Factors associated with performance on the emergency medicine qualifying examination.

Background: Board certification standards exceed the baseline requirements for state licensure, assuring the public that specialists demonstrate additional clinical skills, knowledge, and professional behavior to provide safe and high-quality specialty care. The objective of this study was to determine what physician factors (e.g., gender, age, race/ethnicity, medical school training, and other factors) were associated with the American Board of Emergency Medicine qualifying examination (QE) performance and pass rates. Methods: This was a national retrospective, observational, cross-sectional study exploring factors associated with the QE. Subjects were physicians who graduated from accredited emergency medicine (EM) categorical residency programs who took the QE for the first time in 2017, 2018, or 2019. A series of multilevel models was used to examine if physician characteristics were related to score and passing the QE. Relative risks were calculated. Results: There were 6174 EM graduates, 2118 of whom were women and 588 who were underrepresented in medicine (URiM) physicians. Controlling for other variables, in-training examination (ITE) scores and medical doctor (MD) degrees were positively related to mean QE scores, whereas age, 3-year programs, URiM, and male gender were negatively related to mean QE scores. The QE pass rate was 94%, 95% for non-URiM and 86% for URiM. Results of the full model indicated ITE score, age, URiM, gender, MD degree, and residency program format were significantly related to performance on the QE. In the final model, passing the QE was positively related to ITE scores and negatively related to age and URiM. After other variables were controlled for, the adjusted risk ratio for URiM was 0.94. Conclusions: Several factors were associated with decreased pass rates on the ABEM QE including ITE scores, older age, and URiM, although the risk ratios were small.