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Background Graduates of emergency medicine residency programs can seek certification from the American Board of Emergency Medicine (ABEM), yet the costs and perceived value by residents is not clear. Objective This report sought to better define the value of board certification by asking physicians taking the ABEM Oral Certification Examination (OCE) to describe its costs (eg, time, money) and perceived benefits. Methods A descriptive, cross-sectional, voluntary, anonymous survey was administered to physicians taking the 2018 spring and fall ABEM OCEs. Response frequencies were used to report response rates. Results There were 2016 physicians who participated in the 2018 OCEs, of whom 1565 (78%) completed a survey. With respect to preparation, 38% (599 of 1565 responses) spent more than 30 hours preparing for the examination. Regarding the expense of preparing for the examination, 21% (328) spent nothing, 50% (776) spent less than $1,000, and 2% (38) spent more than $3,000. Most physicians (80%, 1254) reported a learning benefit to preparing for and taking the OCE. There were 49% (765) of respondents who reported that preparing for the examination reinforced their knowledge of emergency medicine; 20% (311) reported no learning benefit. Most physicians (92%, 1442) reported that ABEM certification provided a career benefit, the most common of which was more career opportunities (69%, 1076). Conclusions Initial certification requires a considerable investment of time and money. Physicians seeking initial ABEM certification found both learning and professional benefits, with the most frequently reported being reinforcement of medical knowledge and more career opportunities.

Background In 2013, milestone ratings became a reporting requirement for emergency medicine (EM) residency programs. Programs rate each resident in the fall and spring on 23 milestone subcompetencies. Objective This study examined the incidence of straight line scoring (SLS) for EM Milestone ratings, defined as a resident being assessed the same score across the milestone subcompetencies. Methods This descriptive analysis measured the frequencies of SLS for all Accreditation Council for Graduate Medical Education (ACGME)–accredited EM programs during the 2015–2016 academic year. Outcomes were the frequency of SLS in the fall and spring milestone assessments, changes in the number of SLS reports, and reporting trends. Chi-square analysis compared nominal variables. Results There were 6257 residents in the fall and 6588 in the spring. Milestone scores were reported for 6173 EM residents in the fall (99% of 6257) and spring (94% of 6588). In the fall, 93% (5753 residents) did not receive SLS ratings and 420 (7%) did, with no significant difference compared with the spring (5776 [94%] versus 397 [6%]). Subgroup analysis showed higher SLS results for residents' first ratings (183 of 2136 versus 237 of 4220, P < .0001) and for their final ratings (200 of 2019 versus 197 of 4354, P < .0001). Twenty percent of programs submitted 10% or more SLS ratings, and a small percentage submitted more than 50% of ratings as SLS. Conclusions Most programs did not submit SLS ratings. Because of the statistical improbability of SLS, any SLS ratings reduce the validity assertions of the milestone assessments.

Michael S. Beeson, MD, MBA, is Residency Program Director in the Department of Emergency Medicine, Akron General Medical Center; Wallace A. Carter, MD, is Residency Program Director in the Department of Emergency Medicine, New York Presbyterian Hospital; Theodore A. Christopher, MD, is Professor and Chairman of the Department of Emergency Medicine, Thomas Jefferson University and Hospitals; Jonathan W. Heidt, MD, is Clinical Instructor in the Division of Emergency Medicine, Washington University School of Medicine in St Louis; James H. Jones, MD, is Professor of Clinical Emergency Medicine in the Department of Emergency Medicine, Indiana University School of Medicine; Lynne E. Meyer, PhD, MPH, is Executive Director of the Review Committee for Emergency Medicine, Accreditation Council for Graduate Medical Education; Susan B. Promes, MD, is Professor and Vice Chair for Education in the Department of Emergency Medicine, University of California, San Francisco; Kevin G. Rodgers, MD, is Professor in the Department of Emergency Medicine, Indiana University School of Medicine; Philip H. Shayne, MD, is Professor and is Program Director and Vice Chair for Education in the Department of Emergency Medicine, Emory University School of Medicine; Mary Jo Wagner, MD, is Residency Program Director and Chief in the Department of Emergency Medicine, Central Michigan University College of Medicine; and Susan R. Swing, PhD, is Vice President of Outcome Assessment at the Accreditation Council for Graduate Medical Education.