Board Examination Pass Rates of Emergency Medicine Residency Training Programs: Associations With Founding Year, Teaching Status, Length, and Hospital Ownership

Background Emergency medicine (EM) board certification pass rates have been declining amid a rise in new residency programs—many affiliated with for‐profit hospitals or lacking Council of Teaching Hospital (COTH) designation. This study examines how founding year, COTH‐status, program length, and hospital ownership relate to board examination performance. Methods We conducted an observational cross‐sectional analysis of 234 EM residency programs using American Board of Emergency Medicine, Accredidation Council for Graduate MEdical Education, and American Hospital Association data. The primary outcomes were program‐level first‐time Qualifying Exam (QE) and Oral Certifying Exam (OCE) median pass rates from 2021 to 2023. We examined the associations of pass rates with founding year, primary hospital COTH‐status, program length (3 vs. 4 years), and primary hospital ownership. Linear regression models assessed relationships between program characteristics and pass rates. Results Recently‐founded programs (post‐2015) had significantly lower board performance, with an 11‐percentage point reduction in QE pass rates ( p < 0.001) and a 2.6‐percentage point reduction in OCE pass rates ( p = 0.001). Programs affiliated with COTH hospitals had higher pass rates (QE + 6.1 percentage points, p < 0.001; OCE + 1.6 percentage points, p = 0.001). Three‐ and four‐year programs demonstrated similar board pass rates. In comparison to programs with a for‐profit affiliation, EM residency programs with nonprofit and government affiliations were associated with nonsignificantly higher QE pass rates (+ 2.0 percentage points, p = 0.40 and + 4.6 percentage points, p = 0.061, respectively). Nonprofit affiliation was associated with nonsignificantly higher OCE pass rates (+ 2.0 percentage points, p = 0.11). Government affiliation was associated with significantly higher OCE pass rates (+ 2.9 percentage points, p = 0.026). Conclusion Program characteristics significantly affect board examination outcomes for EM residents. Recently founded programs, those lacking COTH designation, or those affiliated with for‐profit hospitals may lack essential resources and experience for optimal training. Identifying and supporting the institutional factors that contribute to resident success will be vital to maximizing programs' learning environments.