324 A 10-Year Look at Emergency Medicine/Critical Care Medicine Fellows: Comparison of Standardized Exams Results

Abstract

Emergency medicine physicians have sought critical care medicine (CCM) fellowship training for decades, even in spite of being ineligible for American Board of Medical Specialties (ABMS) board certification. Progress has been made for emergency medicine/CCM fellows, as they now have the opportunity to obtain ABMS certification with existing pathways through Internal Medicine (ABIM-ABEM), Surgery (ABS), and Anesthesiology (ABA-ABEM). Even with this progress, emergency medicine/CCM trainees still experience unique challenges, including: 1) additional training prerequisites beyond those of non-emergency medicine/CCM trainees and 2) an unwillingness to accept emergency medicine graduates by many fellowship programs. Given the challenges for emergency medicine/CCM fellows and the lack of robust data, we sought to: 1) compare emergency medicine/CCM fellow knowledge acquisition to medicine (IM-CCM), surgery (SCC), and anesthesiology (ACCM) fellows at the local and national level using the MCCKAP exam as an objective measure; and 2) compare ABMS CCM board pass rates for emergency medicine/CCM trainees with non-emergency medicine trainees. We performed a retrospective analysis comparing the scores obtained by emergency medicine/CCM fellows on the Multidisciplinary Critical Care Knowledge Assessment Program (MCCKAP) in-service exam with SCC and ACCM co-fellows at a single training site over a 10-year period. The MCCKAP exam is a comprehensive, multidisciplinary 200-question exam administered annually to CCM Fellows with national score standardization. Our multidisciplinary CCM fellowship program requires this exam for all trainees. Scores are presented as means with standard deviations. Means are compared using the student’s t-test. We performed similar analysis on national data and ABMS board pass rates. Over a 10-year period, 117 MCCKAP scores (37 EM/CCM, 80 SCC and ACCM fellows) were evaluated from our institution. Emergency medicine/CCM Fellows’ mean scores were 562.4 (SD 67.4) on the MCCKAP in-training exam while their ACCM and SCC co-fellows had a mean score of 505.3 (SD 87.5) at the institutional level (p < 0.001). Similarly, our emergency medicine/CCM fellows outperformed the national mean (562.4, SD 67.4 versus 500 SD 100, p < 0.001). Nationally, 137 emergency medicine/CCM fellowship graduates have obtained ABMS board certification by sitting for the ABIM CCM board exam at similar rates to IM-fellows (91.2 versus 93.2%; p = 0.22). 28 emergency medicine/CCM fellowship graduates have obtained ABMS board certification by sitting for the ABA CCM board exam with pass rates similar to ACCM fellows (90.4 versus 89.3%; p = 0.85). Six emergency medicine/CCM fellowship graduates have obtained ABMS board certification by sitting for the ABS CCM board exam; although national pass rates for this exam are not available for comparison. Emergency medicine/CCM fellows demonstrate successful knowledge acquisition as demonstrated by MCCKAP scores both locally and at a national level. Emergency medicine/CCM fellows achieve ABMS board pass rates similar to those of CCM trainees from other specialties. Further studies should explore whether the additional prerequisites currently required of emergency medicine/CCM trainees are truly indicated as this data challenges the existing training paradigm.