EMS Cognitive Expertise Exam

EMS Cognitive Expertise Exam

EMS-certified physicians must pass the EMS Cognitive Expertise Examination to renew their EMS certification. The examination consists of a secure, proctored, comprehensive examination administered in Pearson VUE professional computer-based testing centers across the United States. This is the same exam that is administered to initial certification candidates in odd-numbered years. 

EMS-certified physicians can register and take the exam during the scheduled EMS Cognitive Expertise Examination administration in years six through ten of their certification. They are not required to meet other continuing certification requirements to take the Cognitive Expertise Examination.

Taking the Exam

The EMS Cognitive Expertise Examination appointment time is approximately 8 hours. This criterion-referenced exam has 300 multiple choice questions, each with a single-best answer.

After check-in, the Pearson VUE test administrator will seat you in the testing room. Each EMS Exam appointment is 8 hours in length. However, only 6 hours and 20 minutes of this time is actual testing time, which is divided into two separately timed testing sessions.

Approximately 1 hour and 40 minutes of the appointment time is devoted to a one-hour scheduled break between the two testing sessions, and several accessory activities related to the exam administration. These accessory activities include acceptance of the ABEM Policy on Examination Irregularities, an optional test tutorial, examination instructions, and a candidate survey.

Content Specifications

The Core Content of EMS Medicine is the basis for all EMS examination content. The 2019 Core Content of Emergency Medical Services Medicine defines the content for the initial certification examination for EMS.
Core Content of EMS Medicine [Word]
Core Content of EMS Medicine 

It is published in Prehospital Emergency Care.

The distribution of test questions on the 2020 EMS Cognitive Expertise Examination by Core Content areas are as follows:

Clinical Aspects of EMS Medicine 40%
Medical Oversight of EMS 30%
Quality Management and Research 15%
Special Operations 15%

Sample Exam Questions

Notification of Examination Results

Results are mailed and posted online within 90 days the last day of the examination administration. ABEM will send an email to candidates notifying them when scores are available. ABEM cannot release your scores over the phone or email. Maintaining up-to-date contact information through your ABEM Personal Page will ensure you receive the results as soon as possible.

Passing Criterion and Scoring

The EMS Cognitive Expertise Exam is criterion referenced. A criterion-referenced exam uses a predetermined standard, against which all candidates are evaluated. All candidates meeting the standard will pass the exam. Quotas or required percentages of candidates passing are not used to determine the passing score.

Your final score on the EMS Cognitive Expertise Exam will be determined by first adding together the number of scored questions you answered correctly. This number-correct score will be used to determine your final score, which will range from 0 to 100.

Determining a Passing Score

Best practice in testing suggests that the passing score for an examination be substantially connected to the content and performance standards defined by The Core Content of EMS Medicine.

In order to maintain this connection, the passing score is typically reviewed every five to seven years, or when the format or content of the exam changes significantly (such as when the Core Content is revised). The process involves a representative panel of clinically active, EMS-certified physicians who are trained in a process called “standard setting.” This process requires the participating physicians to thoroughly understand the Core Content. The panelists then evaluate each test question and assess how a candidate who meets the ABEM standard would perform. The panel then recommends a passing standard (score) to the EMS Subboard. The Subboard weighs this recommendation and uses it to determine a final passing score. The passing score for the EMS Cognitive Expertise Examination was last examined in 2018. The pass rate for the EMS  Cognitive Expertise Examination is 75%.

2021 EMS Cognitive Expertise Examination Scoring FAQs

Statement on Research

ABEM reserves the right to conduct and report research studies of its examinations and its examination data to benefit the specialty and for purposes of quality control and examination development. Individual candidate information will never be reported as part of the research. Your right to confidentiality will be strictly upheld.

ABEM also reserves the right to include, in any examination, certain questions or cases for the purposes of research and validation. These items will not be used in scoring for certification.


Passing the EMS Cognitive Expertise Examination early does not renew your certificate. If all EMS continuing certification requirements are completed, certification will be renewed on January 1 of the year following the expiration of your current certificate.