Why don't trainees pass the emergency medicine fellowship examination?

The pass rate in the Australasian College for Emergency Medicine Fellowship exams between 1996 and 2003 inclusive averaged 61%, substantially lower than that of other specialties with comparable training structures. The explanation for this pass rate, which many would judge as unacceptably low, is likely to be multi-factorial. Possible factors that should be considered include trainee selection, training programme structure, the impact of the Director of Emergency Medicine Training, examination preparation, examination validity and examination reliability. Each of these potential factors needs to be addressed in a systematic fashion in the context of inevitable and increasing internal and external scrutiny of the outcomes of our training programme.