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Emergency Medicine Program Director Perceptions of Declining Qualifying Examination Pass Rates: A National Survey of
Ryan F Coughlin1, Neelou Weeker2, Tara Cassidy-Smith3
1Department of Emergency Medicine Yale University School of Medicine New Haven Connecticut USA.
AEM Education and Training
|June 8, 2026
Summary
Emergency medicine residency program directors perceive declining American Board of Emergency Medicine Qualifying Exam pass rates are linked to decreased specialty competitiveness, altered resident study habits, and concerns about undergraduate medical education rigor.
Area of Science:
- Medical Education
- Emergency Medicine
- Board Certification Examinations
Background:
- The American Board of Emergency Medicine (ABEM) Qualifying Examination (QE) pass rate has recently declined to 82% in 2024.
- Understanding factors influencing QE performance is crucial for improving resident outcomes in emergency medicine (EM).
Purpose of the Study:
- To describe the structures, preparation practices, and program director (PD) perceptions of factors influencing EM residency QE performance.
- To identify potential reasons for the recent decline in EM QE pass rates.
Main Methods:
- A national, cross-sectional survey was distributed to EM residency Program Directors (PDs).
- The survey included multiple-choice and free-text questions, piloted before distribution.
- Descriptive statistics and thematic analysis were used to analyze 128 complete responses (46% response rate).
Main Results:
- Most responding programs were 3-year academic or community-based residencies.
- Program Directors (PDs) commonly believed QE failures occurred immediately post-graduation.
- Key perceived factors for declining QE pass rates included decreased EM specialty competitiveness, changes in resident study habits, and concerns about undergraduate medical education rigor.
Conclusions:
- Structured board preparation is common, but educational structures vary across EM residencies.
- PDs expressed concerns about the changing landscape of EM, resident study habits, and undergraduate medical education.
- Further research should correlate PD perceptions with objective outcomes and program-specific QE data.
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