You’re just about to complete your residency. You’re looking your last big hurdle in the eyes – passing the ABEM boards. In addition to wondering about logistics and preparation, you’re likely to have these three questions:
- What were the 2024 ABEM board exam pass rates?
- How tough is the ABEM exam, really?
- And, the biggest question of all, what happens if you don’t pass?
👉 Quick takeaway: First-time candidates do significantly better. If you fail once, your odds of passing drop considerably.
The ABEM exam is intentionally challenging. Several factors make it demanding:
- Breadth of blueprint coverage — from cardiovascular and trauma to pediatrics, geriatrics, and toxicology.
- Length of the test — over 6 hours of active testing, spread across two long sessions.
- Image-heavy questions — ECGs, radiographs, CT scans, ultrasound.
- Endurance and pacing — cognitive fatigue is a major cause of errors.
The ABEM exam is hard because it combines broad specialty coverage with long testing hours and high proportions of image-based questions, requiring both medical knowledge and test-day stamina.
👉 ABEM Board Exam Guide 2025 - Prep, Format, and Pass Strategies
An 18% failure rate among first-time takers in 2024. Among repeat candidates, failure climbs closer to 25–40%.
For physicians without U.S. EM residency training, pass rates historically hover around 50–60%, underscoring the importance of ACGME-accredited preparation.
Patterns among unsuccessful candidates reveal common traps:
- Over-investing in edge cases while neglecting high-yield more common presentations.
- Struggling with ECG and imaging interpretation.
- Fatigue and loss of focus during the second exam block.
- Ignoring the ABEM blueprint weighting, resulting in misaligned study.
👉 Image-Based Questions on the ABEM Board Exam: What Every EM Resident Needs to Know
Most failures stem from poor blueprint alignment, weak image interpretation, and test-day fatigue rather than lack of raw medical knowledge.
Evidence-based strategies consistently separate those who pass from those who don’t:
1. Align with the 2022 EM Model — allocate study hours to match ABEM’s weighted blueprint.
2. Use a high-quality QBank — Med-Challenger is mapped to the ABEM blueprint, integrates pictorial questions, and simulates exam pacing.
3. Practice full-length exams — train your stamina with 6+ hour mocks.
4. Dedicate time to imaging — weekly ECG, radiology, and ultrasound drills.
5. Leverage your ITE report — focus on the bottom three domains.
6. Build short, consistent study sessions — avoid last-minute marathons.
👉 ABEM Study Strategies: 7 Core Approaches That Work
What score do I need to pass the ABEM exam?
A scaled score of 77/100 is required.
How many times can I retake the ABEM exam?
You may retake during the next available window, but each attempt requires a new application and fee.
Do ITE scores predict board outcomes?
Yes. Low ITE scores are a strong risk factor for failure; high scores provide reassurance but no guarantees.
What happens to the Oral Exam after 2025?
The Oral Exam is being replaced by a new in-person Certifying Exam in 2026.
👉 ABEM Board Exam Update 2026: From Oral Exam to OSCE-Based Certifying Exam
Most residents do pass ABEM on their first attempt. But success is not automatic. Aligning with the blueprint, training with a top-tier QBank, and practicing like it’s exam day can shift you firmly into the passing group.
👉 What is the Best Emergency Medicine Question Bank?
How can you prepare for the ABEM Exams? Med-Challenger Emergency Medicine Board Prep