title: Medical Student Performance on the National Board of Medical Examiners Emergency Medicine Advanced Clinical Examination and the National Emergency Medicine M4 Exams.
abstract: BACKGROUND
  In April 2013, the National Board of Medical Examiners (NBME) released an Advanced Clinical Examination (ACE) in emergency medicine (EM). In addition to this new resource, CDEM (Clerkship Directors in EM) provides two online, high-quality, internally validated examinations. National usage statistics are available for all three examinations, however, it is currently unknown how students entering an EM residency perform as compared to the entire national cohort. This information may help educators interpret examination scores of both EM-bound and non-EM-bound students.
  
  
  OBJECTIVE
  The objective of this study was to compare EM clerkship examination performance between students who matched into an EM residency in 2014 to students who did not. We made comparisons were made using the EM-ACE and both versions of the National fourth year medical student (M4) EM examinations.
  
  
  METHODS
  In this retrospective multi-institutional cohort study, the EM-ACE and either Version 1 (V1) or 2 (V2) of the National EM M4 examination was given to students taking a fourth-year EM rotation at five institutions between April 2013 to February 2014. We collected examination performance, including the scaled EM-ACE score, and percent correct on the EM M4 exams, and 2014 NRMP Match status. Student t-tests were performed on the examination averages of students who matched in EM as compared with those who did not.
  
  
  RESULTS
  A total of 606 students from five different institutions took both the EM-ACE and one of the EM M4 exams; 94 (15.5%) students matched in EM in the 2014 Match. The mean score for EM-bound students on the EM-ACE, V1 and V2 of the EM M4 exams were 70.9 (n=47, SD=9.0), 84.4 (n=36, SD=5.2), and 83.3 (n=11, SD=6.9), respectively. Mean scores for non-EM-bound students were 68.0 (n=256, SD=9.7), 82.9 (n=243, SD=6.5), and 74.5 (n=13, SD=5.9). There was a significant difference in mean scores in EM-bound and non-EM-bound student for the EM-ACE (p=0.05) and V2 (p<0.01) but not V1 (p=0.18) of the National EM M4 examination.
  
  
  CONCLUSIONS
  Students who successfully matched in EM performed better on all three exams at the end of their EM clerkship.
authors.affiliation: University of Arizona School of Medicine, Department of Emergency Medicine, Tucson, Arizona.
authors.forename: Katherine
authors.initials: K
authors.lastname: Hiller
authors.affiliation: University of Michigan School of Medicine, Department of Emergency Medicine, Ann Arbor, Michigan.
authors.forename: Joseph
authors.initials: J
authors.lastname: House
authors.affiliation: East Carolinas University Brody School of Medicine, Department of Emergency Medicine, Greenville, North Carolina.
authors.forename: Luan
authors.initials: L
authors.lastname: Lawson
authors.affiliation: Wright State University School of Medicine, Department of Emergency Medicine, Dayton, Ohio.
authors.forename: Stacey
authors.initials: S
authors.lastname: Poznanski
authors.affiliation: University of Florida School of Medicine-Jacksonville, Department of Emergency Medicine, Jacksonville, Florida.
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Morrissey
mesh_terms: D002982:Clinical Clerkship / Q000592:standards / Q000706:statistics & numerical data; D002983:Clinical Competence / Q000706:statistics & numerical data; D004521:Educational Measurement / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D004635:Emergency Medicine / Q000193:education* / Q000592:standards; D006801:Humans; D007396:Internship and Residency; D012189:Retrospective Studies; D014481:United States