Dr. James D. Thomas, the current president of the American Board of Emergency Medicine, recently joined in a conversation with ACEP Now Medical Editor in Chief Cedric Dark, MD, MPH, FACEP, about ABEM exam certification, subspecialties in emergency medicine, and more.

Cedric Dark, MD, MPH, FACEP: Dr. Thomas, thanks for joining us. I wanted to start off with the ABEM Certifying and Qualifying examinations. Can you describe the pathway for a graduating resident as to what they have to do for initial certification and then describe what happens for those of us that are out in practice to maintain certification.

James D. Thomas, MD: It’s certainly a pleasure to talk to you as ABEM’s president this year.

The basic process is by this time of the year, of your last year of residency, usually starting around April senior residents can start applying and [ABEM] will wait for the program director to attest that the candidate has completed residency. When that’s done, they’ll apply for the qualifying examination, which is done for one week during early November.

The qualifying exam is a half day.

It’s a test conducted at the Pearson View Centers around the country. It is a 300-question, multiple-choice type exam. The qualifying exam has been similar for many, many years. Upon successful completion of the qualifying exam, then you would be invited to sit for the brand new certifying examination. This has replaced the old oral exam. This is not a new oral, it is an entirely different, new exam. [It] is measuring different competencies, including communication skills, procedures, and ultrasound skills, and it continues to have some of the same cases of clinical decision making. In addition to that, there are prioritization cases as well, with a track board case and a mass casualty case. Once that is completed, you’ll be considered board certified.

ABEM has really worked very hard and tirelessly over the past number of years to replace the old once-every-10-year ConCert examination, which was the recertification exam with my EMCERT modules. These are open book modules, which can be done at any time that you’d like.

The board certification is for 5 years, and during the 5-year process you will take four of the MyEMCert modules. You can take one a year, you can take four of them all at one time if you’d like. You also attest to practice improvement. Once that’s completed, you maintain your certification through ABEM.

Cedric Dark, MD, MPH, FACEP: I had this question come up, during sign-out one day, because one of my colleagues who’s a few years off from my cycle was talking about doing LLSAs. Who’s still doing LLSA? Who’s doing my MCERT? Because that does seem a little confusing to me.

Jim Thomas, MD: Yes, it is a little bit confusing, but what’s happened is we transitioned from a 10-year certificate to a 5-year certificate approximately 5 years ago. there are still people that are involved in the 10-year certificate that won’t be transitioning until the end of this decade, around 2030. So, they will have, in the first 5 years, they would still have LLSA modules to complete. However, if a [diplomate] would prefer to do MyEMCert modules instead of LLSA modules from the first 5 years of their 10-year cycle, they can certainly do that just by reaching out to the ABEM office. And then in the last 5 years of their tenure cycle, they would do four MyEMcert modules. So there’s a choice.

Cedric Dark, MD, MPH, FACEP: I was at SAEM last week, just talking to a random emergency doc who had just taken the certifying exam, and they said that they had a really good experience with it. What has the experience been with it and the feedback from test takers about the new certifying exam?

Jim Thomas, MD: The certified exam went into effect in March. We had 315 candidates take the exam at that time. I can tell you that the response rate to the survey which followed was very positive. For the most part, the vast majority of candidates felt the cases were true to life. They felt they were real.

We just had our second cohort of examiners that took the exam a couple of weeks ago. I have not seen the responses to any surveys to date.  But I can tell you from seeing the candidates in action, going into the AIM Center and taking the exam, they seemed to be very comfortable in the experience. I saw them leaving the AIM Center, going to the elevators, and people seemed to be upbeat about the experience they had.

Cedric Dark, MD, MPH, FACEP: I wanted to bring up a couple of recent papers that came out this year. One was in JACEP Open and one was in the Annals of Emergency Medicine. The first one by White et al., and the second by Das et al., and they were talking about the qualifying exam and a recent inflection point in scores. Around 2022, scores which had been sort of on the uptick, are now starting to decline a little bit. And considering program types, one study suggested maybe that programs that are either newer or programs that might be for-profit status as opposed to non-profit status, might have slightly lower scores on the qualifying examination. I’m curious what your take is on papers like these.

Jim Thomas, MD: ABEM is very concerned about the situation, about the decline in pass rates on our written examination, and we support any type of research involved in trying to find the causality of this. We feel this is multifactorial. I can also tell you that many of the other boards have seen similar decline in their performance of their written examinations as well, so this does not seem to be unique to ABEM. I have also been informed, although I don’t have specific facts, that other professions outside of medicine have also seen a decline in pass rates of various written examinations.

I can tell you that the only fact I really know about specifically is that we can say that the MD candidates didn’t have as much of a decline as the non-MD candidates that were taking the examination. With regard to the other statistics that you provide, I really don’t have enough information to comment about newer programs, for-profit programs, and I don’t want to give information that may be inaccurate.

I can also tell you that statistically, there’s been very little difference between 3- and 4-year residency training programs. So that does not seem to make much of a difference in terms of the pass rate of our exam at this point in time. Additionally, the exam has really not changed in the past 6 years or so. Psychometrically, it’s a similar examination with difficulty ratings that have been classified as the same. ABEM strives on being certain that exams are fair and reliable. We also want to maintain a high credential, and that’s very important to us, that we don’t want to lower the standards. This is the examination that we feel needs to be passed in order to become board certified.

Cedric Dark, MD, MPH, FACEP: Let’s pivot a little bit into some subspecialty certifications. There’s a lot of new ones. Disaster medicine is one of the newer ones. How did that become an EM subspecialty, and what other subspecialties are gaining popularity in emergency medicine?

Jim Thomas, MD: We had some interest from our board-certified docs that were interested in having some type of a disaster medicine subspecialty. We applied to ABMS [American Board of Medical Specialties] last year, and this was just recently approved in February, so it’s only been 3 months. We’re still working on curricula for this particular subspecialty.

That’s being done in, with some of the other boards, including surgery and preventive medicine. The first assessment probably will not be ready until spring of 2028. It’s going to take a couple of years for this to occur, and we’ll also be following up with ACGME [Accreditation Council for Graduate Medical Education] on looking at fellowships in disaster medicine.

It’s a new subspecialty, just recently been approved, and we look forward to having these specialists available to us in times of disaster, whether that’s man-made disaster or natural disaster, to have an expert in the field who can help in treating the patients who are  involved in disasters around the country.

Additionally, the emergency behavioral health focus practice designation was approved last year, and there’s been quite a bit of interest in that. That’s being done in conjunction with our fellow board of the American Board of Psychiatry and Neurology.

We realize the boarding of mental health patients in our emergency departments, and we feel that having specialists out there who can assist in caring for these patients while they await inpatient hospitalization for various psychiatric illnesses is certainly very worthwhile. That’s going to be a focused-practice designation. There’s not going to be a written exam for this. This will be a portfolio-based assessment, and it should be available coming later this fall.

Additionally, we’ve been asked to pair up with the American Board of Preventive Medicine for a subspecialty in lifestyle medicine. This would be looking at tobacco cessation, food insecurity, helping to get patients into clinic follow-ups and those kind of things, as well for lifestyle.

Lastly, we’ve also applied to be a qualifying board for the American Board of Internal Medicine and Geriatric Medicine.

Cedric Dark, MD, MPH, FACEP: ABEM really is out there, in my opinion, to help amplify medical discoveries for emergency physicians, making sure with the maintenance of certification that we’re practicing towards the cutting edge of clinical care. How can ACEP members ensure that ABEM is out there testing that knowledge?

Jim Thomas, MD: We have, as part of the MyEM cert examination, our key advanced questions. Approximately 15 questions on any one of those modules will have topics on key advances. Historically, we hear that it takes about 17 years for key advances to become commonplace in practice. And by key advance sections on our exams, it is ABEM’s hope to push this information out in a formative way to those candidates who are taking the exam. We encourage all emergency physicians around the country to really help us, and if there are areas of cutting-edge emergency medicine that people feel are important for all of us to know, we certainly ask that you reach out to the ABEM office. We have key advanced panels that are out there reviewing literature all the time, and we can try to create a little synopsis or vignette that can be prepared that will become part of the MyEMCert modules.

Dr. Dark is assistant professor of emergency medicine at Baylor College of Medicine in Houston, on the Board of Directors of Doctors for America, and Medical Editor in Chief of ACEP Now.