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Board Examination Pass Rates of Emergency Medicine Residency Training Programs: Associations With Founding Year,
Carlisle E W Topping1, Arjun K Venkatesh2,3, Craig Rothenberg2
1Yale School of Medicine New Haven CT USA.
AEM Education and Training
|March 9, 2026
Summary
Newer emergency medicine (EM) residency programs and those without Council of Teaching Hospitals (COTH) designation show lower board certification pass rates. Program affiliation and founding year significantly impact EM resident success on board exams.
Area of Science:
- Medical Education
- Residency Training
- Emergency Medicine
Background:
- Emergency medicine (EM) board certification pass rates are declining.
- There's a rise in new EM residency programs, many affiliated with for-profit hospitals or lacking Council of Teaching Hospital (COTH) designation.
- Study examines factors influencing board examination performance.
Purpose of the Study:
- To investigate the relationship between EM residency program characteristics and board examination pass rates.
- To determine if founding year, COTH status, program length, or hospital ownership affects board performance.
- To identify institutional factors associated with resident success.
Main Methods:
- Observational cross-sectional analysis of 234 EM residency programs.
- Utilized data from the American Board of Emergency Medicine, Accreditation Council for Graduate Medical Education, and American Hospital Association.
- Examined associations between program characteristics (founding year, COTH status, program length, hospital ownership) and first-time Qualifying Exam (QE) and Oral Certifying Exam (OCE) median pass rates (2021-2023) using linear regression.
Main Results:
- Recently founded programs (post-2015) showed significantly lower pass rates (QE: -11%, OCE: -2.6%).
- Programs affiliated with COTH hospitals had higher pass rates (QE: +6.1%, OCE: +1.6%).
- Nonprofit and government affiliations showed nonsignificantly higher QE pass rates compared to for-profit; government affiliation showed significantly higher OCE pass rates.
Conclusions:
- Program characteristics significantly impact EM resident board examination outcomes.
- Recently founded programs, those lacking COTH designation, or affiliated with for-profit hospitals may have fewer resources for optimal training.
- Supporting institutional factors is vital for enhancing resident learning environments and success.
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