Declining Performance on the Qualifying Examination: Modeling of a Potential Inflection Point in Emergency Medicine.

Area of Science:

• Medical Education
• Emergency Medicine
• Board Certification Examinations

Background:

• The American Board of Emergency Medicine (ABEM) Qualifying Examination (QE) is a critical assessment for emergency medicine physicians.
• Longitudinal trends in QE performance and factors influencing pass rates are not fully understood.
• A recent decline in pass rates observed in 2022 warrants investigation.

Purpose of the Study:

• To analyze long-term trends in ABEM QE performance.
• To identify significant inflection points in examination pass rates.
• To determine physician characteristics associated with the recent decline in pass rates.

Main Methods:

• Retrospective observational study analyzing 83,254 ABEM QE attempts from 1980 to 2024.
• Segmented regression and Bayes factor analysis to identify changepoints.
• Multilevel nonlinear piecewise growth models to assess factors associated with pass rates around the 2022 changepoint.

Main Results:

• Three significant changepoints were identified: 1988, 2003, and 2022.
• Pass rates increased in 1988 and 2003 but declined sharply after 2022 (slope change from -0.17 to -0.67).
• MD graduates and physicians trained during the COVID-19 pandemic showed a lesser decline in performance.

Conclusions:

• ABEM QE pass rates have experienced three major inflection points since 1980, with a notable decline beginning in 2022.
• Physician characteristics, including medical school degree type and COVID-era training, are significantly associated with these performance trends.