American Board Of Emergency Medicine Research Articles

Using an alumni survey to target improvements in an emergency medicine training programme

IntroductionThe Accreditation Council for Graduate Medical Education (ACGME) is the governing body responsible for accrediting graduate medical training programme in the USA. The Emergency Medicine Milestones (EM-Milestones) were developed by...

How Robust Are Studies in the American Board of Emergency Medicine Maintenance of Certification Lifelong Learning and Self-assessment? An Examination of Fragility and Bias of Included Randomized Controlled Trials.

Critics have raised concerns regarding the validity of maintenance of certification (MOC) programs. We sought to examine the quality of the randomized controlled trials (RCTs) selected for the lifelong learning and self-assessment (LLS) component of the American Board of Emergency Medicine (ABEM) MOC program. We systematically reviewed the ABEM LLS reading lists from 2004 to 2017 to identify RCTs with dichotomous outcomes and superiority designs. A fragility index (FI) was calculated using Fisher's exact test for all statistically significant dichotomous outcomes. Bivariate correlation was performed to examine associations between the FI and RCT study characteristics. Each included study was evaluated with the Cochrane Collaboration risk-of-bias (ROB) tool. Thirteen superiority RCTs with dichotomous outcomes were included in the 2004-2017 LLS reading lists. Ten had a statistically significant outcome, and the majority were robust and at low ROB. The median trial size was 511 patients (interquartile range [IQR]= 251-1,517), and the median FI was 10 (IQR= 7-18); i.e., if 10 patients in the treatment arm had not had events, the results would not have been statistically significant. The majority of RCTs included in the LLS are robust and at low ROB.

American Board of Emergency Medicine Report on Residency and Fellowship Training Information (2016-2017)

The American Board of Emergency Medicine (ABEM) gathers extensive background information on emergency medicine residency programs and the residents training in those programs. We present the 2017 annual report on the status of US emergency medicine training programs.

A Longitudinal Emergency Medical Services Track in Emergency Medicine Residency.

Emergency medicine residency programs offer Emergency Medical Services (EMS) curricula to address Accreditation Council for Graduate Medical Education (ACGME) milestones. While some programs offer advanced clinical tracks in EMS, no standard curriculum exists. We sought to establish a well-defined EMS curriculum to allow interested residents to develop advanced clinical skills and scholarship within this subspecialty.Core EMS fellowship trained faculty were recruited to help develop the curriculum. Building on ACGME graduation requirements and milestones, important elements of EMS fellowship training were incorporated into the curriculum to develop the final document.The final curriculum focuses on scholarly activities relating to the four core areas of EMS identified by The American Board of Emergency Medicine and serves as an intermediary between ACGME graduation requirements for education in EMS and fellowship level training.Standardization of the EMS scholarly track can provide residents with the potential to obtain competency beyond ACGME requirements and prepare them for success in fellowship training and/or leadership within EMS on graduation.

USMLE Scores Predict Success in ABEM Initial Certification: A Multicenter Study.

IntroductionThere are no existing data on whether performance on the United States Medical Licensing Examination (USMLE) predicts success in American Board of Emergency Medicine (ABEM) certification. The aim of this study was to determine the presence of any association between USMLE scores and first-time success on the ABEM qualifying and oral certification examinations.MethodsWe retrospectively collected USMLE Step 1, Step 2 Clinical Knowledge (CK) scores and pass/fail results from the first attempt at ABEM qualifying and oral examinations from residents graduating between 2009 and 2011 from nine EM programs. A composite score was defined as the sum of USMLE Step 1 and Step 2 CK scores.ResultsSample was composed of 197 residents. Median Step 1, Step 2 CK and composite scores were 218 ([IQR] 207–232), 228 (IQR 217–239) and 444 (IQR 427–468). First-time pass rates were 95% for the qualifying examination and 93% for both parts of the examination. Step 2 CK and composite scores were better predictors of achieving ABEM initial certification compared to Step 1 score (area under the curve 0.800, 0.759 and 0.656). Step 1 score of 227, Step 2 CK score of 225 and composite score of 444 predicted a 95% chance of passing both boards.ConclusionHigher USMLE Step 1, Step 2 CK and composite scores are associated with better performance on ABEM examinations, with Step 2 CK being the strongest predictor. Cutoff scores for USMLE Step 1, Step 2 CK and composite score were established to predict first-time success on ABEM initial certification.

Evolution of the Model of the Clinical Practice of Emergency Medicine: 1979 to Present.

The Model of the Clinical Practice of Emergency Medicine (the EM Model) is a three-dimensional representation of the clinical practice of emergency medicine. It is a product of successful collaboration involving the American Board of Emergency Medicine (ABEM), the American College of Emergency Physicians (ACEP), the Society for Academic Emergency Medicine (SAEM), the Emergency Medicine Residents' Association (EMRA), the Council of Emergency Medicine Residency Directors (CORD), the Residency Review Committee for Emergency Medicine (RRC-EM), and the American Academy of Emergency Medicine (AAEM). In 2017, the most recent update and revision of the EM Model will be published. This document will represent the culmination of nearly 40 years of evolution, from a simple listing of presenting patient complaints, clinical symptoms, and disease states into a three-dimensional representation of the clinical practice of emergency medicine. These dimensions include conditions and components, physician tasks, and patient acuity. In addition, over the years, two other documents have been developed, the Knowledge, Skills, and Abilities (KSAs) and the Emergency Medicine Milestones. Both serve as related and complementary educational and assessment tools. This article will review the development of the EM Model from its inception in 1979 to today.

Initial Validity Analysis of the American Board of Emergency Medicine Enhanced Oral Examination.

The American Board of Emergency Medicine (ABEM) has introduced a new testing format for the oral certification examination (OCE): the enhanced oral or "eOral" format. The purpose of this study was to perform initial validity analyses of the eOral format. The two hypotheses were: 1) the case content in the eOral format was sufficiently similar to clinical practice and 2) the eOral case materials were sufficiently similar to clinical practice. The eOral and traditional formats were compared for these characteristics. This was a prospective survey study. The survey was administered as a voluntary postexamination activity at the end of the 2015 spring (April 25-27) and fall (October 10-13) ABEM OCEs. The survey is a routine part of the ABEM oral examination experience. For 2015, two additional questions were added to gauge the similarity of the eOral format to clinical practice. Validity was defined by content and substantive elements within Messick's model of construct validity as well as portions of Kane's validity model. Of the 1,746 physicians who took the oral examination, 1,380 physicians (79.0%) completed all or part of the study survey questions. The majority of respondents agreed the patient presentations in the cases were similar (strongly agreed or agreed) to cases seen in clinical practice, in both the traditional cases (95.1%) and the eOral cases (90.1%). Likewise, the majority of respondents answered that the case materials (e.g., laboratory, radiographs) were similar (strongly agreed or agreed) to what they encounter in clinical practice, both in the traditional format (85.8%) and in the eOral cases (93.7%). Most emergency physicians reported that the types of cases tested in the traditional and eOral formats were similar to cases encountered in clinical practice. In addition, most physicians found the case materials to be similar to what is seen in clinical practice. This study provides early validity evidence for the eOral format.

Goal-directed Focused Ultrasound Milestones Revised: A Multiorganizational Consensus.

In 2012 the Accreditation Council for Graduate Medical Education and the American Board of Emergency Medicine released the emergency medicine milestones. The Patient Care 12 (PC12) subcompetency delineates staged and progressive accomplishment in emergency ultrasound. While valuable as an initial framework for ultrasound resident education, there are limitations to PC12. This consensus paper provides a revised description of criteria to define the subcompetency. A multiorganizational task force was formed between the American College of Emergency Physicians Ultrasound Section, the Council of Emergency Medicine Residency Directors, and the Academy of Emergency Ultrasound of the Society for Academic Emergency Medicine. Representatives from each organization created this consensus document and revision.

Validation of weekly teaching activities of Emergency Medicine Residency Training Program, Qatar against the American Board of Emergency Medicine Curriculum

Introduction: The Emergency Medicine Residency Training Program (EMRTP) in Qatar conducts weekly didactic teaching activities based on syllabus from the Arab Board of Emergency Medicine, but with the accreditation by Accreditation Council for Graduate Medical Education International (ACGMEI) in 2013, we set out to validate the teaching activities against an internationally recognized curriculum of the American Board of Emergency Medicine (ABEM) known as the EM Model. Methods: We undertook a full review of all the teaching topics undertaken throughout the academic year of 2012–13 and found a moderate degree of compliance with the ABEM curriculum. Following this review, we identified developmental points addressed during the last three years. A further review was repeated for the academic year 2015–16 to ensure ongoing improvement. Results: The results show improved content delivery. The overall compliance increased by 16% (58% to 74%) in the domain of medical knowledge and patient care and a staggering 48% (46% to 94%) in the other competencies. Conclusion: On the whole the EMRTP annual curriculum has achieved a strong emphasis on the medical knowledge and patient care competencies (including procedures & skills). Further improvement was noted in other core competencies.

The Relationship Between ACGME Duty Hour Requirements and Performance on the American Board of Emergency Medicine Qualifying Examination.

In 2003, the Accreditation Council for Graduate Medical Education (ACGME) instituted requirements that limited the number of hours residents could spend on duty, and in 2011, it revised these requirements. This study explored whether the implementation of the 2003 and 2011 duty hour limits was associated with a change in emergency medicine residents' performance on the American Board of Emergency Medicine (ABEM) Qualifying Examination (QE). Beginning with the 1999 QE and ending with the 2014 QE, candidates for whom all training occurred without duty hour requirements (Group A), candidates under the first set of duty hour requirements (Group C), and candidates under the second set of duty hour requirements (Group E) were compared. Comparisons included mean scores and pass rates. In Group A, 5690 candidates completed the examination, with a mean score of 82.8 and a 90.2% pass rate. In Group C, 8333 candidates had a mean score of 82.4 and a 90.5% pass rate. In Group E, there were 1269 candidates, with a mean score of 82.5 and an 89.4% pass rate. There was a small but statistically significant decrease in the mean scores (0.04, P < .001) after implementation of the first duty hour requirements, but this difference did not occur after implementation of the 2011 standards. There was no difference among pass rates for any of the study groups (χ2 = 1.68, P = .43). We did not identify an association between the 2003 and 2011 ACGME duty hour requirements and performance of test takers on the ABEM QE.

Opportunities and Challenges Facing the Integrated Physician Workforce of Emergency Medicine and Hospice and Palliative Medicine

BackgroundThe American Board of Emergency Medicine joined nine other American Board of Medical Specialties member boards to sponsor the subspecialty of Hospice and Palliative Medicine; the first subspecialty examination was administered in 2008. Since then an increasing number of emergency physicians has sought this certification and entered the workforce. There has been limited discussion regarding the experiences and challenges facing this new workforce. DiscussionWe use excerpts from conversations with emergency physicians to highlight the challenges in hospice and palliative medicine training and practice that are commonly being identified by these physicians, at varying phases of their careers. The lessons learned from this initial dual-certified physician cohort in real practice fills a current literature gap. Practical guidance is offered for the increasing number of trainees and mid-career emergency physicians who may have an interest in the subspecialty pathway but are seeking answers to what a future integrated practice will look like in order to make informed career decisions. ConclusionThe Emergency and Hospice and Palliative Medicine integrated workforce is facing novel challenges, opportunities, and growth. The first few years have seen a growing interest in the field among emergency medicine resident trainees. As the dual certified workforce matures, it is expected to impact the clinical practice, research, and education related to emergency palliative care.

The American Board of Emergency Medicine ConCert Examination: Emergency Physicians' Perceptions of Learning and Career Benefits.

As part of the American Board of Emergency Medicine (ABEM) Maintenance of Certification (MOC) program, ABEM-certified physicians are required to pass the Continuous Certification (ConCert) examination at least every 10 years. With the 2015 ConCert examination, ABEM sought to better understand emergency physicians' perceptions of the benefits of preparing for and taking the examination and the career benefits of staying ABEM-certified. This was a prospective survey study. A voluntary postexamination survey was administered at the end of the 2015 ABEM ConCert examination (September 21-26, 2015). Physicians were asked about the benefits of preparing for the examination and maintaining ABEM certification. Examination performance was compared to perceptions of learning and career benefits. Of the 2,601 on-time test takers, 2,511 respondents participated (96.5% participation rate). The majority of participants (92.0%) identified a benefit to preparing for the ConCert examination, which included reinforced medical knowledge (73.9%), increased knowledge (66.8%), and making them a better clinician (39.4%). The majority of respondents (90.8%) identified a career benefit of maintaining ABEM certification, which included more employment options (73.8%), more positively viewed by other physicians (56.8%), and better financial outcomes (29.8%). There was a statistically significant association between the perception of knowledge reinforcement and examination performance (p < 0.001). There was also a statistically significant association between the perception that staying certified created more career opportunities and examination performance (p < 0.001). Most emergency physicians identified benefits of preparing for and taking the ABEM ConCert examination, which included reinforcing or adding medical knowledge and making them better clinicians. Most physicians also found career benefits to remaining ABEM-certified, which included greater employment choices, higher financial compensation, and higher esteem from other physicians. The belief that preparing for and taking the examination reinforced medical knowledge was associated with better examination performance.

MINDFUL EM

FigureFigureFigureIf you like parasites, you will love TWiP (This Week in Parasitism), a podcast about all the noxious critters that wreak havoc in the human body, like Plasmodium (which causes malaria), Trypanosoma brucei (which causes sleeping sickness), Wuchereria bancrofti (which causes lymphatic filariasis or elephantiasis), Necator americanus (the bloodsucking roundworm that causes hookworm disease), and Taenia solium (the pig tapeworm that causes neurocysticercosis). If you're into viruses or bacteria, you can listen to TWiV (This Week in Virology) or TWiM (This Week in Microbiology). Physicians need to keep up with the latest in medicine, and podcasts are a great way of staying current and being exposed to just about any field of study our inquisitive heart desires. If microbiology isn't your thing, a plethora of emergency medicine podcasts are available to choose from, including Mel Herbert's EMRAP, Scott Weingart's EMCrit, Amal Mattu's EMCast, and Anton Helman's Emergency Medicine Cases. Many journals have podcasts, too, including Emergency Medicine News' Everyday Medicine with Ryan Stanton, MD, Annals of Emergency Medicine, the New England Journal of Medicine, and Emergency Medicine Clinics. Many high-quality medical blogs are also available, including R.E.B.E.L. EM (http://rebelem.com), Academic Life in Emergency Medicine (www.aliem.com), Life in the Fast Lane (http://lifeinthefastlane.com), Strip Tease (www.electricant.net/ekg), Resus.Me (http://resus.me), and The Poison Review (www.thepoisonreview.com). An exhaustive list of more than 300 emergency medicine and critical care blogs and podcasts are available on Life in the Fast Lane. Twitter also gives you minute-by-minute updates on the latest tidbits of interesting medical news and is arguably the best source for FOAMed (Free Open Access Medical Education), a collection of resources meant to assist physicians in keeping up with the latest in medicine. Beyond these modern methods for keeping up with the medical literature are still the old-fashioned approaches, such as reading medical journals, browsing medical textbooks, or attending one of dozens of medical conferences offered at various popular destinations throughout the world. More Effective Approach The one thing that is unlikely to help you keep up with the latest medical innovations or retain the knowledge you have gained since medical school, however, is the 10-year recertification examination, a mandatory requirement by the American Board of Emergency Medicine. It doesn't make sense to spend a couple of weeks every 10 years cramming for a test that does little to ensure that we stay up to date on our medical education. This is, in many ways, an obsolete exam that doesn't benefit our overall education. Our anesthesiologist colleagues have found a more effective approach than the recertification exam. The American Board of Anesthesiology this year became the first medical board to do away with the 10-year recertification exam. Instead, anesthesiologists will be offered a “more relevant and personalized approach ... to assess their knowledge and address knowledge gaps” through online quizzes and other educational material. (http://bit.ly/1S1Y5HJ.) Much of the criticism of the anesthesia recertification exam, which also applies to the emergency medicine 10-year test, argued that it was an expensive pass/fail assessment that did not provide feedback on performance or demonstrate that it was an effective way to keep anesthesiologists current in their field. Addressing these concerns, the regular online quizzes that are part of the MOCA 2.0 (Maintenance of Certification in Anesthesiology) program will give immediate comments, assist the practitioner in identifying any knowledge gaps, and provide better patient care. Our current technology allows for any of us with a computer or smartphone to have the entire breadth of medical knowledge at our fingertips. We are not naïve enough to think that every single practicing emergency physician will take advantage of the myriad podcasts, blogs, and other FOAMed resources, but cramming for a costly exam once a decade is not the most effective way to ensure we stay up to date with medical knowledge. The current Lifelong Learning and Self-Assessment program, through its yearly requirement of 10 to 15 journal articles and attached examination, is certainly a much more effective way to promote continuous learning, and does a much better job at encouraging us to stay current. Most emergency physicians agree that we should reform maintenance of board certification by abolishing the 10-year exam. Opposition continues to grow not only in our field but also throughout the medical community. If the 10-year recertification has been abandoned by one branch of medicine, shouldn't all of the others, including emergency medicine, follow suit? Share this article on Twitter and Facebook. Access the links in EMN by reading this on our website or in our free iPad app, both available at www.EM-News.com. Comments? Write to us at [email protected].

American Board of Emergency Medicine Report on Residency Training Information (2015-2016)

The American Board of Emergency Medicine (ABEM) gathers extensive background information on emergency medicine residency programs and the residents training in those programs. We present the 2016 annual report on the status of US emergency medicine training programs.

A Cross-Sectional Study of Medical Student Knowledge of Evidence-Based Medicine as Measured by the Fresno Test of Evidence-Based Medicine

BackgroundEvidence-based medicine (EBM) has been included in the Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Emergency Medicine (ABEM) milestones project as a required component during emergency medicine (EM) residency training. Milestone Level One states that graduating medical students must be able to “describe basic principles of EBM.” ObjectiveWe sought to identify the EBM skills of third- and fourth-year medical students. MethodsOur institution, a network with 17 different residencies, hosts U.S. osteopathic and allopathic medical students. As a part of orientation, students are required to complete an entry Fresno Test of EBM (FTEBM). Retrospectively, medical student FTEBM scores from 2011 were assessed using descriptive statistics. ResultsFour hundred seventeen FTEBM scores were analyzed. Participants represented 40 medical schools, including 17 allopathic (MD) and 23 osteopathic (DO) schools. Fifty percent of participants (n = 210) were female, and 51.6% (n = 215) were from a DO medical school. Overall mean performance for the FTEBM was 47.2%. Exploring the results by individual question were (individual EBM question topics are in parentheses): 1A (study question), 62.0%; 1B (study question), 64.4%: 2 (sources of evidence), 67.6%; 3 (study design), 57.1%; 4 (search strategies), 53.2%; 5 (relevance), 41.2%; 6 (internal validity), 43.6%; 7 (magnitude), 37.8%; 8 (two-by-two grids), 30.0%; 9 (number needed to treat), 16.9%; 10 (confidence intervals), 34.3%; 11 (diagnosis), 5.0%; and 12 (prognosis), 43.4%. ConclusionsAs measured by the FTEBM, senior medical students demonstrate understanding of about half of EBM. EM residencies can anticipate the need to instruct their residents in EBM concepts in order to meet ACGME/ABEM milestone requirements.

An Evaluation of Emergency Medicine Core Content Covered by Free Open Access Medical Education Resources

Emergency physicians are using free open access medical education (FOAM) resources at an increasing rate. The extent to which FOAM resources cover the breadth of emergency medicine core content is unknown. We hypothesize that the content of FOAM resources does not provide comprehensive or balanced coverage of the scope of knowledge necessary for emergency medicine providers. Our objective is to quantify emergency medicine core content covered by FOAM resources and identify the predominant FOAM topics. This is an institutional review board-approved, retrospective review of all English-language FOAM posts between July 1, 2013, and June 30, 2014, as aggregated on http://FOAMem.com. The topics of FOAM posts were compared with those of the emergency medicine core content, as defined by the American Board of Emergency Medicine's Model of the Clinical Practice of Emergency Medicine (MCPEM). Each FOAM post could cover more than 1topic. Repeated posts and summaries were excluded. Review of the MCPEM yielded 915 total emergency medicine topics grouped into 20 sections. Review of 6,424 FOAM posts yielded 7,279 total topics and 654 unique topics, representing 71.5% coverage of the 915 topics outlined by the MCPEM. The procedures section was covered most often, representing 2,285 (31.4%) FOAM topics. The 4 sections with the least coverage were cutaneous disorders, hematologic disorders, nontraumatic musculoskeletal disorders, and obstetric and gynecologic disorders, each representing 0.6% of FOAM topics. Airway techniques; ECG interpretation; research, evidence-based medicine, and interpretation of the literature; resuscitation; and ultrasonography were the most overrepresented subsections, equaling 1,674 (23.0%) FOAM topics when combined. The data suggest an imbalanced and incomplete coverage of emergency medicine core content in FOAM. The study is limited by its retrospective design and use of a single referral Web site to obtain available FOAM resources. More comprehensive and balanced coverage of emergency medicine core content is needed if FOAM is to serve as a primary educational resource.

Physician Preparation for the American Board of Emergency Medicine ConCert Examination.

To maintain certification by the American Board of Emergency Medicine (ABEM), physicians are required to pass the Continuous Certification (ConCert) examination at least every 10 years. On the 2014 ConCert postexamination survey, ABEM sought to understand the manner in which ABEM diplomates prepared for the test and to identify associations between test preparation approaches and performance on the ConCert examination. This was a cross-sectional survey study. The survey was administered at the end of the 2014 ConCert examination. Analyses included chi-square and linear regression to determine the association of preparation methods with performance. Of the 2,431 on-time test-takers, 2,338 (96.2%) were included. The most commonly used study approach was the review of written materials designed for test preparation (1,585; 67.8%), followed by an online training course (1,006; 43.0%). There were 758 (32.4%) physicians who took a single onsite board review course, while 41 (1.8%) took two or more onsite courses. Most physicians (1,611; 68.9%) spent over 35 hours preparing for the ConCert examination. The study method that was most associated with favorable test scores was the review of written materials designed for test preparation (p < 0.001). Attending an onsite preparation course was associated with poorer performance (p < 0.001). There was a significant association between no additional preparation and failing the examination (chi-square with Yates correction; p = 0.001). A substantial majority (97.8%) of physicians taking the 2014 ABEM ConCert examination prepared for it. The majority of physicians used written materials specifically designed for test preparation. Reviewing written materials designed for test preparation was associated with the highest performance.

Past Performance Probably IS Indicative of Future Results.

Past Performance Probably IS Indicative of Future Results.

Development of a Medical Toxicology Curriculum in Spanish with Content Informed by a Population Survey for Medical Trainees in the Dominican Republic

Introduction: The aim of this study is to develop a curriculum based on the American Board of Emergency Medicine (ABEM) core content toxicology category with emphasis on exposures prevalent in the Dominican Republic (DR) as informed by a population survey. Methods: A survey was designed to identify common toxicological exposures, practices, and perceptions in community members and medical trainees in Santiago, DR. A toxicology curriculum was taught to medical residents using a curriculum made available online through the Global Educational Toxicology Uniting Project (GETUP). Results: 175 people completed the survey and 34 medical residents completed the course. The average percent of students/residents and community members reported the following, respectively: frequent substance abuse (12.2%, 44.0%), safe storage practices (21.7%, 13.7%), and traditional remedy use (15.2%, 21.8%). Community members answered 44%, medical students answered 61%, and residents answered 73% of the basic knowledge questions correctly. The mean pretest and posttest scores in the medical residents who took the toxicology course were 61% and 83%, respectively. Conclusions: The results suggest this population would benefit from education regarding safe-storage practices, the potential dangers of traditional remedy use, as well as education on the sources and effects of common exposures like lead and pesticide poisoning. Many practice high risk behaviors including substance abuse, unsafe remedy use, as well as the use of products that are either illegal or improperly labeled/handled. The long-term goals of this project are to raise awareness and implement expanded toxicology training in this country.

Correlation of the National Board of Medical Examiners Emergency Medicine Advanced Clinical Examination Given in July to Intern American Board of Emergency Medicine in-training Examination Scores: A Predictor of Performance?

IntroductionThere is great variation in the knowledge base of Emergency Medicine (EM) interns in July. The first objective knowledge assessment during residency does not occur until eight months later, in February, when the American Board of EM (ABEM) administers the in-training examination (ITE). In 2013, the National Board of Medical Examiners (NBME) released the EM Advanced Clinical Examination (EM-ACE), an assessment intended for fourth-year medical students. Administration of the EM-ACE to interns at the start of residency may provide an earlier opportunity to assess the new EM residents’ knowledge base. The primary objective of this study was to determine the correlation of the NBME EM-ACE, given early in residency, with the EM ITE. Secondary objectives included determination of the correlation of the United States Medical Licensing Examination (USMLE) Step 1 or 2 scores with early intern EM-ACE and ITE scores and the effect, if any, of clinical EM experience on examination correlation.MethodsThis was a multi-institutional, observational study. Entering EM interns at six residencies took the EM-ACE in July 2013 and the ABEM ITE in February 2014. We collected scores for the EM-ACE and ITE, age, gender, weeks of clinical EM experience in residency prior to the ITE, and USMLE Step 1 and 2 scores. Pearson’s correlation and linear regression were performed.ResultsSixty-two interns took the EM-ACE and the ITE. The Pearson’s correlation coefficient between the ITE and the EM-ACE was 0.62. R-squared was 0.5 (adjusted 0.4). The coefficient of determination was 0.41 (95% CI [0.3–0.8]). For every increase of one in the scaled EM-ACE score, we observed a 0.4% increase in the EM in-training score. In a linear regression model using all available variables (EM-ACE, gender, age, clinical exposure to EM, and USMLE Step 1 and Step 2 scores), only the EM-ACE score was significantly associated with the ITE (p<0.05). We observed significant colinearity among the EM-ACE, ITE and USMLE scores. Gender, age and number of weeks of EM prior to the ITE had no effect on the relationship between EM-ACE and the ITE.ConclusionGiven early during intern year, the EM-ACE score showed positive correlation with ITE. Clinical EM experience prior to the in-training exam did not affect the correlation.