Delaying the American Board of Emergency Medicine Qualifying Examination Is Associated With Poorer Performance

Objectives The initial step in certification by the American Board of Emergency Medicine (ABEM) requires passing a multiple-choice-question qualifying examination. The qualifying examination is typically taken in the first year after residency training. This study was undertaken to determine if a delay in taking the qualifying examination is associated with poorer performance. The authors also examined the relationship between in-training examination scores and qualifying examination scores. Methods This was a pooled time-series cross-section study. Primary measurements were initial qualifying examination scores, the timing of the qualifying examination, and in-training examination scores. The three groups, based on qualifying examination timing, were immediate, 1-year delay, and ≥2-year delay. In-training examination scores were analyzed to determine the relationship between intrinsic ability, examination timing, and qualifying examination scores. For analysis, a generic pooled ordinary least-squares dummy variable model with robust standard errors was used. A pre hoc level of significance was determined to be α < 0.01. Results There were 16,353 qualifying examination test administrations between 2000 and 2012. In-training examination scores were positively correlated with qualifying examination scores (p < 0.001). The group pass rates were 98.9% immediate, 95.6% 1-year delay, and 86.6% ≥2-year delay. After controlling for in-training examination scores, delay taking the qualifying examination of 1 year was associated with a decrease in score of –0.6 (p = 0.003). A delay in taking the qualifying examination ≥2 years was associated with a decrease in score of –2.5 points (p < 0.001). Conclusions After accounting for innate ability using in-training examination scores, delay taking the qualifying examination was associated with poorer performance. This effect was more pronounced if the delay was ≥2 years. Resumen Objetivos El paso inicial en la certificacion por la American Board of Emergency Medicine (ABEM) requiere aprobar un examen de cualificacion (EC) de preguntas de eleccion multiple. El EC se realiza habitualmente en el primer ano tras la formacion de la residencia. Este estudio se llevo a cabo para determinar si un retraso en la realizacion del EC esta asociado con un peor rendimiento. Tambien se examino la relacion entre las puntuaciones del examen durante la formacion (EDF) y las puntuaciones del EC. Metodologia Estudio transversal de series temporales sumatorias. Las mediciones principales fueron las puntuaciones iniciales del EC, el momento del EC y las puntuaciones del EDF. Los tres grupos, basados en el momento del EC fueron: inmediato, un ano de retraso y 2 o mas anos de retraso. Se analizaron las puntuaciones del EDF para determinar la relacion entre la capacidad intrinseca, el tiempo del examen y las puntuaciones del EC. Para el analisis, se utilizo un modelo variable de minimos cuadrados ordinarios sumatorio generico con errores estandar robustos. Se determino un nivel de significacion pre hoc de α < 0,01. Resultados Hubo 16.353 EC entre el 2000 y el 2012. Las puntuaciones del EDF se correlacionaron positivamente con las puntuaciones del EC (p < 0,001). La proporcion de aprobados de cada grupo fue: 98,9% para el grupo inmediato, 95,6% para 1 ano de retraso y 86,6% para 2 o mas anos de retraso. Tras ajustar por las puntuaciones de EDF, el retraso del EC un ano se asocio con un descenso en la puntuacion de -0,6 (p = 0,003). Un retraso de realizacion del EC de 2 o mas anos se asocio con descenso en la puntacion de -2,5 puntos (p < 0,001). Conclusiones Tras tener en cuenta las capacidades innatas mediante las puntuaciones del EDF, el retrasar la realizacion del EC se asocio con un peor rendimiento. Este efecto fue mas pronunciado si el retraso fue ≥ a 2 anos.