EM Board Exam: Why Are Pass Rates Falling?

In 2024, the American Board of Emergency Medicine (ABEM) qualifying exam first-time pass rate dropped to a historic low of 82% (down from 92.3% in 2019). While structured board preparation is nearly universal across residency programs, pass rates continue to slide—not just in emergency medicine, but across other specialties, as well.

Our own Dr. Neelou Weeker joins arDr. Nickolas Srica and Dr. Ryan Coughlin to break down a national survey of program directors, examining underlying systemic forces, changing study habits, and what the academic community can do to better support trainees.

Key Findings: What Program Directors Think

To understand this downward trend, researchers surveyed 280 EM residency program directors nationally. While 98% of programs provide structured board prep (using question banks, conference reviews, and commercial platforms), the qualitative data revealed three major perceived root causes:

1. Shifting Applicant Pool & Competitiveness: Declining overall competitiveness in EM over recent years (partially driven by rapid residency expansion) may have impacted the academic profile of incoming classes.
2. Changing Study Habits: A notable shift among residents away from comprehensive reading resources (like textbooks) toward topically fragmented Q-banks, short video formats, and podcasts.
3. Undergraduate Medical Education (UME) Shifts: Changes in medical school curriculums—including USMLE Step 1 moving to pass/fail—may be altering foundational preparedness prior to residency.

The Data & The Stakes

• In-Training Exams (ITEs) as an Early Warning: Literature shows a strong positive correlation between PGY-3 ITE scores and ABEM qualifying and oral board scores. Mean ITE scores nationally have dropped by roughly 5 points since 2018.
• The Vulnerable Window: Most board failures happen immediately after graduation, highlighting the stressful transition from trainee to independent attending. Delaying the exam beyond two years also correlates with reduced pass rates.
• Why It Matters: Board certification is tied to hospital credentialing, independent licensure, workforce readiness, and overall patient safety. Declining pass rates signal a need to rethink how we build durable, long-term medical knowledge rather than just chasing test-taking metrics.

Actionable Takeaways for Programs and Trainees

• For Programs: Don’t assume resources alone will fix the problem. Track ITE score trends early, identify struggling learners proactively, and implement individualized coaching. Data shows newer, smaller, and lower-resourced hospital programs are disproportionately impacted.
• For Residents & Trainees: Figure out your learning style and play to your strengths—don’t rely solely on passive question-bank scrolling if your brain does better with deeper, more deliberate study. ITE scores and Q-bank feedback can help identify content areas that need more attention. Utilize your residency program’s structured guidance. Prepare well and take the qualifying exam within 1-2 years after graduation.

Recent grads – what do you feel best prepared you for the boards? Academic EM Physicians – what is your program doing to address the dip in board exam pass rates? Share your thoughts with us on social media @empulsepodcast or connect with us on ucdavisem.com

Host:

Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis

Guests:

Dr. Ryan Coughlin, Assistant Professor of Emergency Medicine and Associate Residency Program Director at Yale School of Medicine

Dr. Nickolas Srica, Assistant Professor of Emergency Medicine and Assistant Residency Program Director at Yale School of Medicine

Dr. Neelou Weeker, Assistant Professor of Emergency Medicine at UC Davis

Resources:

American Board of Emergency Medicine (ABEM) Exam & Certification Statistics

Coughlin RF, Weeker N, Cassidy-Smith T, Pomeranz K, Menowsky M, Jones D, Sobehart RJ, Jordan J, Bradby C, Srica NE. Emergency Medicine Program Director Perceptions of Declining Qualifying Examination Pass Rates: A National Survey of Program Structure and Board Preparation Practices. AEM Educ Train. 2026 May 27;10(3):e70200. doi: 10.1002/aet2.70200. PMID: 42256851; PMCID: PMC13239127.

Topping CEW, Venkatesh AK, Rothenberg C, Goldflam K, Carter WA, Chung AS, Siegelman JN, Sangal RB, Iscoe MS, Ulrich A, Gettel CJ. Board Examination Pass Rates of Emergency Medicine Residency Training Programs: Associations With Founding Year, Teaching Status, Length, and Hospital Ownership. AEM Educ Train. 2026 Mar 6;10(2):e70144. doi: 10.1002/aet2.70144. PMID: 41798586; PMCID: PMC12964488.

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Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

Disclaimer: The opinions expressed on this podcast are those of the hosts or guests and do not necessarily reflect the views of UC Davis Department of Emergency Medicine, UC Davis Health, or their parent organizations.