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NOVEMBER 2017

®

&

POLICIES

PROCEDURES FOR CERTIFICATION

1

TABLE OF CONTENTS Requirements for Certification in Internal Medicine

2

Requirements for Certification in Subspecialties

7

Certification Using the Research Pathway

11

Special Training Policies

13

Other Policies

14

COPYRIGHT AND EXAMINATION NON-DISCLOSURE POLICY All ABIM materials are protected by the federal Copyright Act, 17

Candidates and diplomates further acknowledge that disclosure

U.S.C. § 101, et seq. Access to all such materials, as further detailed

or any other use of ABIM examination content constitutes profes-

below, is strictly conditioned upon agreement to abide by ABIM’s

sional misconduct and may expose them to criminal as well as

rights under the Copyright Act and to maintain examination confi-

civil liability, and may also result in ABIM’s imposition of penalties

dentiality.

against them, including but not limited to, invalidation of examina-

ABIM examinations are confidential, in addition to being protected by

tion results, exclusion from future examinations, suspension or

federal copyright and trade secret laws. Candidates and diplomates

revocation of Board Certification and other sanctions.

who undertake examinations agree that they will not copy, repro-

With respect to ABIM’s Maintenance of Certification (MOC)

duce, adapt, disclose or transmit examinations, in whole or in part,

products, including its medical knowledge and assessment activi-

before or after taking an examination, by any means now known or

ties, candidates agree that they will not copy, reproduce or make

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any adaptations of such materials in any manner; and will not assist

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someone else in the infringement or misuse of these or any other

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ABIM-copyrighted works.

2

INTRODUCTION To answer the public call to establish more uniform standards

For diplomates certified prior to 2013, ABIM will honor time

for physicians, the American Board of Internal Medicine (ABIM)

remaining on all 10-year certifications. ABIM Board Certified physi-

was founded more than 80 years ago. Certification by the ABIM

cians will continue to be certified for the length of their current

has stood for the highest standard in internal medicine and its

certification(s), assuming they hold a current and valid license.

20 subspecialties. ABIM is one of 24 medical specialty boards

•  For those newly certified in Internal Medicine: You will be

that make up the American Board of Medical Specialties (ABMS).

issued a certificate, which will remain valid as long as you are

It is not a membership society, but a physician-led non-profit,

meeting the requirements of the Maintenance of Certification

independent evaluation organization driven by doctors who want

program. Therefore, those that are newly certified and wish to

to achieve higher standards for better care in a rapidly changing

continue to be reported as “Certified, Participating in MOC” must

world. ABIM receives no public funds and has no licensing

be meeting ongoing program requirements. Upon passing the

authority or function. Our accountability is both to the profession

exam, you will receive a waiver for the first year of the annual

of medicine and to the public.

MOC program fee.

Certification is a continuous process of lifelong learning. ABIM

• For those in a fellowship program: Upon successful completion

does not confer privileges to practice, nor does ABIM intend

of an eligible fellowship year and ABIM’s receipt of your evalu-

either to interfere with or to restrict the professional activities of a

ation from your program director via FasTrack, you will receive

licensed physician based on certification status.

20 MOC points and a one-year MOC fellowship fee credit.

ABIM administers its certification process by: (1) establishing

Fellowship years are eligible for credit if they are accredited

requirements for training and self-evaluation; (2) assessing the

by the Accreditation Council for Graduate Medical Education

professional credentials of candidates; (3) obtaining substantiation

(ACGME), the Royal College of Physicians and Surgeons of

by appropriate authorities of the clinical competence and profes-

Canada, or the Professional Corporation of Physicians of

sional standing of candidates; and (4) developing and conducting

Quebec. Fee credits will be granted upon receipt of an eligible

examinations and other assessments.

training evaluation and will be applied to your annual MOC

Internists and subspecialists certified in or after 1990 remain certi-

program fees. Unaccredited training years either before or during fellowship do not qualify for the MOC credit.

fied through ABIM’s Maintenance of Certification (MOC) program. Participation in MOC means that a physician is demonstrating

• For those certified in an ABIM subspecialty: You will be issued

that s/he participates in certain continuing learning and education

a certificate which will remain valid as long as you are meeting

activities. Participating ABIM Board Certified physicians regularly

the requirements of the Maintenance of Certification Program.

(at least every two years) complete approved MOC activities using

If you wish to be reported as “Certified and Participating in

a structured framework created by their peers for keeping up with

MOC”, you must be meeting ongoing program requirements.

and assessing knowledge of the latest scientific developments

For information about the Maintenance of Certification program

and changes in practice and in specialty areas. Those certified

and to learn how you can participate in MOC, visit abim.org or call

prior to 1990 hold certifications that are valid indefinitely but are

1-800-441-ABIM.

strongly urged to participate in MOC. For all diplomates, in addition to reporting board certification, ABIM will report if they are participating in the MOC program (i.e., engaging in MOC activities frequently).

Eligibility for certification is determined by the policies and procedures described in this document and on the ABIM website (abim.org). This edition of Policies and Procedures for Certification supersedes all previous publications, and the ABIM website (abim.org) supersedes the information found here. ABIM reserves the right to make changes in its fees, examinations, policies, and procedures at any time without advance notice. Admission to ABIM’s certification process is determined by the policies in force at the time of application.

1

REQUIREMENTS FOR CERTIFICATION IN INTERNAL MEDICINE To become certified in internal medicine, a physician must

(2) May include up to three months of other electives approved

complete the requisite predoctoral medical education, meet the

by the internal medicine program director.

graduate medical education training requirements, demonstrate

(3) Includes up to three months for vacation time. See “Leave of

clinical competence in the care of patients, meet the licensure and

Absence and Vacation” policy on page 11.

procedural requirements and pass the Certification Examination in

(4) For deficits of less than one month in required training time,

Internal Medicine.

see “Deficits in Required Training Time” policy on page 11.

Predoctoral Medical Education

In addition, the following requirements for direct patient responsi-

Candidates who graduated from medical schools in the United

bility must be met:

States or Canada must have attended a school that was accredited

(1) At least 24 months of the 36 months of residency educa-

at the date of graduation by the Liaison Committee on Medical

tion must occur in settings where the resident personally

Education (LCME), the Committee for Accreditation of Canadian

provides, or supervises less experienced residents who

Medical Schools, or the American Osteopathic Association.

provide direct care to patients in inpatient or ambulatory settings.

Graduates of international medical schools must have one of the following: (1) a standard certificate from the Educational

(2) At least six months of the direct patient responsibility on

Commission for Foreign Medical Graduates without expired exami-

internal medicine rotations must occur during the R-1 year.

nation dates; (2) comparable credentials from the Medical Council of Canada; or (3) documentation of training for those candidates

Clinical Competence Requirements

who entered graduate medical education training in the United

ABIM requires documentation that candidates for certification in

States via the Fifth Pathway, as proposed by the American Medical

internal medicine are competent in: (1) patient care and proce-

Association.

dural skills; (2) medical knowledge; (3) practice-based learning and improvement; (4) interpersonal and communication skills; (5)

Graduate Medical Education

professionalism; and (6) systems-based practice.

To be admitted to the Certification Examination in Internal Medicine,

Through its tracking process, FasTrack®, ABIM requires verification

physicians must have satisfactorily completed, by August 31 of the

of candidates' clinical competence from an ABIM certified program

year of examination, 36 calendar months, including vacation time,

director (other ABMS Board and Canadian certification is accept-

of U.S. or Canadian graduate medical education accredited by the

able, if applicable). See the table on page 3.

Accreditation Council for Graduate Medical Education (ACGME),

In addition, candidates must receive satisfactory ratings in each

the Royal College of Physicians and Surgeons of Canada, or the

of the ACGME/ABMS Competencies and the requisite procedures

Professional Corporation of Physicians of Quebec. Residency or

during the final year of required training. It is the candidate's

research experience occurring before completion of the require-

responsibility to arrange for any additional training needed to

ments for the MD or DO degree cannot be credited toward the

achieve a satisfactory rating in each component of clinical compe-

requirements for certification.

tence.

The 36 months of residency training must include 12 months of

As outlined in the table above, all residents must receive satisfac-

accredited internal medicine training at each of three levels: R-1,

tory ratings in overall clinical competence in each year of training.

R-2, and R-3. No credit is granted for training repeated at the same

In addition, residents must receive satisfactory ratings in each of

level or for administrative work as a chief medical resident. In addi-

the ACGME/ABMS Competencies during the final year of required

tion, training as a subspecialty fellow cannot be credited toward fulfilling the internal medicine training requirements.

training. It is the resident’s responsibility to arrange for any addi-

Content of Training

component of clinical competence.

tional training needed to achieve a satisfactory rating in each

The 36 calendar months of full-time internal medicine residency

Procedures Required for Internal Medicine

education:

Safety is the highest priority when performing any procedure on

(1) Must include at least 30 months of training in general internal

a patient. ABIM recognizes that there is variability in the types

medicine, subspecialty internal medicine and emergency

and numbers of procedures performed by internists in practice.

medicine. Up to four months of the 30 months may include

Internists who perform any procedure must obtain the appropriate

training in areas related to primary care, such as neurology,

training to safely and competently perform that procedure.

dermatology, office gynecology or office orthopedics. 2

PROGRAM DIRECTOR RATINGS OF CLINICAL COMPETENCE COMPONENTS AND RATINGS

RESIDENTS/FELLOWS: NOT FINAL YEAR OF TRAINING

RESIDENTS/FELLOWS: FINAL YEAR OF TRAINING

Overall Clinical Competence This rating represents the assessment of the resident’s development of overall clinical competence during this year of training.

Satisfactory or Superior

Full credit

Full credit

Conditional on Improvement

Full credit

No credit, must achieve satisfactory rating before receiving credit*

Unsatisfactory

No credit, must repeat year

No credit, must repeat year

Six ACGME/ABMS Competencies** The resident is demonstrating satisfactory development of the knowledge, skill, and attitudes/behaviors needed to advance in training. He/she is demonstrating a learning trajectory that anticipates the achievement of competency for unsupervised practice that includes the delivery of safe, effective, patient-centered, timely, efficient and equitable care. Yes

Full credit

Full credit

Conditional on Improvement

Full credit

No credit, must achieve satisfactory rating before receiving credit*

No

Full credit

No credit, must repeat year

* At the discretion of the program director, training may be extended so that the resident or fellow can attain satisfactory competence in overall clinical competence and/ or the six ACGME/ABMS Competencies. ** The six ACGME/ABMS Competencies are: (1) patient care and procedural skills, (2) medical knowledge, (3) practice-based learning and improvement, (4) interpersonal and communication skills, (5) professionalism and (6) systems-based practice.

It is also expected that the internist be thoroughly evaluated and

To help acquire both knowledge and performance competence,

credentialed as competent in performing a procedure before he

ABIM believes that residents should be active participants in

or she can perform it unsupervised. For certification in internal

performing procedures. Active participation is defined as serving

medicine, ABIM has identified a limited set of procedures in which

as the primary operator or assisting another primary operator.

it expects all candidates to be competent with regard to their

ABIM encourages program directors to provide each resident

knowledge and understanding. This includes: (1) demonstration of

with sufficient opportunity to be observed as an active participant

competence in medical knowledge relevant to procedures through

in the performance of required procedures. In addition, ABIM

their ability to explain indications, contraindications, patient prepa-

strongly recommends that procedural training be conducted

ration methods, sterile techniques, pain management, proper

initially through simulations. At the end of training, as part of

techniques for handling specimens and fluids obtained, and test

the evaluation required for admission to the Internal Medicine

results; (2) ability to recognize and manage complications; and

Certification Examination, program directors must attest to each

(3) ability to clearly explain to a patient all facets of the procedure

resident’s knowledge and competency to perform the procedures

necessary to obtain informed consent.

in the table above. ABIM does not specify a minimum number

For a subset of procedures, ABIM requires all candidates to

of procedures to demonstrate competency; however, to assure adequate knowledge and understanding of the common proce-

demonstrate competence and safe performance by means of eval-

dures in internal medicine, each resident should be an active

uations performed during residency training. The set of procedures

participant for each procedure five or more times.

and ACGME/ABMS Competencies required for each are presented in the table on page 4.

3

PROCEDURES REQUIRED FOR INTERNAL MEDICINE Competency Know, Understand and Explain Perform Safely and Competently

Indications; Contraindications; Recognition and Management of Complications; Pain Management; Sterile Techniques

Specimen Handling

Interpretation of Results

Requirements and Knowledge to Obtain Informed Consent

Abdominal paracentesis

X

X

X

X

Advanced cardiac life support

X

N/A

N/A

N/A

Arterial line placement

X

N/A

X

X

Arthrocentesis

X

X

X

X

Central venous line placement

X

X

N/A

X

Drawing venous blood

X

X

X

N/A

X

Drawing arterial blood

X

X

X

X

X

Electrocardiogram

X

N/A

X

N/A

Incision and drainage of a  n abscess

X

X

X

X

Lumbar puncture

X

X

X

X

Nasogastric intubation

X

X

X

X

Pap smear and endocervical culture

X

X

X

X

X

Placing a peripheral venous line

X

N/A

N/A

N/A

X

Pulmonary artery catheter placement

X

N/A

X

X

Thoracentesis

X

X

X

X

X

CREDIT IN LIEU OF STANDARD TRAINING FOR INTERNAL MEDICINE CANDIDATES Training Completed Prior to Entering Internal Medicine Residency



(a) The internal medicine training occurred under the direction of a program director of an accredited internal medicine program.

ABIM may grant credit for some or all of the 12-month require-



ment at the R-1 level for training taken prior to entering training in

(b)  The training occurred in an institution accredited for training internal medicine residents.

internal medicine. The program director of an accredited internal medicine residency program must petition ABIM to grant credit



in lieu of standard R-1 internal medicine training. Candidates who

(c)  The rotations were identical to the rotations of the residents enrolled in the accredited internal medicine

have already completed 12 months of accredited U.S. or Canadian

residency program.

R-1 internal medicine training are not eligible to be petitioned for

(2) For trainees who have satisfactorily completed some U.S.

credit. Before being proposed, the candidate should have been

or Canadian accredited training in another specialty, ABIM

observed by the proposer for a minimum of three months. No

may grant:

credit will be granted to substitute for 24 months of accredited R-2



and R-3 internal medicine training.

(a) month-for-month credit for the internal medicine rotations that meet the criteria listed under (1) above; plus,

(1)  Month-for-month credit may be granted for satisfactory



completion of internal medicine rotations taken during a

(b) a maximum of six months of credit for the training in family medicine or a pediatrics program; or,

U.S. or Canadian accredited non-internal medicine residency program if all of the following criteria are met:



(c) a maximum of three months of credit for training in a non-internal medicine specialty program.

4

(3) Up to 12 months of credit may be granted for at least three

pathway, but must be proposed by the Chair of the Department of

years of U.S. or Canadian accredited training in another clin-

Medicine, or the internal medicine and/or the subspecialty program

ical specialty and certification by an ABMS member Board in

director at the institution where the candidate holds a current full-

that specialty.

time faculty appointment.



(a) Include a non-refundable Special Candidate fee of $300.

Eligible faculty will have:

(4) Up to 12 months’ may be granted for three or more years

• Completed three or more years of verified graduate medical

of training completed abroad prior to entering accredited

education training in internal medicine and/or a subspecialty

training in the United States or Canada.

abroad.



(a)  Must demonstrate satisfactory overall clinical compe-

• An academic rank of Assistant Professor or higher.

tence as an internist.

•  A full-time faculty appointment for a minimum of three (3)

(b) Must complete a minimum of 18 months of direct patient

immediately prior and consecutive years at the same institution.

responsibility.

• Full-time faculty members are those who supervise and teach

(c)  Must have either a standard certificate from the

trainees (students, residents or fellows) in clinical settings that

Educational Commission for Foreign Medical Graduates

include direct patient care.

(ECFMG) without expired examination dates or compa-

• The appointment must be at an LCME- or Canadian-accredited

rable credentials from the Medical Council of Canada at

medical school or at an ACGME- or Canadian-accredited

the time of application for admission to the Certification

internal medicine residency or subspecialty fellowship training

Examination in Internal Medicine.

program.

(d) Include a non-refundable Special Candidate fee of $300.

Complete the application form at abim.org/path-a

Proposals for credit in lieu of standard training must:

Program Directors of ACGME-Accredited Training Programs under the Single Accreditation System

• Document the reasons the proposer feels the candidate merits special consideration.

A program director of an ACGME-accredited residency or fellow-

• Include letters from the program directors where prior training

ship training program under the Single Accreditation System who

was completed documenting the training.

has successfully completed training in internal medicine and/or

- E  xact from-to dates of training.

a subspecialty in an AOA-accredited residency and/or fellowship training program may become eligible to achieve ABIM Board

- A  brief description of the training.

Certification in Internal Medicine and/or a subspecialty as a candi-

- Confirmation of the candidate's satisfactory clinical compe-

date for special consideration.

tence in the program. Please note that ABIM does not

Through its tracking process, FasTrack®, ABIM requires verification

accept certificates of completion of training or certification

of trainees' clinical competence from an ABIM certified program

by other certifying boards as fulfilling this requirement.

director (other ABMS Board and Canadian certification is accept-

• Include a copy of the candidate's curriculum vitae and bibliog-

able, if applicable). In support of the Single Accreditation System,

raphy.

ABIM has recognized the need for a transition period (2015–2020).

•  If applicable, include documentation of certification by an

During the transition period for the SAS (2015–2020), ABIM will

ABMS member board in another clinical specialty.

accept attestations for ABIM initial certification eligibility criteria from those who are program directors through the SAS, but who

• Include the candidate's date of birth and Social Security/social

have not yet become ABIM certified. Beginning in 2021, all attesta-

insurance number.

tions to ABIM initial certification eligibility criteria will need to come

International Medical Graduates who are Full-time U.S. or Canadian Faculty

from program directors who are ABIM certified, consistent with ABIM policy.

A full-time faculty member at an LCME- or Canadian-accredited

Eligible program directors will have:

medical school, or at an ACGME- or Canadian- accredited residency

• Designation as the program director of an ACGME-accredited

or fellowship program, who has successfully completed training

internal medicine and/or subspecialty training program.

in internal medicine and/or a subspecialty abroad, may become

Complete the application form at abim.org/path-b

eligible to achieve ABIM Board Certification in Internal Medicine and/or a subspecialty as a candidate for special consideration. The candidate may not propose him/herself for consideration in this 5

Faculty Members of ACGME Training Programs Accredited under the Single Accreditation System

AOBIM Certification does not meet the underlying certification

A faculty member of an ACGME-accredited residency or fellow-

Eligible fellows will have:

ship training program under the Single Accreditation System who

• Completed three or more years of verified graduate medical

requirement for ABIM Board Certification in a subspecialty.

has successfully completed training in internal medicine and/

education training in internal medicine in an AOA-accredited

or a subspecialty in an AOA-accredited residency and/or fellow-

residency program and/or certified by the AOBIM.

ship training program may become eligible to achieve ABIM

• Completed all required subspecialty training in an ACGME-

Board Certification in Internal Medicine and/or a subspecialty as

accredited fellowship program.

a candidate for special consideration. The candidate may not

• Satisfactory subspecialty training must be attested for each

propose him/herself for consideration in this pathway, but must be

year of subspecialty fellowship training via ABIM’s FasTrack

proposed by the internal medicine and/or subspecialty program

Clinical Competence Evaluation System.

director at the institution where the candidate holds the full-time faculty appointment.

Complete the application form at abim.org/path-d

Eligible faculty will have:

Training in Combined Programs

• AOBIM Certification in Internal Medicine and/or a subspecialty.

ABIM recognizes internal medicine training combined with training

•  A full-time faculty appointment for a minimum of three (3)

in the following programs: Anesthesia; Dermatology; Emergency

immediately prior and consecutive years at the same institu-

Medicine; Emergency Medicine/Critical Care Medicine; Family

tion.

Medicine; Medical Genetics; Neurology; Nuclear Medicine; Pediatrics*; Physical Medicine and Rehabilitation; Preventive

• Full-time faculty members are those who supervise and teach trainees (students, residents or fellows) in clinical settings that

Medicine; and Psychiatry.

include direct patient care.

* While ABIM recognizes combined medicine/pediatrics training, such training initiated July 1, 2007 or after must be undertaken in a combined medicine/pediatrics program accredited by the ACGME.

• The appointment must be at an ACGME- or Canadian-accredited internal medicine residency or subspecialty fellowship training program.

Guidelines for the combined training programs and require-

•  Faculty at ACGME-accredited residency and/or fellowship

ments for credit toward the ABIM Internal Medicine Certification

programs may still qualify if the program became ACGME

Examination are available at abim.org/certification/policies/imss/

accredited less than three years ago.

im.aspx.

Complete the application form at abim.org/path-c

Graduates of AOA-Accredited Training Programs who have Completed ACGME-Accredited Fellowship Training A graduate of an ACGME-accredited fellowship program who has successfully completed training in internal medicine in an AOA-accredited residency program may become eligible to achieve ABIM Board Certification in Internal Medicine as a candidate for special consideration. All required subspecialty fellowship training must be completed and evaluated as satisfactory in ABIM’s FasTrack Clinical Competence Evaluation System to establish eligibility for ABIM Board Certification in Internal Medicine. Those who pass ABIM’s Internal Medicine Certification Examination would then become eligible for subspecialty certification.

6

REQUIREMENTS FOR CERTIFICATION IN SUBSPECIALTIES General Requirements

Diplomates must be previously certified by ABIM in Cardiovascular Disease to apply for certification in:

In addition to the primary certificate in internal medicine, ABIM certifies physicians in the following subspecialties:

• Advanced Heart Failure and Transplant Cardiology

• Adolescent Medicine

• Adult Congenital Heart Disease

• Adult Congenital Heart Disease

• Clinical Cardiac Electrophysiology

• Advanced Heart Failure and Transplant Cardiology

• Interventional Cardiology

• Cardiovascular Disease

Diplomates must be previously certified by ABIM in Gastroenterology to apply for certification in:

• Clinical cardiac electrophysiology

• Transplant Hepatology

• Critical Care Medicine

Fellowship training must be accredited by the Accreditation

• Endocrinology, Diabetes, and Metabolism

Council for Graduate Medical Education (ACGME), the Royal

• Gastroenterology

College of Physicians and Surgeons of Canada, or the Professional Corporation of Physicians of Quebec. No credit will be granted

• Geriatric Medicine

toward certification in a subspecialty for training completed outside

• Hematology

of an accredited U.S. or Canadian program.

• Hospice and Palliative Medicine

Fellowship training taken before completing the requirements

• Infectious Disease

for the MD or DO degree, training as a chief medical resident, practice experience and attendance at postgraduate courses may

• Interventional Cardiology

not be credited toward the training requirements for subspecialty

• Medical Oncology

certification.

• Nephrology

To be admitted to an examination, candidates must have completed

• Pulmonary Disease

the required training in the subspecialty, including vacation time,

• Rheumatology

by October 31 of the year of examination.

• Sleep Medicine

Candidates for certification in the subspecialties must meet ABIM’s

• Sports Medicine

requirements for duration of training as well as minimum duration of full-time clinical training. Clinical training requirements may be

• Transplant Hepatology

met by aggregating full-time clinical training that occurs throughout

At the time of application for certification in a subspecialty, physi-

the entire fellowship training period; clinical training need not

cians must have been previously certified in Internal Medicine

be completed in successive months. Time spent in continuity

by ABIM.

outpatient clinic, during non-clinical training, is in addition to the

To become certified in a subspecialty, a physician must satisfactorily

requirement for full-time clinical training.

Educational rotations

completed during training may not be double-counted to satisfy

complete the requisite graduate medical education fellowship

both internal medicine and subspecialty training requirements.

training, demonstrate clinical competence, and procedural skills.

Likewise, training which qualifies a diplomate for admission to one

Diplomates must be previously certified in either internal medicine

subspecialty examination cannot be double-counted toward certi-

or a subspecialty to apply for certification in:

fication in another subspecialty, with the exception of the formally

• Adolescent Medicine

approved pathways for dual certification.

• Hospice and Palliative Medicine • Sleep Medicine • Sports Medicine

7

Training and Procedural Requirements

Clinical Cardiac Electrophysiology

The total months of training required, including specific clinical

Electrophysiologic studies both with a catheter and intraoperatively; catheter-based and other ablation procedures; and

months, and requisite procedures for each subspecialty, are

implantation of pacemakers, and cardioverters-defibrillators (a

outlined by discipline in the table below.

minimum of 150 intracardiac procedures in at least 75 patients, of which 75 are catheter-based ablation procedures, including

MINIMUM MONTHS OF TRAINING/ CLINICAL MONTHS REQUIRED TOTAL MONTHS OF TRAINING

CLINICAL MONTHS

Cardiovascular Disease

36

24

Gastroenterology

36

18

SUBSPECIALTY

Adolescent Medicine Critical Care Medicine Endocrinology, Diabetes, and Metabolism+ Hematology** Infectious Disease Medical Oncology** Nephrology Pulmonary Disease Rheumatology

post-diagnostic testing, and 25 are initial implantable cardioverterdefibrillator procedures, including programming). Procedures performed during training in cardiovascular disease may be counted toward fulfilling these requirements provided that they are adequately documented and are performed with supervision equivalent to that of a clinical cardiac electrophysiology fellowship. The ABIM Council has approved an increase in training requirements for Clinical Cardiac Electrophysiology to two years for fellows beginning training in Academic Year 2017–2018. The following are the procedural requirements for the two-year curriculum.

24

12

• 160 catheter ablation procedures, including: - 50 supraventricular tachycardia - 30 atrial flutter/macro-reentrant atrial tachycardia procedures - 50 atrial fibrillation procedures

Advanced Heart Failure and Transplant Cardiology Clinical Cardiac Electrophysiology* Geriatric Medicine Hospice and Palliative Medicine Interventional Cardiology Sleep Medicine Sports Medicine Transplant Hepatology

12*

Adult Congenital Heart Disease

24

- 30 ventricular tachycardia/premature ventricular contraction ablations 12

• 100 cardiac implantable electric device (CIED)-related implantation procedures • 30 CIED-related replacement/revision procedures • 200 CIED-related interrogation or programming procedures

18

• 5 tilt-table tests

* The total months of training required for fellows beginning their clinical cardiac electrophysiology fellowship training in or after Academic Year 2017–18 will be 24 months. For more information, please visit www.abim.org/certification/policies/ imss/ccep.aspx#tpr.

Procedures performed during training in cardiovascular disease may be counted toward fulfilling these requirements provided that

** Requires minimum ½ day per week in continuity outpatient clinic.

they are adequately documented and are performed with super-

Note: For deficits of less than one month in required training time, see “Deficits in Required Training Time” policy on page 11.

vision equivalent to that of a clinical cardiac electrophysiology fellowship.

Procedures for Subspecialties

Critical Care Medicine Airway management and endotracheal intubation; ventilator

Adolescent Medicine

management and noninvasive ventilation; insertion and manage-

No required procedures.

ment of chest tubes, and thoracentesis; advanced cardiac life

Adult Congenital Heart Disease

support (ACLS); placement of arterial, central venous, and pulmo-

Procedures to be determined.

nary artery balloon flotation catheters; calibration and operation

Advanced Heart Failure and Transplant Cardiology

of hemodynamic recording systems; proficiency in use of ultra-

Procedures to be determined.

sound to guide central line placement and thoracentesis is

Cardiovascular Disease

strongly recommended. Candidates should know the indications, contraindications, complications, and limitations of the following

Advanced cardiac life support (ACLS), including cardioversion;

procedures: pericardiocentesis, transvenous pacemaker insertion,

electrocardiography, including ambulatory monitoring and exercise

continuous renal replacement therapy (CRRT) and hemodialysis,

testing; echocardiography; arterial catheter insertion; right-heart

and fiberoptic bronchoscopy. Practical experience is recom-

catheterization, including insertion and management of temporary

mended.

pacemakers; and left-heart catheterization and diagnostic coronary angiography. 8

Endocrinology, Diabetes, and Metabolism

Nephrology

Thyroid aspiration biopsy

Placement of temporary vascular access for hemodialysis and

Thyroid ultrasound*

related procedures; acute and chronic hemodialysis; peritoneal dialysis (excluding placement of temporary peritoneal catheters);

Skeletal dual photon absorptiometry interpretation*

continuous renal replacement therapy (CRRT); and percutaneous

Management of insulin pumps*

biopsy of both autologous and transplanted kidneys.

Continuous glucose monitoring*

Pulmonary Disease

* These new requirements will go into effect for those beginning

Airway management including endotracheal intubation; fiberoptic bronchoscopy and accompanying procedures; noninvasive and

fellowship in the 2016–17 academic year. Please note that to

invasive ventilator management; thoracentesis; arterial puncture;

be eligible for ABIM Endocrinology, Diabetes, and Metabolism

placement of arterial, central venous and pulmonary artery balloon

certification, fellows graduating in June 2017 will be evaluated

flotation catheters; calibration and operation of hemodynamic

on thyroid aspiration biopsy competency only. Endocrinology

recording systems; supervision of the technical aspects of pulmo-

fellows graduating in June 2018 and after will be evaluated on

nary function testing; progressive exercise testing; insertion and

the above procedures.

manage-ment of chest tubes; moderate sedation. Proficiency

Gastroenterology

in use of ultra-sound to guide central line placement is strongly

Diagnostic and therapeutic upper and lower endoscopy.

recommended.

Geriatric Medicine

Rheumatology

No required procedures.

Diagnostic aspiration of and analysis by light and polarized light

Hematology

microscopy of synovial fluid from diarthrodial joints, bursae and

Bone marrow aspiration and biopsy, including preparation,

tenosynovial structures; and therapeutic injection of diarthrodial

examination and interpretation of bone marrow aspirates and

joints, bursae, tenosynovial structures and entheses.

touch preparations of bone marrow biopsies; interpretation of

Sleep Medicine

peripheral blood smears, including manual white blood cell and

Ability to interpret results of polysomnography, multiple sleep

platelet counts; administration of chemotherapeutic agents and

latency testing, maintenance of wakefulness testing, actigraphy

biological products through all therapeutic routes; management

and portable monitoring related to sleep disorders.

and care of indwelling venous access catheters; and management

Sports Medicine

of methods of apheresis.

No required procedures.

Hospice and Palliative Medicine

Transplant Hepatology

No required procedures.

Performance of at least 30 percutaneous liver biopsies,* including

Infectious Disease

allograft; interpretation of 200 native and allograft liver biopsies;

No required procedures.

and knowledge of indications, contraindications, and complica-

Interventional Cardiology

tions of allograft biopsies.

A minimum of 250 therapeutic interventional cardiac procedures

The ABIM Gastroenterology Board has approved an update to

during accredited interventional cardiology fellowship training.

the procedural requirements for initial certification in Transplant

Those out of interventional cardiology training three years or more

Hepatology for fellows beginning training in Academic Year 2016–

as of June 30 of the year of exam must document post-training

2017. The following are the revised procedures:

performance as primary operator of 150 therapeutic interventional

•  Demonstrate competence in performance of native and

cardiac procedures in the two years prior to application for exam.

allograft liver biopsy and interpretation of results.

Medical Oncology

• A minimum of 20 liver biopsies, including native and allograft,

Bone marrow aspiration and biopsy; administration of chemo-

should be performed. Biopsies performed prior to transplant

therapeutic agents and biological products through all therapeutic

hepatology fellowship (e.g., during GI fellowship) may count

routes; and management and care of indwelling venous access

toward this minimum.

catheters.

9

• A minimum of 200 liver biopsy specimens, including native

Candidates must complete all three years of required combined

and allograft, should be interpreted during the transplant

training before being admitted to an examination in either subspe-

hepatology fellowship year using resources available within

cialty. Those who elect to take an examination in one subspecialty

the fellowship program and/or from outside resources such as

following only two years of fellowship training will be required to

teaching slide-sets.

complete four years of accredited training for dual certification.

• Demonstrate knowledge of the indications, contra-indications,

Pulmonary Disease and Critical Care Medicine

limitations, complications, alternatives and techniques of

Candidates seeking dual certification in pulmonary disease and

native and allograft liver biopsy and noninvasive methods of

critical care medicine must complete a minimum of three years of

fibrosis assessment.

accredited combined training, 18 months of which must be clinical training.

Clinical Competence Requirements

Only candidates certified in a subspecialty following at least two

ABIM requires documentation that candidates for certification in

years of accredited fellowship training (three years for cardio-

the subspecialties are competent in: (1) patient care and procedural

vascular disease and gastroenterology) are permitted to take the

skills (which includes medical interviewing and physical examina-

critical care medicine examination after completion of 12 months

tion skills); (2) medical knowledge; (3) practice-based learning

of accredited clinical critical care medicine fellowship training.

and improvement; (4) interpersonal and communication skills; (5)

Candidates certified in internal medicine only must complete

professionalism; and (6) systems-based practice.

24 months of accredited critical care medicine fellowship training,

Through its tracking process, FasTrack®, ABIM requires verification

including 12 months of clinical training, to qualify for the critical care

of subspecialty fellows’ clinical competence from the subspecialty

medicine examination.

training program director. See the table on page 3.

Thus, for candidates applying for dual certification in pulmonary

In addition, fellows must receive satisfactory ratings in each of the

disease and critical care medicine with three years of combined

ACGME/ABMS Competencies and the requisite procedures during

training, certification in pulmonary disease must be achieved

the final year of required training. It is the fellow’s responsibility to

before the candidate is eligible to apply for admission to the critical

arrange for any additional training needed to achieve a satisfactory

care medicine examination.

rating in each component of clinical competence.

Rheumatology and Allergy and Immunology

Dual Certification Requirements

Dual certification in rheumatology and allergy and immunology requires a minimum of three years of training which must include:

Hematology and Medical Oncology

(1) at least 12 months of clinical rheumatology training supervised

Dual certification in hematology and medical oncology requires

by the director of an accredited rheumatology training program;

three years of accredited combined training which must include:

(2) 18 consecutive months of rheumatology continuity clinic; and

a minimum of 18 months of full-time clinical training, of which at

(3) at least 18 months of allergy and immunology training super-

least 12 months are in the diagnosis and management of a broad

vised by the training program director of an accredited program

spectrum of neoplastic diseases including hematological malig-

in allergy and immunology. Plans for combined training should

nancies, and six months are in the diagnosis and management

be prospectively approved in writing by both the rheumatology

of a broad spectrum of non-neoplastic hematological disorders. If

and the allergy and immunology training program directors and

the combined training must be taken in two different programs, 24

by ABIM and the American Board of Allergy and Immunology.

continuous months must be in one institution, and both institutions

Admission to either examination requires: (1) certification in internal

must be accredited in both hematology and medical oncology.

medicine; (2) satisfactory clinical competence; and (3) completion

During the entire three years, the fellow must attend a minimum of

of the entire three-year combined program. Candidates seeking

one-half day per week in continuity outpatient clinic. Time spent in

dual certification for other subspecialty combinations should

continuity outpatient clinic, during non-clinical training, is in addi-

contact ABIM for information.

tion to the requirement for full-time clinical training.

10

CERTIFICATION USING THE RESEARCH PATHWAY The Research Pathway is intended for trainees planning academic

During the research period, 80 percent of time is devoted to

careers as investigators in basic or clinical science. The pathway

research and 10 to 20 percent of time to clinical work. The trainee

integrates training in clinical medicine with a minimum of three

must attend a minimum of one half-day per week in continuity

years of training in research methodology. Prospective planning of

outpatient clinic. Time spent in continuity outpatient clinic during

this pathway by trainees and program directors is necessary.

non-clinical training is in addition to the requirement for full-time

Program directors must document the clinical and research training

clinical training.

experience each year through ABIM’s tracking program. The chart

ABIM defines research as scholarly activities intended to develop

on the following page describes the Research Pathway require-

new scientific knowledge. The research experience of trainees

ments.

should be mentored and reviewed. Unless the trainee has already

All trainees in the Research Pathway must satisfactorily complete

achieved an advanced graduate degree, training should include completion of work leading to one or its equivalent. The last year

24 months of accredited categorical internal medicine residency

of the Research Pathway may be taken in a full-time faculty position

training. A minimum of 20 months must involve direct patient

if the level of commitment to mentored research is maintained at

responsibility.

80 percent.

The minimum full-time clinical training required for each subspe-

During internal medicine research training, 20 percent of each year

cialty is also required for Certification through the research

must be spent in clinical experiences including a half-day per week

pathway. Specifically:

in a continuity clinic. During subspecialty research training, at least

• 12 months in adolescent medicine; allergy and immunology;

one half-day per week must be spent in an ambulatory clinic.

critical care medicine; endocrinology, diabetes, and metabo-

Ratings of satisfactory clinical performance must be maintained

lism; geriatric medicine; hematology; hospice and palliative medicine; infectious disease; nephrology; medical oncology;

annually for each trainee in the ABIM Research Pathway.

pulmonary disease; rheumatology; sleep medicine or sports

For additional information, see www.abim.org/certification/policies/

medicine

research-pathway-policies-requirements.aspx.

• 18 months in gastroenterology, hematology/oncology, pulmonary/critical care medicine, or rheumatology/allergy and immunology • 24 months in cardiology

11

MINIMUM TRAINING REQUIREMENT IN THE INTERNAL MEDICINE RESEARCH PATHWAY DISCIPLINE

Internal Medicine

IM CLINICAL TRAINING

SS CLINICAL TRAINING

RESEARCH TRAINING (80%)

TOTAL TRAINING

EXAM ADMINISTRATION ELIGIBILITY

24 months

N/A

36 months

60 months/5 years

Summer, PGY-5

– Internal medicine training requires 20 months direct patient responsibility – Ambulatory clinics during research training (10%) ½ day per week – Additional clinical training during research (10%) may be intermittent or block time

MINIMUM TRAINING REQUIREMENT IN THE SUBSPECIALTY RESEARCH PATHWAY DISCIPLINE

IM CLINICAL TRAINING

SS CLINICAL TRAINING

RESEARCH TRAINING (80%)

TOTAL TRAINING

EXAM ADMINISTRATION ELIGIBILITY

24 months

12 months

36 months

72 months/6 years

Fall, PGY-6

24 months

18 months

36 months

78 months/6.5 years

Fall, PGY-7

24 months

24 months

36 months

84 months/7 years

Fall, PGY-7

Adolescent Medicine Allergy & Immunology Critical Care Medicine Endocrinology, Diabetes, & Metabolism Geriatric Medicine Hematology Hospice & Palliative Medicine Infectious Disease Nephrology Medical Oncology Pulmonary Disease Rheumatology Sleep Medicine Sports Medicine Gastroenterology Hematology/Medical Oncology Pulmonary/Critical Care Medicine Rheumatology/Allergy & Immunology Cardiovascular Disease

Tertiary certification: Add the minimum clinical requirement of the subspecialty to the Research Pathway Transplant Hepatology

24 months

30 months (18 GI + 12 T-HEP)

36 months

90 months/7.5 years

Fall, PGY-8

Advance Heart Failure & Transplant Cardiology

24 months

36 months (24 CVD + 12 AHFTC)

36 months

96 months/8 years

Fall, PGY-8

Interventional Cardiology

24 months

36 months (24 CVD + 12 ICARD)

36 months

96 months/8 years

Fall, PGY-8

Adult Congenital Heart Disease

24 months

42 months (24 CVD + 18 ACHD)

36 months

102 months/8.5 years

Fall, PGY-9

Clinical Cardiac Electrophysiology

24 months

48 months (24 CVD + 24 CCEP)

36 months

108 months/9 years

Fall, PGY-9

– Internal medicine training requires 20 months direct patient responsibility – Ambulatory clinics during research training (10%) ½ day per week – IM exam administration eligibility, Summer PGY-4 – All other standard ABIM requirements for ABIM initial certification eligibility must be met

12

SPECIAL TRAINING POLICIES Disclosure of Performance Information

Deficits in Required Training Time

Trainees planning to change programs must make requests to their

ABIM recognizes that delays or interruptions may arise during

former program(s) and to ABIM to send written evaluations of past

training such that the required training cannot be completed within

performance to the new program. These requests must be made

the standard total training time for the training type. In such circum-

in a timely manner to ensure that the new program director has

stances, if the trainee's program director and clinical competency

the performance evaluations for review before offering a position.

committee attest to ABIM that the trainee has achieved required

A new program director may also request performance evaluations

competence with a deficit of less than one month, extended

from previous programs and from ABIM concerning trainees who

training may not be required. Only program directors may request

apply for a new position. ABIM will respond to written requests

that ABIM apply the Deficits in Required Training Time policy on

from trainees and program directors by providing any performance

a trainee’s behalf, and such a request may only be made during

evaluations it has in its possession and the total credits accumu-

the trainee’s final year of training. Program directors may request

lated toward ABIM’s training requirements for Board Certification.

a deficit in training time when submitting evaluations for the final

This information will include the comments provided with the

year of standard training via FasTrack, subject to ABIM review.

evaluation.

Examples:

Responsibility for Evaluations

•  A rheumatology trainee beginning training on July 1, 2015 anticipates a completion date by June 30, 2017. A six-week

The responsibility for the evaluation of a trainee’s competence in

medical leave in the F1 year causes the total cumulative leave

the six ACGME/ABMS Competencies and overall clinical compe-

over the 24-month training period to exceed the 62 days of

tence rests with the program director, not with ABIM. ABIM is not

permitted leave by ten days and extending the completion

in a position to re-examine the facts and circumstances of an indi-

date until July 10, 2017.

vidual’s performance. As required by the ACGME in its Essentials of Accredited Residencies in Graduate Medical Education, the

• An internal medicine trainee beginning training on July 27,

educational institution must provide appropriate due process for

2014 (27 days off-cycle due to a visa delay) anticipates a

its decisions regarding a trainee’s performance.

completion date by July 26, 2017. In each example, the trainee may complete training on June 30 if:

Leave of Absence and Vacation

• The program attests to the trainee's achieving the required

Up to one month per academic year is permitted for time away

competence on June 30, 2017

from training, which includes vacation, illness, parental or family

• The program documents the reasons for the deficit in training

leave, or pregnancy-related disabilities. Training must be extended

on the trainee’s ABIM FasTrack® evaluation, and

to make up any absences exceeding one month per year of training. Vacation leave is essential and should not be forfeited or

• ABIM approves the program director's request to apply the

postponed in any year of training and cannot be used to reduce

Deficits in Required Training Time policy.

the total required training period. ABIM recognizes that leave poli-

The Deficits in Required Training Time policy is not intended to be

cies vary from institution to institution and expects the program

used to shorten training before the end of the academic year.

director to apply his/her local requirements within these guidelines

Example:

to ensure trainees have completed the requisite period of training.

• An internal medicine trainee who initiated training on July 1, 2015 and anticipates a completion date on June 30, 2018 may not invoke the Deficits in Required Training Time policy in an effort to truncate his or her training (e.g., to enter a fellowship prior to July 1, 2018).

13

Definition of Full-Time Training

become certified by ABIM and for a transition period (2015-2020) to allow them to do so. If the program director of a program

Full-time training is defined as daily assignments for periods of

achieving accreditation through the SAS is not currently certified

no less than one month to supervised patient care, educational,

by ABIM in the discipline for which he or she is program director,

or research activities designed to fulfill the goals of the training

there is now a Special Consideration Pathway which will allow the

program. Full-time training must include formative and summative

program director to become certified by ABIM.

evaluation of clinical performance, with direct observation by faculty and senior trainees.

During the transition period for the SAS (2015–2020), ABIM will

Transition to the ACGME/AOA Single Accreditation System

from those who are program directors through the SAS, but who

accept attestations for ABIM initial certification eligibility criteria have not yet become ABIM certified. Beginning in 2021, all attestations to ABIM initial certification eligibility criteria will need to come

Beginning in July 2015, for residents and fellows who begin

from program directors who are ABIM certified. For additional infor-

training in an AOA-accredited program which receives ACGME

mation please see the Clinical Competence Requirements section

accreditation before graduation, all satisfactorily completed years

under each certification area.

of training will be accepted towards ABIM’s initial certification eligibility requirements. To be granted admission to an ABIM certi-

Interrupted Full-Time Training

fication examination, candidates must meet all applicable training,

ABIM approval must be obtained before initiating an interrupted

licensure, professional standing and procedural requirements.

training plan. Interrupted full-time training is acceptable, provided

Through its tracking process, FasTrack®, ABIM requires verification

that no period of full-time training is less than one month. In any

of trainees' clinical competence from an ABIM certified program

12-month period, at least six months should be spent in training.

director (other ABMS Board and Canadian certification is accept-

During training periods, patient care responsibilities should be

able, if applicable). In support of the Single Accreditation System

maintained in a continuity clinic consistent with ACGME program

(SAS), ABIM recognized the need for a change in eligibility poli-

requirements for the discipline. Part-time training, whether or not

cies to allow program directors of newly accredited programs to

continuous, is not acceptable.

OTHER POLICIES ABIM’s Evaluations and Judgments

Board Eligibility

Candidates for Board Certification and Maintenance of Certification

Policy

agree that their professional qualifications, including their moral

As of July 2012, the American Board of Internal Medicine considers

and ethical standing in the medical profession and their compe-

internal medicine and subspecialist physicians who have met the

tence in clinical skills, will be evaluated by ABIM, and ABIM’s good

standards for Board Certification in general internal medicine or

faith judgment concerning such matters will be final.

any of its subspecialties to be “Board Eligible” in the relevant

ABIM may make inquiry of persons named in candidates’ applica-

specialty for a period of seven years. The 7-year period of Board Eligibility shall begin upon the candidate’s successful completion

tions and of other persons, such as authorities of licensing bodies,

of the initial requirements in their field or July 1, 2012, whichever

hospitals, or other institutions as ABIM may deem appropriate with

is later. During the period of Board Eligibility, the candidate may

respect to such matters. Candidates agree that ABIM may provide

apply for the certifying examination in the relevant specialty. If

information it has concerning them to others whom ABIM judges to

the candidate does not become Board Certified during the 7-year

have a legitimate need for it.

period of Board Eligibility, the candidate will no longer be deemed

ABIM makes academic and scientific judgments in its evaluations

“Board Eligible” and may no longer represent himself or herself as

of the results of its examinations. Situations may occur, even

“Board Eligible.”

through no fault of the candidates, that render examination results

A candidate who is no longer Board Eligible may nevertheless

unreliable in the judgment of ABIM. Candidates agree that if ABIM

apply for a certifying examination, but only if the candidate has:

determines that, in its judgment, the results of their examination are

(i) completed at least one year of retraining in the relevant specialty

unreliable, ABIM may require the candidates to retake an examina-

after the expiry of the candidate’s period of Board Eligibility, but no

tion at its next administration or other time designated by ABIM.

more than seven years before the application; and (ii) met all other

ABIM also may evaluate candidates’ or diplomates’ fitness for

requirements for Board Certification in effect at that time. Retraining

Board Certification – including their professionalism, ethics and

will require the successful completion of at least one year of

integrity – in disciplinary matters, and ABIM’s good faith judgment

additional residency/fellowship training in an ACGME-accredited

concerning such matters will be final.

U.S. training program or an RCPSC-accredited Canadian training 14

program and an attestation from the program that the candidate has

A physician who misrepresents his or her Board Certification or

demonstrated the requisite competency for unsupervised practice.

Board Eligibility status may be subject to disciplinary sanctions,

Candidates and diplomates remain subject to other ABIM policies

including the revocation or suspension of the physician’s Board

and requirements for certification, such as the Re-examination

Certification or eligibility to participate in the Board Certification or

policy.

Maintenance of Certification processes.

Exceptions

Errors and Disruptions in Examination Administration

The Board recognizes that extraordinary circumstances—such

Occasionally problems occur in the creation, administration, and

as military deployment or illness—may prevent a trainee from

scoring of examinations. For example, power failures, hardware

completing the requirements for Board Certification in the 7-year

and software problems, human errors, or weather problems

period of Board Eligibility. In such extraordinary cases the candi-

may interfere with some part of the examination process.

date may appeal for an extension of the 7-year period. Any such

When such problems occur and ABIM determines that they have

appeal will be adjudicated by the Staff Credentials Committee of

compromised the integrity of examination results, ABIM will provide

the Board, and the decision of the Staff Credentials Committee will

affected candidates with an opportunity for re-examination.

be the final decision of the Board.

A candidate who believes that testing conditions or other examination

Reporting Certification Status

administration issues have adversely affected the candidate’s

ABIM, in addition to reporting certification status, reports whether

ability to take and complete an examination should notify the

or not diplomates are participating in Maintenance of Certification.

proctor at the test center, or contact ABIM as soon as possible after the exam. In no event will ABIM consider a request to cancel

On a candidate’s written request to ABIM, the following informa-

an examination result after the result has been released to the

tion may also be provided in writing: (1) that an application for Board Certification or Maintenance of Certification is currently in

candidate.

process; and/or (2) the year the candidate was last admitted to an

Re-examination shall be the candidate’s sole remedy. ABIM shall

examination.

not be liable for inconvenience, expense, or other damage caused by any problems in the creation, administration, or scoring of an

Reporting Board Eligibility

examination, including the need for retesting or delays in score

ABIM does not confirm or report the Board Eligibility status of its

reporting. In no circumstance will ABIM reduce its standards as a

candidates. Parties interested in a candidate’s Board Eligibility

means of correcting a problem in examination administration.

status may wish to communicate directly with the candidate and/or

Confidentiality Policy

with the appropriate training program.

ABIM considers the certification and Maintenance of Certification

Representation of Board Certification and Board Eligibility Status

participation status of its candidates and diplomates to be public information.

Physicians must accurately state their ABIM Board Certification

ABIM provides a diplomate’s Board Certification status,

or Board Eligibility status at all times. This includes descriptions

Maintenance of Certification status and personal identifying infor-

in curriculum vitae, advertisements, publications, directories and

mation, including mailing address, e-mail address and Social

letterheads.

Security number, to the Federation of State Medical Boards (FSMB) and the American Board of Medical Specialties (ABMS),

Please note: ABIM does not authorize the use of its logo by others.

which publishes The Official ABMS Directory of Board Certified

Diplomates with expired time-limited certification or those whose

Medical Specialists. The FSMB and ABMS use personal identifying

certification is suspended or revoked may not claim ABIM Board

information, including Social Security numbers, as a unique

Certification and must revise all descriptions of their qualifications

internal identifier and maintain the confidentiality of this

accordingly. Additionally, a candidate who does not meet the

information.

requirements for Board Eligibility set forth above may not repre-

On

request,

ABIM

provides

a

diplomate’s

Board Certification and Maintenance of Certification status

sent himself or herself as Board Eligible. Diplomates who have

and address to professional medical societies and other

multiple certifications and allow one of them to lapse should revise

organizations that provide ABIM-sanctioned educational resources

their public materials (letterhead, business cards, advertisements,

and products used for Self-Evaluation of Medical Knowledge or

etc.) to reflect those certifications that are currently valid.

Practice Assessment in the Maintenance of Certification program.

15

Disabled Candidates

ABIM provides residency and fellowship training directors with information about a trainee’s prior training and pass/fail status on

ABIM recognizes that some candidates have physical limitations

certifying examinations. If a trainee has given permission, ABIM

that make it impossible for them to fulfill the requirement for

will provide the program director with the trainee’s score on his/

proficiency in performing procedures. For such individuals, the

her first attempt at the Certification examination for that area of

procedural skills requirement may be waived. Program directors

training. ABIM uses examination performance, training program

should write to ABIM for an exception before the individual enters

evaluations, outcomes-based milestones for resident performance,

training or when the disability becomes established.

Self-Evaluation of Medical Knowledge and Practice Assessment,

ABIM is committed to offering suitable examination accommoda-

and other information for its determination of eligibility and quali-

tions for all candidates, including individuals with disabilities. When

fication of candidates for certification, for evaluation of resident

necessary, alternative arrangements under conditions comparable

development and performance, and/or for research and related

to those provided for other candidates are offered to disabled

purposes. In any such research, ABIM will not identify specific

individuals. Candidates who need accommodation for a disability

individuals, hospitals or practice associations. Candidates acknowl-

during an examination must provide a written request to ABIM

edge and agree that examination performance and milestones

and documentation must be received by ABIM no later than the

data may be shared by and between ABIM and ACGME. All prac-

examination registration deadline. Reapplication for special accom-

tice performance data is HIPAA compliant.

modation is not required for each examination administration unless

ABIM reserves the right to disclose information it possesses about

a new accommodation is requested. ABIM treats requests for

any individual whom it judges has violated ABIM rules, engaged in

accommodations as confidential. For additional information about

misrepresentation or unprofessional behavior, or shows signs of

the process and documentation requirements, please contact

impairment.

ABIM at [email protected], or refer to the ABIM website,

Licensure

abim.org/exam/testing-accommodations-disabilities/default.aspx.

The ability to practice medicine is a fundamental tenet of Board

Substance Abuse

Certification. Candidates for Board Certification and Maintenance

If a candidate or a diplomate has a history of substance abuse,

of Certification must possess a permanent, valid, unrestricted and

documentation of at least one year of continuous sobriety from

unchallenged medical license in the United States, its territories or

a reliable monitoring source may be required for admission to an

Canada. Physicians practicing exclusively abroad and who do not

examination or to receive a certificate. ABIM treats such information

hold a U.S. or Canadian license must hold a license where they

as confidential.

practice and provide documentation from the relevant licensing

Examination Ethics

authority that their license is in good standing and without conditions or restrictions. Restrictions include but are not limited to

Those who take ABIM examinations have a continuing obliga-

conditions, contingencies, probation, limitations and stipulated

tion to maintain examination confidentiality. See Copyright and

agreements.

Examination Non-Disclosure Policy on the inside cover of this

A physician with a restricted, suspended, revoked or surrendered

document.

license in any jurisdiction is not eligible to be certified or admitted

All ABIM examinations are administered in secure testing centers

to a certification examination.

by test administrators who are responsible for maintaining the

ABIM will suspend or revoke the Board Certification of any diplo-

integrity and security of the certification process. Test adminis-

mate who has a license that is suspended, revoked, surrendered

trators are required to report to ABIM any irregular or improper

or restricted (whether voluntarily or otherwise) so as to prohibit

behavior by a candidate, such as giving or obtaining information

the practice of medicine in one or more jurisdictions, and no valid

or aid; looking at the test material of others; removing examination

license in any other jurisdiction. A diplomate who has a license that

materials from the test center; taking notes; bringing unauthor-

is suspended, revoked, surrendered or restricted (whether volun-

ized items, including electronic devices (e.g., pagers, cell phones,

tarily or otherwise) so as to prohibit the practice of medicine in one

tablets, smart phones, etc.), into the examination; failing to comply

or more jurisdictions, but who continues to hold a valid license in

with time limits or instructions, talking or other disruptive behavior.

another jurisdiction—or a diplomate whose license in any jurisdic-

Test administrators may intervene to stop any of the foregoing.

tion has been restricted—may be subject to disciplinary sanctions,

In addition, as part of its effort to assure exam integrity, ABIM

including the suspension or revocation of the physician’s Board

utilizes data forensic techniques that use statistical analyses of

Certification.

test-response data to identify patterns of test fraud, including cheating and copyright infringement. ABIM investigates all reports of irregular or improper activity. 16

Irregular or improper behavior in examinations that is observed,

In the event the CCC determines to recommend a disciplinary sanc-

made apparent by data forensics or statistical analysis, or uncovered

tion, it shall so notify the physician in writing. Such notification will:

by other means will be considered a subversion of the certification

(1) set forth the factual bases for such determination; (2) summarize

process and will constitute grounds for invalidation of a candidate’s

the reasons for such determination; (3) advise the physician of

examination and subject the candidate to disciplinary sanctions,

his or her right to request an appeal of the CCC’s determination;

including suspension or revocation of Board Certification or

(4) advise the physician that any request for an appeal must be

eligibility to participate in the Board Certification or Maintenance

submitted to ABIM within thirty days of the date of the notice of

of Certification processes. Failure to fully cooperate with an ABIM

the CCC’s determination; (5) provide procedural information about

investigation is considered unprofessional conduct and constitutes

the appeal process; (6) advise the physician that if a hearing is

grounds for disciplinary sanctions.

requested, ABIM will provide notice of the members of the appeal panel and the date, time, and if applicable, place of the hearing at

Disciplinary Sanctions and Appeals

least forty-five days in advance of the hearing; and (7) advise the

ABIM may, at its discretion, rescind a diplomate’s Board Certification

physician that while a recommended sanction is not final and does

if the diplomate was not qualified to receive the certificate at the

not affect a physician’s Board Certification status, a physician who

time it was issued, even if the certificate was issued as a result of

is subject to a recommended sanction is not eligible to participate

a mistake on the part of ABIM.

in the Certification process. If a physician declines to appeal a recommended sanction, the recommended sanction determined

ABIM may impose disciplinary sanctions, including the suspen-

by the CCC shall become the final decision of ABIM.

sion or revocation of Board Certification or participation in the Certification or Maintenance of Certification processes, invalidation

An appeal of a recommended sanction shall be determined

of an examination, or other professional sanctions, if ABIM obtains

by a panel consisting of three non-ABIM employee physicians

evidence that in its judgment demonstrates that a candidate or

designated by ABIM’s Board of Directors and including at least

diplomate: (1) has had a license to practice medicine restricted in

one member of the Board of Directors (an “Appeal Panel”). An

any jurisdiction, has surrendered a license but continues to hold a

Appeal Panel shall have the discretion to affirm, rescind, or modify

valid license in another jurisdiction, or has had one or more licenses

a recommended sanction, or impose an alternative sanction. In

suspended or revoked but continues to hold a valid license;

advance of each appeal hearing ABIM shall provide each member

(2) engaged in irregular or improper behavior or other miscon-

of the Appeal Panel and the physician appellant with copies of

duct in connection with an ABIM examination; (3) made a material

the documentary record for the physician’s sanction and appeal

misstatement of fact or omission in connection to ABIM with an

proceeding. In its consideration of an appeal of a recommended

application, or misrepresented his or her Board Certification or

sanction, an Appeal Panel shall not be bound by any technical

Board Eligibility status to anyone; (4) failed to maintain moral,

rules of evidence, shall consider any information timely submitted

ethical or professional behavior satisfactory to ABIM; or (5)

by or on behalf of the physician at any stage of the proceeding,

engaged in misconduct that adversely affects professional compe-

and shall hold a hearing. At an appeal hearing, the physician and/

tence or integrity.

or the physician’s counsel may present information and, subject to the Appeal Panel’s discretion, witnesses. ABIM’s counsel may

In the event ABIM obtains such evidence, it shall so notify the

ask questions of the physician, the physician’s counsel, and any

physician in writing. Such notification shall: (1) advise the physician

witnesses. Appeal hearings shall be transcribed by a professional

that the ABIM Credentials and Certification Committee (“CCC”) will

stenographer. After reaching a decision, an Appeal Panel shall

determine on behalf of ABIM, no fewer than forty-five days after the

notify the physician of its decision in writing. Such written decisions

date of the notice, whether to recommend any disciplinary sanction;

shall include the factual bases of the decision and a summary of

(2) summarize the evidence in ABIM’s possession; (3) include copies

the reasons for the decision. The decision of the majority of an

of any documentary evidence in ABIM’s possession; (4) provide the

Appeal Panel shall be the final decision of ABIM.

physician an opportunity to make a written submission to the CCC; (5) disclose the policy(ies) and/or procedure(s) pursuant to which

The foregoing sanction and appeal procedures shall apply to

ABIM may recommend a sanction, and the possible sanction(s);

matters arising on or after July 1, 2013. Earlier arising matters will

(6) advise the physician that the failure to respond timely to the

be handled in accordance with ABIM’s policies and procedures

notice may be considered unprofessional and weighed against

previously in effect.

the physician by the CCC; and (7) advise the physician that if the

Notwithstanding these procedures, ABIM reserves the right to

CCC recommends a sanction, the physician would have a right

revoke or suspend a diplomate’s Board Certification summarily in

of appeal with an in-person or telephonic hearing before a panel

extraordinary circumstances.

designated by ABIM’s Board of Directors.

17

Re-examination

ABIM, in its sole discretion, may notify local credentialing bodies, licensing bodies, law enforcement agencies, program direc-

Beginning in 2011, candidates who are unsuccessful on an exami-

tors, impaired physicians advocacy groups, or others of any final

nation may apply for re-examination as set forth below. To be

disciplinary sanctions.

granted admission, candidates must meet all applicable licensure,

To regain Board Certification after a suspension, the physician must

professional standing, underlying certifications and procedural

comply with such conditions as ABIM may impose and successfully

requirements. Candidates who fail three consecutive initial certi-

complete ABIM’s Maintenance of Certification program.

fication exams in the same discipline over three years will not be permitted to take an exam in that discipline during the next annual

Competency in Technology

exam administration. Only exam failures occurring in 2011 and

Consistent with the ACGME/ABMS Competencies in Systems-

thereafter will count toward the three examination limit.

Based Practice, ABIM requires its candidates and diplomates

For example, a candidate who is unsuccessful on the Internal

to possess sufficient competencies in information technology,

Medicine Certification Exam in 2014, 2015, and 2016 would need

including the use of personal computers, the Internet, and e-mail,

to wait until the 2018 administration of the exam to re-apply for

for correspondence and completion of examinations and modules

admission.

throughout their participation in ABIM certification and Maintenance of Certification programs.

Candidates who fail one or two consecutive initial certification

Test Accommodations for Nursing Mothers

the third consecutive year will not be subject to this policy. They

exams in the same discipline and do not register for the exam in will be able to register for the exam the next time it is offered, and

The American Board of Internal Medicine (ABIM) recognizes the importance of a mother’s decision to breastfeed her child and

the three consecutive attempt cycle will begin again.

will consider requests for medically necessary testing accom-

For example, a candidate who is unsuccessful in passing the

modations to support nursing mothers. For example, candidates

Internal Medicine Certification Exam in 2015 and 2016 and does

who are nursing may be afforded additional break time in order

not register or cancel the exam in 2017 will be able to register for

to accommodate their need to express breast milk when medi-

the exam in 2018.

cally supported. For additional information about the process and

documentation

requirements,

please

contact

This policy applies only to ABIM initial certification exams offered

ABIM

annually; it does not apply to initial certification exams offered

[email protected] or refer to www.abim.org/certification/

every other year. The policy does not apply to the Sports Medicine

exam-information/test-accommodations-nursing-mothers.aspx.

Certification Exam and the Adolescent Medicine Certification Exam, which are administered by other ABMS Boards, or to ABIM Maintenance of Certification Exams. ABIM strictly enforces this policy and does not permit exceptions or appeals.

Schedule of Examinations The schedule of examination dates, examination fees and policies regarding late applications and refunds may be found at www.abim.org/certification/exam-information.aspx. It is the sole responsibility of the candidate to be aware of and comply with registration deadlines. To register for an examination, go to www.abim.org/certification/exam-information.aspx.

18

NOTES

19

The information provided in this print publication, Policies and Procedures for Certification, November 2017, and on ABIM’s website governs the American Board of Internal Medicine’s decision about eligibility for certification. This edition supersedes all previous publications, and the ABIM website (www.abim.org) supersedes the information found here. ABIM reserves the right to make changes in fees, examinations, policies and procedures at any time without advance notice. Admission to ABIM’s certification process is determined by policies in force at the time of application. Copyright © November 2017, American Board of Internal Medicine ABIM is one of 24 medical specialty boards that make up the American Board of Medical Specialties (ABMS).

510 Walnut Street Suite 1700 Philadelphia, PA 19106 - 3699 1.800.441.ABIM

www.abim.org

E47-11-2017

20

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NOVEMBER 2017 ® & POLICIES PROCEDURES FOR CERTIFICATION 1 TABLE OF CONTENTS Requirements for Certification in Internal Medicine 2 Requiremen...

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