, including shock with less focus on the outlying areas (liver, endocrine, GI) |
| Labs | 8 | 9 | Minimal changes, although there is greater mention of the osmolar gap and HIT-related labs. |
| Imaging | 8 | 4 | This area has decreased as well - we are recommending that you brush up on CXR, CT, and US ... but maybe less focus now on MRIs and Angiography. |
| Pharmacology | 12 | 8 | Less focus on basic information (what drug causes methemoglobinemia?) and more focus on the how and when of drugs, including titration and weaning. |
| Nutrition | 4 | 2 | Almost non-existent now. A quick glance is all that is needed. |
| Infection | 6 | 4 | Tricky! It went from some basic knowledge to some heavy-hitting areas (think: SOFA, qSOFA, APACHE, MEWS). These could be 4 difficult questions. |
| End of Life | 4 | 3 | Minimal changes overall |
| Disaster | 3 | 2 | |
| Teams | 2 | 3 | |
| Procedures | 3 | 4 | New! esophageal monitoring |
| Troubleshooting | 4 | 6 | More focus on hemodynamic-forward topics (ECMO, IABP, LVAD, RVAD) |
| Quality Improvement | -- | 4 | New Area |
