Medical knowledge is clearly the tenant of what’s important in emergency medicine. But how smart you are only takes you so far in your success as an emergency physician. It’s important to know how you communicate with your patients, how you communicate with coworkers, how you prioritize patient acuity, and how you think in a fluid environment. Although our previous testing was valid, it needs to be broadened to align with the specialty now and in the future; the practice of EM has drastically expanded in breadth and depth compared to when the oral exam first started. This initiative started in 2021 and really went into 2024 where we sought opinions from 4,300 different individual stakeholders, including employers and hospital administrators, ABEM diplomates, the public, residents, and our ABEM volunteers.

All those stakeholders leaned into this opportunity and spoke to the truth of where they thought some of the strengths of our certification process were – and the opportunities. The big opportunities were procedural, Ultrasound, and communication.

Dr. Dark: It sounds a little bit like transitioning from a tabletop exercise, which I think is the way I experienced the oral examination, to more of a simulation.

Dr. Gorgas: Yes. I think that that’s entirely accurate.

Dr. Dark: Let’s get back to the written examination. A report recently came out that says the pass rate for first-time test takers on the written “qualifying” exam was 82 percent, down from 88 percent.¹ This is following a trend we’ve seen for a few years. What do you think the explanations are for changes in written exam performance over time?

Dr. Gorgas: Let me put it this way, focusing on the very early realm of discovery and association without postulating on causation. The number of EM residency training programs has increased. We know the number of medical students who then become residents taking qualifying exams is a larger number than it was before. The model of emergency medicine has expanded over time, and we’re going to have another model revision here in another couple months in 2025.² The number of patient encounters that an average resident sees during training has gone down; it’s gone down to historically low numbers. The number of patient encounters used to be between 3,000 and 5,000. Today, residents in EM are lucky if they can get 3,000 patient encounters during their training.

Dr. Dark: I remember reading somewhere that you need to do something 10,000 times to be an expert at it.³ So that’s very interesting that you bring up that the number of cases that someone sees over time has gone down. It kind of spills into my next couple of questions. JACEP Open recently published an article that explored the difference in exam passing rates among programs. The qualifying exam (i.e., the written exam)pass  rates were slightly higher for those in three-year programs. The percentages were very narrow, like 93 percent versus 91 percent, probably not clinically significant but statistically different.⁴ Does ABEM think there’s much difference between a three-year and a four-year program in terms of the quality of the graduates that are being put out there?