“Do you reckon I should sit?” Is it possible to predict success in the ACEM fellowship examination?

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Introduction: The ACEM (Australasian College for Emergency Medicine) fellowship examination is a high-stakes assessment occurring at the end of postgraduate training in emergency medicine. The objectives of this study were to identify factors that allow prediction of success or failure in the ACEM fellowship examination, information that may be useful to those involved in examination preparation. Methods: From 2009–2012, six consecutive cohorts of Victorian ACEM trainees sat a practice written examination and completed surveys regarding examination preparation. Subsequent ACEM fellowship examination outcome was obtained by contacting trainees and using ACEM annual reports. Univariate analysis was undertaken to determine which factors would most reliably predict examination success. Each sitting of the practice examination was viewed separately. Results: From the 150 examination candidates, we received responses on 111 occasions from a total of 80 trainees (several candidates sat the exam more than once). Pass/fail data was available for 72 datasets. The strongest positive predictors for examination success included the number of examination sections passed in the practice examination (OR 3.34, 95% CI 1.61–6.90), reading outside of the major international emergency medicine textbooks (OR 2.53, 95% CI 1.21–5.28) and a belief that attending a course was helpful for examination preparation (OR 1.70, 95% CI 1.06–2.73). Years since graduating from medical school (OR 0.79, 95% CI 0.69–0.91) was negatively associated with examination success. Conclusions: In this cohort of Victorian trainees, performance in a practice examination had one of the strongest associations with performance in the real ACEM fellowship examination. Practice examinations are a useful method to provide benchmarking and advice to candidates prior to the formal examination.