title: Delaying the American Board of Emergency Medicine qualifying examination is associated with poorer performance.
abstract: OBJECTIVE
  The initial step in certification by the American Board of Emergency Medicine (ABEM) requires passing a multiple-choice-question qualifying examination. The qualifying examination is typically taken in the first year after residency training. This study was undertaken to determine if a delay in taking the qualifying examination is associated with poorer performance. The authors also examined the relationship between in-training examination scores and qualifying examination scores.
  
  
  METHODS
  This was a pooled time-series cross-section study. Primary measurements were initial qualifying examination scores, the timing of the qualifying examination, and in-training examination scores. The three groups, based on qualifying examination timing, were immediate, 1-year delay, and ≥2-year delay. In-training examination scores were analyzed to determine the relationship between intrinsic ability, examination timing, and qualifying examination scores. For analysis, a generic pooled ordinary least-squares dummy variable model with robust standard errors was used. A pre hoc level of significance was determined to be α < 0.01.
  
  
  RESULTS
  There were 16,353 qualifying examination test administrations between 2000 and 2012. In-training examination scores were positively correlated with qualifying examination scores (p < 0.001). The group pass rates were 98.9% immediate, 95.6% 1-year delay, and 86.6% ≥2-year delay. After controlling for in-training examination scores, delay taking the qualifying examination of 1 year was associated with a decrease in score of -0.6 (p = 0.003). A delay in taking the qualifying examination ≥2 years was associated with a decrease in score of -2.5 points (p < 0.001).
  
  
  CONCLUSIONS
  After accounting for innate ability using in-training examination scores, delay taking the qualifying examination was associated with poorer performance. This effect was more pronounced if the delay was ≥2 years.
authors.affiliation: The Department of Emergency Medicine, University of Toledo College of Medicine, Toledo, OH.
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Marco
authors.forename: Francis L
authors.initials: FL
authors.lastname: Counselman
authors.forename: Robert C
authors.initials: RC
authors.lastname: Korte
authors.forename: Robert G
authors.initials: RG
authors.lastname: Purosky
authors.forename: Cameron Thomas
authors.initials: CT
authors.lastname: Whitley
authors.forename: Earl J
authors.initials: EJ
authors.lastname: Reisdorff
mesh_terms: D002568:Certification; D003430:Cross-Sectional Studies; D004521:Educational Measurement; D004635:Emergency Medicine / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D013044:Specialty Boards; D013997:Time Factors; D014481:United States