Preparing for the Boards

Click here for Board Review practice questions

Preparing for the Emergency Medicine Boards: 

The Emergency Medicine Residents’ Association (EMRA) Emergency Medicine Qualifying and Certification Exam Preparation Survey 

by Todd Guth, MD   

Background: 

Emergency medicine (EM) residency graduates need to pass both the written qualifying exam and oral certification exam as the final benchmark to achieve board certification through The American Board of Emergency Medicine (ABEM).  Following the successful completion of an accredited emergency medicine residency, candidates for board certification take the written qualifying exam in the fall after graduation as the first step to becoming an ABEM diplomate.  If successful in this first step, candidates will take the oral certification exam in the spring or fall of the following year. 

Many residents and recent graduates spend a significant amount of time and money preparing for the board exams.  As a result, EMRA would like to help you to make informed decisions about how best to spend your time and money preparing for the boards.   As EMRA neither produces nor promotes any specific board review product, the EMRA Board of Directors has sponsored a survey of recent graduates to assess their overall preparation for the boards and their opinions and comments about specific board review products that they may have used during their preparations.  Every effort was made to include a comprehensive list of all textbooks, review courses, tutoring, and online products available.  

The objectives of the survey are to: 

1) Determine the amount of residency and individual preparation,  

2) Determine the extent of the use of various board review products, and  

3) Elicit evaluations of the various board review products used for the ABEM qualifying and certification exams. 

Methods: 

EM residency graduates from the past three years who were members of EMRA upon their graduation from residency were surveyed via email.  There are approximately 900 residents graduating from residency each year with 95% of these graduates being EMRA members.  Residents were sent an introductory email explaining the survey and three follow-up emails with links to the online survey.  A total of 520 graduates completed the survey corresponding to a response rate of approximately 19%. 

Respondents were asked about the presence of formalized educational activities within residency training for the written and oral board exams, frequency of formalized training sessions, average numbers of hours per week spent studying for the boards.  They were asked to comment upon the numbers and types of board review products used.  For each product, respondents were asked to rate the quality of content; quality of the figures and photos; level of detail; relevance of practice questions; ease of use; value for time and money; and overall impression. 

Results: 

Preparation: 

Many residencies seek to prepare their residents by including written (67%) and oral board (85%) preparation activities.  The majority of the written board preparation activities occur around the in-service exam (50%), but are often spread throughout the academic calendar.  Similarly, residency-sponsored oral board review sessions are clustered around an annual educational activity, such as a retreat (36%), or are administered on a quarterly basis (33%). 

Individual board preparation starts in earnest on average 9 weeks [range: 4-40 weeks] prior to the written qualifying exam and 5 weeks [range: 0-20 weeks] prior to the oral certification exam.  Respondents to the survey reported an average of 15 hours per week [range: 4-60 hours] of study time for the written qualifying exam and 8 hours per week [range: 0-30 hours] of study time for the oral certification exam in the month prior to the exam. 

In preparing for the written qualifying exam, 90% of respondent used a board preparation textbook with 69% using 2 or more books.  Half of recent graduates answering the survey (51%) used a written qualifying board review course while 17% used a commercially available online written board exam preparation product.  In preparing for the oral certification exam, 57% of respondents used a board preparation textbook and 34% took an oral board review course. 

Similar to the reported ABEM passing rates on the written qualifying and oral certification exams, respondents reported passing rates of 94% and 97% respectively.  Respondents reported an average estimated cost of $716 spent on books, course, and online products in preparing for the written qualifying exam and $510 in preparing for the oral certification exam. 

Products Used: 

Respondents used a variety of print books, online resources, and review courses in preparing for the written qualifying and oral certification exams.  As many respondents used more than one preparation book for both the written qualifying and oral certification exams, reported percentages for these products are higher than the review courses as respondents typically took only a single course.  Table 1 includes the most popular board review products with greater than 5% use from the respondents. 

Table 1. Most Popular Board Review Products

The highest rated preparation products that at least 5% of respondents used are listed in Table 2.  Respondents were asked to provide an overall impression on a scale of Excellent-4, Good-3, Average-2, or Poor-1.  Average scores of the overall impression are reported.  Additional details of the individual variables of each board review product are listed here. 

Table 2. Highest Rated Board Review Products

Respondents were asked to name a board review product that was essential for them to pass the boards and these are listed in Table 3. 

Table 3. – Essential Board Review Product for Passing the Boards  

Discussion: 

For those EM residents and graduates preparing to take the ABEM written qualifying and oral certification exams a number of written texts, in-person review courses, and online review products are available.  The vast majority of preparation products received good to excellent ratings across the variables asked in the survey, including overall impression. 

As many respondents pointed out in their comments about preparing for the EM boards, the best preparation for the boards is a quality EM residency. In addition to quality clinical training, many residency programs specifically facilitate preparation for the boards by having written and oral board preparation activities, such as inservice exam reviews and mock oral board sessions. 

In addition to those activities organized within residency programs, respondents to the survey spent a significant amount of time and money in preparing for the EM boards.  Almost all respondents (90%) used a book to prepare for the written exams and half of respondents (57%) used an oral board preparation textbook.  In general, respondents start preparing sooner and spend more time per week preparing for the written qualifying exam when compared to the oral certification exam.  Perhaps this is due to the greater breadth of knowledge covered by the written exam or the higher passing rate for the oral certification exam when compared to the written qualifying exam. 

While far fewer respondents took either a written (51%) or oral (34%) board preparation review course compared to those using textbooks, many respondents spent the money and made the commitment to attend a formal review course.  Uniformly, review courses received favorable reviews; therefore, cost, convenience, and proximity are likely the most important considerations vs overall course quality choosing to attend a particular board review course.  The American College of Osteopathic Emergency Physicians (ACOEP) provides both written qualifying and oral certification preparation courses specific for their specialty board, and several respondents reported favorable reviews of these products.  There are also private tutorials available for the oral certification board that a few respondents have used and they also receive favorable reviews.  

Although only a few online or computer-based board review products are currently available to EM graduates preparing for the boards, these types of resources are likely to become increasing popular in the future.  This is especially true of the written board preparation products as the current version of the qualifying exam is now computer based.  While these products are not as popular among respondents when compared to currently available textbook and review courses, the quality of these products will likely improve as experience with this format increases.  There are no current oral certification computer-based products on the market, but it does not take much to imagine a live chat oral board preparation format with an instructor in the near future. 

Fortunately for EM graduates, the passing rates for the written qualifying exam and the oral certification exam remain greater than 90%.  Despite these reassuring passing rates, EM graduates should not underestimate these high-stakes examinations.  Candidates applying to take these board examinations should come up with a preparation strategy while in residency and execute the plan following graduation and the first year out of training.   Performance on the inservice exam and mock oral board sessions will help guide the amount of preparation that an individual graduate will need to invest in their preparation.  Familiarity with the electronic format of the written exam and the interview scenarios of the oral written are imperative for successful performance on examination day.  Many of the board review products provide guidance about the structure and logistics of the examination day to shape examinee expectations of the testing experience. 

The written qualifying exam and the oral certification exam represent not only the final hurdle for board certification in EM, but also a significant investment of time and financial expense.  Hopefully, the results of this survey will help upcoming graduates and current residents to make informed choices about their board preparation strategy.