Introduction
Passing the American Board of Emergency Medicine (ABEM) Boards is without a doubt a huge accomplishment, and represents the culmination of many years of hard work and sacrifice. This post will review the steps to becoming board certified, providing a clear roadmap to achieving success.
All information shared here comes directly from the ABEM website.
Their site is divided into sections on Applying for Board Certification, Passing the Qualifying Exam, and Passing the Oral Exam.
Board Eligibility
Before sitting for the Qualifying Exam, one must first establish Board Eligibility.
To establish Board Eligibility, one must:
- Have graduated from an ACGME- or RCPSC-accredited Emergency Medicine program or an ABEM-approved combined training program.
- Fulfill the ABEM Policy on Medical Licensure.
Board eligibility is time-limited, and Board Eligibilty begins on the Physicians graduation date, and expires on December 31, five years after the graduation date.
An second period of eligibility may be granted for an additional five years as long as the candidate passes the Qualifying Exam during the initial eligibilty period, and completes all additional certification requirements.
Information from this section is taken directly from the ABEM Board Eligibility page, where additional information can be found.
Applying for Board Certification
Applying for Board Certification is a relative straighforward process.
There are two application periods per year – the regular application window running from April 23 – September 5 ; and a late application window running from September 6 – October 4 (both windows current as of May 26, 2024).
Candidates who fail to apply during the application period of their initial year of eligibility will have additional requirements to apply in the next or future application windows.
Information from this section is taken directly from the ABEM Apply for Certification page, where additional information can be found.
Passing the Qualifying Exam
The next major step in obtaining Board Certification is passing the Qualifying Exam.
The challenge presented by the Qualifying Exam cannot be overstated. 2023 marked the lowest passage rates in years, with only 88% of first-time test takers passing the exam, and and only 66% of repeat test takers passing the exam. Average passage rates over the years include a 91% passage rate for first-time test takers, and a 42% passage rate for repeat test takers. Complete statistics can be found at the ABEM Examination and Certification Statistics Page.
The Qualifying Exam is admistered each fall over a several day period from late October into early November (for 2024 the dates are October 28 – November 2). The exam is administered at Pearson VUE testing centers, and is comprised of 305 questions over an 8 hour period (with 6 hours and 20 minutes of actual test time).
All major topics are tested, with the largest emphasis placed on Signs, Symptoms and Presentations (10%); Cardiovascular Disorders (10%); Traumatic Disorders (9%); and Procedures & Skills (8%). A complete breakdown of tested elements can be found on the ABEM Exam Content page.
The Qualifying Exam is a creterion referenced exam, meaning there is a pre-determined passing score. While ABEM states scores will be released within 90 days, scores over the last few years have been released progressively sooner (in 2021 scores were released on 12/21; in 2022 scores were released on 12/1; and in 2023 scores were released on 11/20). How the test is scored appears rather convoluted, but the bottom line is that you must have a passing score of 77 on a scale of 0 to 100, and the score is not a percentage correct, but a scaled score. Additional information can be found at the ABEM Results and Scoring page.
If you fail the Qualifying Exam, you may attempt to take the exam each year until your Board Eligibilty expires. If you have still failed to pass the Qualifyine Exam, there is a Board Re-eligibiltiy process outlined on the ABEM Board Eligibility page.
Information from this section is taken directly from the ABEM Qualifying Examination page, where additional information can be found.
Passing the Oral Exam
The final hurdle to ABEM Board Certification is passing the Oral Exam.
While still challenging, the Oral Exam is statistically easier to pass than the Qualifying Exam. In 2023, 94% of first-time test takers passed the Oral Exam, and 85% of repeat test takers passed the Oral Exam. Average passage rates over the years include a 95% passage rate for first-time examinees, and a 74% passage rate for repeat examinees.
Unlike the Qualifying Exam, the Oral Exam is administered three times per year (April 16-19, September 10-13, and December 3-6 for 2024). Published exam dates for 2025 are April 29-May 2, October 7-10, and December 9-12. While the exam has historically been administered in person in Chicago, following 2020 and scheduled through 2025, the oral exam is administered via virtual format over zoom. ABEM announced in January 2024 that beginning in 2026 the Oral Exam will be admistered in person in Raleigh, NC.
The Oral Exam focuses on cases which are more common and core to the practice of Emergency Medicine, unlike the Qualifying Exam which tends to cover the common and not-so-common content. You can expect to have cases likely including a trauma case, cardiac case, and at least one pediatric case. The format includes 4-6 standardized single-patient encounters and 1-3 structured interview cases. Unlike the standardized single-patient encounters, the structured interview cases are more similar to a doc-to-doc pimping exporing the management and reasoning for managment of a selected case. Here is a link to a sample structured interview and more information from ABEM on the structured interview case here.
Scoring for the Oral Exam is different from that of the Qualifying Exam. For standardized single-patient encounthers, the Oral Exam rates candidates on performance of eight categories as follows: Data Acquisition, Problem Solving, Patient Management, Resource Utilization, Health Care Provided (Outcome), Interpersonal Relations and Communication Skills, Comprehension of Pathophysiology, and Clinical Competence (Overall). Scores are assigned from 1 to 8 as follows: Very Acceptable (7, 8), Acceptable (5, 6), Unacceptable (3, 4), and Very Unacceptable (1, 2). Candidates are also scored on whether or not “critical actions” are completed, with failure of completing critical actions as scoring a 4 or lower, making passage of a case far less likely.
Sturcture interviews on 25 points across eight stages of a typcial patient interaction over the following eight areas: History, Physical Exam, Differential Diagnosis, Testing, Treatment, Final Diagnosis, Disposition, Transitions of Care.
Unlike the Qualifying Exam which has a predetermined passing score, the Oral Exam has a recommended passing score based on the case difficulty as determed by a representative sample of examiners. For the April 2024 exam, the passing score was 5.25 or higher.
Information from this section is taken directly from the ABEM Oral Exam page, where additional information can be found.
Summary
ABEM Board Certification is a long, but fairly straightforward process. Prerequisites include graduating from medical school, completing an ACGME-approved Emergency Medicine residency, and obtaining and maintaining a medical license.
Following residency, the process involves applying for certification, then successfully passing the ABEM Qualifying Exam followed by the ABEM Oral Exam.
Once Board Certified, there are required steps to maintaining Board Certification which will be covered in a future post.
Additional Resources
ABEM has a Youtube channel, with many useful videos including this webinar titled Certification Explained: A Guide for Graduating Residents.
Additionally, all information relevant to ABEM Board Certification can be found at the ABEM website.