Policies and Procedures for Certification - College of Medicine

AUGUST 2009&FOR CERTIFICATIONPOLICIESPROCEDURES

COPYRIGHT AND EXAMINATION NON-DISCLOSURE POLICYAll ABIM materials are protected by the federal Copyright Act,17 U.S.C. § 101, et seq. Access to all such materials, as furtherdetailed below, is strictly conditioned upon agreement to abideby ABIM’s rights under the Copyright Act and to maintainexamination confidentiality.ABIM examinations are confidential, in addition to being protectedby federal copyright and trade secret laws. Candidates anddiplomates who undertake examinations agree that they will notcopy, reproduce, adapt, disclose, or transmit examinations, in wholeor in part, by any means now known or hereafter invented. Theyfurther agree that they will not reconstruct examination contentfrom memory, by dictation, or by any other means or otherwisediscuss examination content with others. Candidates anddiplomates further acknowledge that disclosure or any other use ofexamination content may expose them to criminal as well as civilliability, and may also result in sanctions by ABIM.With respect to ABIM’s Maintenance of Certification (MOC)products, including without limitation its Self-Evaluation ProcessMedical Knowledge Modules and Practice Improvement Modules(PIMs), candidates are encouraged to discuss these materials withtheir colleagues as they develop their answers or other responses asrequired by the Modules. They agree, however, that, as with allABIM materials, they will not copy, reproduce or make anyadaptations of such materials in any manner; and will not assistsomeone else in the infringement or misuse of these or any otherABIM-copyrighted works.

TABLE OF CONTENTSRequirements for Certification in Internal Medicine 2Requirements for Certification in Subspecialties 6Certification Using the Research Pathway 9Special Training Policies 10Other Policies 11INTRODUCTIONThe American Board of Internal Medicine (referred to throughoutthis document as “ABIM”) was established in 1936 and is a private,not-for-profit corporation. Board members are elected by the Boardof Directors and serve two-year terms.ABIM receives no public funds and has no licensing authority orfunction. ABIM’s mission is to enhance the quality of health careby certifying internists and subspecialists who demonstrate theknowledge, skills, and attitudes essential for excellent patient care.Certification is not a requirement to practice internal medicine,and ABIM does not confer privileges to practice. ABIM doesnot intend either to interfere with or to restrict the professionalactivities of a licensed physician based on certification status.ABIM administers the certification process by: (1) establishingrequirements for training and self-evaluation; (2) assessing theprofessional credentials of candidates; (3) obtaining substantiationby appropriate authorities of the clinical competence andprofessional standing of candidates; and (4) developing andconducting examinations and other assessments.All ABIM certifications issued in 1990 (1987 for critical caremedicine and 1988 for geriatric medicine) and thereafter arevalid for 10 years. Dates of validity are noted on the certificates.To remain valid, these certifications must be renewed throughABIM’s Maintenance of Certification program. Certificationsissued before these dates are valid indefinitely, although ABIMstrongly recommends such certificate holders recertify as well.For information about the Maintenance of Certification program,visit ABIM’s website, www.abim.org, or contact ABIM,1-800-441-ABIM.A candidate’s eligibility for certification is determined by the policies and procedures described in this document and on ABIM’s website,www.abim.org. This edition of Policies and Procedures for Certification supersedes all previous publications. ABIM reserves the rightto make changes in its fees, examinations, policies, and procedures at any time without advance notice. Admission to ABIM’scertification process is determined by the policies in force at the time of application.August 20091

REQUIREMENTS FOR CERTIFICATION ININTERNAL MEDICINETo become certified in internal medicine, a physician mustcomplete the requisite predoctoral medical education, meet thegraduate medical education training requirements, demonstrateclinical competence in the care of patients, meet the licensure andprocedural requirements, and pass the Certification Examination inInternal Medicine.Predoctoral Medical EducationCandidates who graduated from medical schools in the UnitedStates or Canada must have attended a school that was accredited atthe date of graduation by the Liaison Committee on MedicalEducation (LCME), the Committee for Accreditation of CanadianMedical Schools, or the American Osteopathic Association.Graduates of international medical schools must have one of thefollowing: (1) a standard certificate from the EducationalCommission for Foreign Medical Graduates without expired examinationdates; (2) comparable credentials from the Medical Councilof Canada; or (3) documentation of training for those candidateswho entered graduate medical education training in the UnitedStates via the Fifth Pathway, as proposed by the American MedicalAssociation.Content of TrainingThe 36 calendar months of full-time internal medicine residencyeducation:(1) Must include at least 30 months of training in generalinternal medicine, subspecialty internal medicine andemergency medicine. Up to four months of the 30 monthsmay include training in areas related to primary care, such asneurology, dermatology, office gynecology, or officeorthopedics.(2) May include up to three months of other electives approvedby the internal medicine program director.(3) Includes up to three months for vacation time.See “Leave of Absence and Vacation” policy on page 11.In addition, the following requirements for direct patientresponsibility must be met:(1) At least 24 months of the 36 months of residency educationmust occur in settings where the resident personally provides,or supervises less experienced residents who provide directcare to patients in inpatient or ambulatory settings.Graduate Medical EducationTo be admitted to the Certification Examination in InternalMedicine, physicians must have satisfactorily completed, byAugust 31 of the year of examination, 36 calendar months,including vacation time, of graduate medical education accreditedby the Accreditation Council for Graduate Medical Education(ACGME), the Royal College of Physicians and Surgeons ofCanada, or the Professional Corporation of Physicians of Quebec.Residency or research experience occurring before completion ofthe requirements for the MD or DO degree cannot be creditedtoward the requirements for certification.(2) At least six months of the direct patient responsibility oninternal medicine rotations must occur during the R-1 year.Clinical Competence RequirementsABIM requires documentation that candidates for certification ininternal medicine are competent in: (1) patient care (medicalinterviewing, physical examination, and procedural skills); (2)medical knowledge; (3) practice-based learning and improvement;(4) interpersonal and communication skills; (5) professionalism;and (6) systems-based practice.The 36 months of residency training must include 12 months ofaccredited internal medicine training at each of three levels: R-1,R-2, and R-3. No credit is granted for training repeated at the samelevel or for administrative work as a chief medical resident. Inaddition, training as a subspecialty fellow cannot be credited towardfulfilling the internal medicine training requirements.Through its tracking process, FasTrack, ABIM requires programdirectors to complete clinical competence evaluations each year forinternal medicine residents. A candidate may be excluded from anABIM examination if the required components of clinical competenceare not satisfactorily documented by the training program.2

PROGRAM DIRECTOR RATINGS OF CLINICAL COMPETENCECOMPONENTS and RATINGSR-1 and R-2 R-3 Fellows (any year)Overall Clinical CompetenceSatisfactory or SuperiorFull creditFull creditFull creditMarginalFull credit for one marginal yearRepeat one year if both R-1and R-2 are marginalNot ApplicableNot ApplicableUnsatisfactoryNo credit, must repeat yearNo credit, must repeat yearNo credit, must repeat yearMoral and Ethical BehaviorSatisfactoryFull credit Full credit Full creditUnsatisfactoryNo credit, must repeat year or, at the request of theprogram director and at ABIM’s discretion, a successfulperiod of observation can be arranged in lieu ofrepeating the year to be granted creditNo credit, must repeat year or, at the request of theprogram director and at ABIM’s discretion, a successfulperiod of observation can be arranged in lieu ofrepeating the year to be granted creditNo credit, must repeat year or, at the request of theprogram director and at ABIM’s discretion, a successfulperiod of observation can be arranged in lieu ofrepeating the year to be granted creditEvaluation of Individual General Competencies*Satisfactory or SuperiorFull credit Full credit Full creditUnsatisfactoryFull creditNo credit, must repeat yearMust repeat year if during finalyear of required training* The six required competencies are: (1) patient care (which includes medical interviewing, physical examination, and procedural skills); (2) medical knowledge;(3) practice-based learning and improvement; (4) interpersonal and communication skills; (5) professionalism, and (6) systems-based practice.As outlined in the table above, all residents must receive satisfactoryratings in overall clinical competence and moral and ethicalbehavior in each year of training. In addition, residents mustreceive satisfactory ratings in each of the components of clinicalcompetence during the final year of required training. It is theresident's responsibility to arrange for any additional trainingneeded to achieve a satisfactory rating in each component of clinicalcompetence.Procedures Required for Internal MedicineSafety is the highest priority when performing any procedure on apatient. ABIM recognizes that there is variability in the types andnumbers of procedures performed by internists in practice.Internists who perform any procedure must obtain the appropriatetraining to safely and competently perform that procedure. It is alsoexpected that the internist be thoroughly evaluated and credentialedas competent in performing a procedure before he or she canperform it unsupervised. For certification in internal medicine,ABIM has identified a limited set of procedures in which it expectsall candidates to be competent with regard to their knowledge andunderstanding. This includes: (1) demonstration of competence inmedical knowledge relevant to procedures through their ability toexplain indications, contraindications, patient preparation methods,sterile techniques, pain management, proper techniques forhandling specimens and fluids obtained, and test results; (2) abilityto recognize and manage complications; and (3) ability to clearlyexplain to a patient all facets of the procedure necessary to obtaininformed consent.For a subset of procedures, ABIM requires all candidates todemonstrate competence and safe performance by means ofevaluations performed during residency training. The set ofprocedures and associated competencies required for each arepresented in the table on page 4.3

PROCEDURES REQUIRED FOR INTERNAL MEDICINECompetencyKnow, Understand and ExplainIndications; Contraindications;Recognition and Managementof Complications; PainManagement; Sterile TechniquesSpecimen HandlingInterpretation of ResultsRequirements andKnowledge to ObtainInformed ConsentPerform Safelyand CompetentlyAbdominal paracentesisXXXXAdvanced cardiac life supportXN/A N/A N/AXArterial line placementXN/A X XArthrocentesisXX X XCentral venous line placementXXN/AXDrawing venous bloodXXXN/AXDrawing arterial bloodXXXXXElectrocardiogramX N/A X N/AIncision and drainage ofan abscessXXXXLumbar punctureXXXXNasogastric intubationXXXXPap smear andendocervical cultureXXXXXPlacing a peripheral venous lineXN/AN/AN/AXPulmonary artery catheter placementXN/AXXThoracentesisXXXXTo help acquire both knowledge and performance competence,ABIM believes that residents should be active participants inperforming procedures. Active participation is defined as serving asthe primary operator or assisting another primary operator. ABIMencourages program directors to provide each resident withsufficient opportunity to be observed as an active participant in theperformance of required procedures. In addition, ABIM stronglyrecommends that procedural training be conducted initiallythrough simulations. At the end of training, as part of theevaluation required for admission to the Certification Examinationin Internal Medicine, program directors must attest to eachresident’s knowledge and competency to perform the procedures inthe table above. ABIM does not specify a minimum number ofprocedures to demonstrate competency; however, to assure adequateknowledge and understanding of the common procedures ininternal medicine, each resident should be an active participant foreach procedure five or more times.CREDIT IN LIEU OF STANDARD TRAINING FOR INTERNALMEDICINE CANDIDATESTraining Completed Prior to Entering InternalMedicine ResidencyABIM may grant credit for some or all of the 12-month requirementat the R-1 level for training taken prior to entering training ininternal medicine. The program director of an accredited internalmedicine residency program must petition ABIM to grant credit inlieu of standard R-1 internal medicine training. Candidates whohave already completed 12 months of accredited U.S. or CanadianR-1 internal medicine training are not eligible to be petitioned forcredit. Before being proposed, the candidate should have beenobserved by the proposer for a minimum of three months. No creditwill be granted to substitute for 24 months of accredited R-2 andR-3 internal medicine training.4

(1) Month-for-month credit may be granted for satisfactorycompletion of internal medicine rotations taken during aU.S. or Canadian accredited non-internal medicine residencyprogram if all of the following criteria are met:(a) the internal medicine training occurred under thedirection of a program director of an accredited internalmedicine program;(b) the training occurred in an institution accredited fortraining internal medicine residents; and(c) the rotations were identical to the rotations of theresidents enrolled in the accredited internal medicineresidency program.(1) are proposed by the chair or program director of an accreditedinternal medicine residency program;(2) have completed three or more years of verified internalmedicine training abroad;(3) hold an appointment at the level of Associate Professor orhigher at the time of proposal; and(4) have completed eight years, after formal training, as aclinician-educator or a clinical investigator in internalmedicine with a full-time appointment on a medicalschool faculty.* Requires a fee of $300. Guidelines for proposals are available atwww.abim.org/certification/policies/special.aspx.(2) For trainees who have satisfactorily completed some U.S. orCanadian accredited training in another specialty, ABIMmay grant:(a) month-for-month credit for the internal medicinerotations that meet the criteria listed under (1) above;plus,(b) a maximum of six months of credit for the trainingin family medicine or a pediatrics program; or,(c) a maximum of three months of credit for training in anon-internal medicine specialty program.(3) Up to 12 months of credit may be granted for at least threeyears of U.S. or Canadian accredited training in anotherclinical specialty and certification by an ABMS member Boardin that specialty.*(4) Up to 12 months of credit may be granted for at least threeyears of verified internal medicine training abroad.*Training in Combined ProgramsABIM recognizes internal medicine training combined withtraining in the following programs:• Dermatology• Emergency Medicine• Emergency Medicine/Critical Care Medicine• Family Medicine• Medical Genetics• Neurology• Nuclear Medicine• Pediatrics*• Physical Medicine and Rehabilitation• Preventive Medicine• Psychiatry* Combined medicine/pediatrics training initiated July 1, 2007 or aftermust be undertaken in a combined medicine/pediatrics programaccredited by the ACGME.* Requires a fee of $300. Guidelines for proposals are available atwww.abim.org/certification/policies/special.aspx.Guidelines for the combined training programs and requirementsfor credit toward the ABIM Certification Examination in InternalMedicine are available atwww.abim.org/certification/policies/imss/im.aspx.Training Completed Abroad by Current Full-Time U.S.or Canadian Faculty*Full-time internal medicine faculty members in an LCMEaccreditedmedical school or an accredited Canadian medical schoolmay qualify for admission to the Certification Examination inInternal Medicine if they:5

REQUIREMENTS FOR CERTIFICATIONIN SUBSPECIALTIESGENERAL REQUIREMENTSIn addition to the primary certificate in internal medicine, ABIMcertifies physicians in the following subspecialties:• Adolescent Medicine• Advanced Heart Failure and Transplant Cardiology• Cardiovascular Disease• Clinical Cardiac Electrophysiology• Critical Care Medicine• Endocrinology, Diabetes, and Metabolism• Geriatric Medicine• Gastroenterology• Hematology• Hospice and Palliative Medicine• Infectious Disease• Interventional Cardiology• Medical Oncology• Nephrology• Pulmonary Disease• Rheumatology• Sleep Medicine• Sports Medicine• Transplant HepatologyTo apply for certification in a subspecialty, physicians must havebeen previously certified in internal medicine by ABIM. To becomecertified in a subspeciality, a physician must satisfactorily completethe requisite graduate medical education fellowship training,demonstrate clinical competence in the care of patients, meetthe licensure and procedural requirements, and pass the secureexamination for that discipline.To apply for certification and renewal of a certificate in adolescentmedicine, hospice and palliative medicine, sleep medicine, andsports medicine, diplomates must maintain a valid underlyingcertificate in either internal medicine or a subspecialty.Diplomates must maintain a valid underlying certificate in cardiovasculardisease to obtain certification and be eligible for renewal ofa certificate in advanced heart failure and transplant cardiology,clinical cardiac electrophysiology or interventional cardiology.Diplomates must maintain a valid underlying certificate ingastroenterology to obtain certification and be eligible for renewalof a certificate in transplant hepatology.Fellowship training must be accredited by the AccreditationCouncil for Graduate Medical Education (ACGME), the RoyalCollege of Physicians and Surgeons of Canada, or the ProfessionalCorporation of Physicians of Quebec. No credit will be grantedtoward certification in a subspecialty for training completed outsideof an accredited U.S. or Canadian program.Fellowship training taken before completing the requirementsfor the MD or DO degree, training as a chief medical resident,practice experience, and attendance at postgraduate courses maynot be credited toward the training requirements for subspecialtycertification.To be admitted to an examination, candidates must have completedthe required training in the subspecialty, including vacation time, byOctober 31 of the year of examination.Candidates for certification in the subspecialties must meet ABIM’srequirements for duration of training as well as minimum durationof full-time clinical training. Clinical training requirements maybe met by aggregating full-time clinical training that occursthroughout the entire fellowship training period; clinical trainingneed not be completed in successive months. Time spent incontinuity outpatient clinic, during non-clinical training, is inaddition to the requirement for full-time clinical training.Educational rotations completed during training may not bedouble-counted to satisfy both internal medicine and subspecialtytraining requirements. Likewise, training which qualifies adiplomate for admission to one subspecialty examination cannotbe double-counted toward certification in another subspecialty,with the exception of the formally approved pathways for dualcertification.6

Training and Procedural RequirementsThe total months of training required, including specific clinicalmonths, and requisite procedures for each subspecialty are outlinedby discipline in the table below.Minimum Months of Training/Clinical Months RequiredSubspecialtyCardiovascular Disease*Gastroenterology*Adolescent MedicineCritical Care MedicineEndocrinology, Diabetes,and MetabolismHematology**Infectious DiseaseMedical Oncology**NephrologyPulmonary DiseaseRheumatologyAdvanced Heart Failureand Transplant CardiologyClinical CardiacElectrophysiologyGeriatric MedicineHospice and PalliativeMedicineInterventional CardiologySleep MedicineSports MedicineTransplant HepatologyProcedures for SubspecialtiesTotal Months ofTrainingClinical Months36* 2436*2412 12* The training requirements for admission to the Cardiovascular Disease Examinationand the Gastroenterology Examination increased to 36 months of accredited fellowshiptraining in 1990 and 1996 respectively. Beginning with the 2007examinations, 36 months of accredited fellowship training are required of allfirst-time applicants for these examinations, regardless of when they trained.** Requires minimum ½ day per week in continuity outpatient clinic.1812Clinical Cardiac ElectrophysiologyElectrophysiologic studies both with a catheter and intraoperatively;catheter-based and other ablation procedures; and implantation ofpacemakers, and cardioverters-defibrillators (a minimum of 150intracardiac procedures in at least 75 patients, of which 75 arecatheter-based ablation procedures, including post-diagnostictesting, and 25 are initial implantable cardioverter-defibrillatorprocedures, including programming). Procedures performed duringtraining in cardiovascular disease may be counted toward fulfillingthese requirements provided that they are adequately documentedand are performed with supervision equivalent to that of a clinicalcardiac electrophysiology fellowship.Critical Care MedicineAirway management and endotracheal intubation; ventilatormanagement and noninvasive ventilation; insertion and managementof chest tubes, and thoracentesis; advanced cardiac lifesupport (ACLS); placement of arterial, central venous, andpulmonary artery balloon flotation catheters; calibration andoperation of hemodynamic recording systems; proficiency in useof ultrasound to guide central line placement and thoracentesis isstrongly recommended. Candidates should know the indications,contraindications, complications, and limitations of the followingprocedures: pericardiocentesis, transvenous pacemaker insertion,continuous renal replacement therapy (CRRT) and hemodialysis,and fiberoptic bronchoscopy. Practical experience is recommended.Endocrinology, Diabetes, and MetabolismThyroid aspiration biopsy.GastroenterologyDiagnostic and therapeutic upper and lower endoscopy.Geriatric MedicineNo required procedures.Adolescent MedicineHematologyNo required procedures.Bone marrow aspiration and biopsy, including preparation, examination,and interpretation of bone marrow aspirates and touchAdvanced Heart Failure and Transplant Cardiologypreparations of bone marrow biopsies; interpretation of peripheralProcedures to be determined.blood smears, including manual white blood cell and plateletcounts; administration of chemotherapeutic agents and biologicalCardiovascular Diseaseproducts through all therapeutic routes; management and care ofAdvanced cardiac life support (ACLS), including cardioversion;indwelling venous access catheters; and management of methods ofelectrocardiography, including ambulatory monitoring and exerciseapheresis.testing; echocardiography; arterial catheter insertion; right-heartcatheterization, including insertion and management of temporaryHospice and Palliative Medicinepacemakers; and left-heart catheterization and diagnostic coronaryNo required procedures.angiography.7

Infectious DiseaseMicroscopic evaluation of diagnostic specimens including preparation,staining, and interpretation; management, maintenance, andremoval of indwelling venous access catheters; and administrationof antimicrobial and biological products via all routes.Interventional CardiologyA minimum of 250 therapeutic interventional cardiac proceduresduring accredited interventional cardiology fellowship training.Those out of interventional cardiology training three years or moreas of June 30 of the year of exam must document post-trainingperformance as primary operator of 150 therapeutic interventionalcardiac procedures in the two years prior to application for exam.Sleep MedicineAbility to interpret results of polysomnography, multiple sleeplatency testing, maintenance of wakefulness testing, actigraphy, andportable monitoring related to sleep disorders.Sports MedicineNo required proceduresTransplant HepatologyPerformance of at least 30 percutaneous liver biopsies, includingallograft; interpretation of 200 native and allograft liver biopsies;and knowledge of indications,contraindications, and complicationsof allograft biopsies.Medical OncologyBone marrow aspiration and biopsy; administration of chemotherapeuticagents and biological products through all therapeuticroutes; and management and care of indwelling venous accesscatheters.NephrologyPlacement of temporary vascular access for hemodialysis and relatedprocedures; acute and chronic hemodialysis; peritoneal dialysis(excluding placement of temporary peritoneal catheters); continuousrenal replacement therapy (CRRT); and percutaneous biopsyof both autologous and transplanted kidneys.Pulmonary DiseaseAirway management including endotracheal intubation; fiberopticbronchoscopy and accompanying procedures; noninvasive andinvasive ventilator management; thoracentesis; arterial puncture;placement of arterial, central venous and pulmonary artery balloonflotation catheters; calibration and operation of hemodynamicrecording systems; supervision of the technical aspects ofpulmonary function testing; progressive exercise testing; insertionand management of chest tubes; moderate sedation. Proficiency inuse of ultrasound to guide central line placement is strongly recommended.RheumatologyDiagnostic aspiration of and analysis by light and polarized lightmicroscopy of synovial fluid from diarthrodial joints, bursae, andtenosynovial structures; and therapeutic injection of diarthrodialjoints, bursae, tenosynovial structures, and entheses.Clinical Competence RequirementsABIM requires documentation that candidates for certificationin the subspecialties are competent in: (1) patient care (whichincludes medical interviewing, physical examination, andprocedural skills); (2) medical knowledge; (3) practice-basedlearning and improvement; (4) interpersonal and communicationskills; (5) professionalism; and (6) systems-based practice.Through its tracking process, FasTrack, ABIM requires verificationof subspecialty fellows’ clinical competence from the subspecialtytraining program director. As outlined in the table on page 3,all fellows must receive satisfactory ratings of overall clinicalcompetence and moral and ethical behavior in each of the requiredyears of training.In addition, fellows must receive satisfactory ratings in each of thecomponents of clinical competence and the requisite proceduresduring the final year of required training. It is the fellow’s responsibilityto arrange for any additional training needed to achieve asatisfactory rating in each component of clinical competence.Dual Certification RequirementsHematology and Medical OncologyDual certification in hematology and medical oncology requiresthree years of accredited combined training which must include: aminimum of 18 months of full-time clinical training, of which atleast 12 months are in the diagnosis and management of a broadspectrum of neoplastic diseases including hematological malignancies,and six months are in the diagnosis and management of abroad spectrum of non-neoplastic hematological disorders. If the8

combined training must be taken in two different programs, 24continuous months must be in one institution, and both institutionsmust be accredited in both hematology and medical oncology.During the entire three years, the fellow must attend a minimum ofone-half day per week in continuity outpatient clinic. Time spentin continuity outpatient clinic, during non-clinical training, is inaddition to the requirement for full-time clinical training.the allergy and immunology training program directors and byABIM and the American Board of Allergy and Immunology.Admission to either examination requires: (1) certification ininternal medicine; (2) satisfactory clinical competence; and(3) completion of the entire three-year combined program.Candidates seeking dual certification for other subspecialtycombinations should contact ABIM for information.Candidates must complete all three years of required combinedtraining before being admitted to an examination in eithersubspecialty. Those who elect to take an examination in onesubspecialty following only two years of fellowship training willbe required to complete four years of accredited training fordual certification.Pulmonary Disease and Critical Care MedicineCandidates seeking dual certification in pulmonary disease andcritical care medicine must complete a minimum of three years ofaccredited combined training, 18 months of which must be clinicaltraining.Only candidates certified in a subspecialty following at least twoyears of accredited fellowship training (three years for cardiovasculardisease and gastroenterology) are permitted to take the critical caremedicine examination after completion of 12 months of accreditedclinical critical care medicine fellowship training. Candidatescertified in internal medicine only must complete 24 months ofaccredited critical care medicine fellowship training, including12 months of clinical training, to qualify for the critical care medicineexamination.Thus, for candidates applying for dual certification in pulmonarydisease and critical care medicine with three years of combinedtraining, certification in pulmonary disease must be achieved beforethe candidate is eligible to apply for admission to the critical caremedicine examination.Rheumatology and Allergy and ImmunologyDual certification in rheumatology and allergy and immunologyrequires a minimum of three years of training which must include:(1) at least 12 months of clinical rheumatology training supervisedby the director of an accredited rheumatology training program;(2) 18 consecutive months of rheumatology continuity clinic; and(3) at least 18 months of allergy and immunology training supervisedby the training program director of an accredited program inallergy and immunology. Plans for combined training should beprospectively approved in writing by both the rheumatology andSpecial Candidates for Subspecialties*ABIM diplomates in internal medicine may be proposed for specialconsideration for admission to a subspecialty examination by theprogram director of an accredited fellowship program if they:(1) have completed the full training required by ABIM in thesubspecialty in another country and have met all currentapplicable ABIM procedural requirements;(2) are a full-time Associate Professor or higher in the specifiedsubspecialty division of the Department of Medicine in anLCME-accredited medical school or an accreditedCanadian medical school;(3) have served eight years, after formal training, as a clinicianeducator or clinical investigator with a full-time appointmenton a medical school faculty.* Proposals require a fee of $300. Guidelines for proposals areavailable at www.abim.org/certification/policies/special/aspx.CERTIFICATION USING THE RESEARCHPATHWAYThe Research Pathway is intended for trainees planning academiccareers as investigators in basic or clinical science. The pathwayintegrates training in clinical medicine with a minimum of threeyears of training in research methodology. Prospective planning ofthis pathway by trainees and program directors is necessary.Program directors must document the clinical and research trainingexperience each year through ABIM’s tracking program. The charton page 10 describes the Research Pathway requirements.All trainees in the Research Pathway must satisfactorily complete 24months of accredited categorical internal medicine residencytraining. A minimum of 20 months must involve direct patientresponsibility.9

Internal Medicine Research PathwayInternal medicine training(Direct patient responsibility 20 months)Research training (80%)Ambulatory clinics during research training (10%)Additional clinical training during research (10%)Total trainingInternal medicine examinationSubspecialty Research PathwayInternal medicine training(Direct patient responsibility 20 months)Subspecialty clinical training (80%)Research training (80%)Ambulatory clinic during research training (10%)Total training24 months36 months1/2 day per week[may be intermittentor block time]5 yearsSummer, R-524 months12-24 months*a minimum of 36 months1/2 day per week6 or 7 years*completion of work leading to one or its equivalent. The last year ofthe Research Pathway may be taken in a full-time faculty position ifthe level of commitment to mentored research is maintained at 80percent.During internal medicine research training, 20 percent of each yearmust be spent in clinical experiences including a half-day per weekin a continuity clinic. During subspecialty research training, at leastone half-day per week must be spent in an ambulatory clinic.Ratings of satisfactory clinical performance must be maintainedannually for each trainee in the ABIM Research Pathway.For additional information, seewww.abim.org/certification/policies/research/requirements.aspx.SPECIAL TRAINING POLICIESInternal medicine examinationSummer, R-4Subspecialty examinationFall, R-6 or 7** based on subspecialtyThe Research Pathway for certification in internal medicine and asubspecialty that requires 12 months of clinical training is a six-yearprogram. For subspecialties such as cardiovascular disease andgastroenterology, which require more than 12 months of clinicaltraining, and for dual certification in hematology/oncology,pulmonary disease/critical care medicine, and rheumatology/allergyand immunology, the Research Pathway is a full seven-yearprogram, including 36 to 42 months of research, depending on thenumber of months of clinical training completed.Disclosure of Performance InformationTrainees planning to change programs must make requests to theircurrent program and to ABIM to send written evaluations of pastperformance to the new program. These requests must be made ina timely manner to ensure that the new program director has theperformance evaluations for review before offering a position. Anew program director may also request performance evaluationsfrom previous programs and from ABIM concerning trainees whoapply for a new position. ABIM will respond to written requestsfrom trainees and program directors by providing any performanceevaluations it has in its possession and the total credits accumulatedtoward ABIM’s training requirements for certification. Thisinformation will include the comments provided with theevaluation.During the research period, 80 percent of time is devoted toresearch and 10 to 20 percent of time to clinical work. The traineemust attend a minimum of one half-day per week in continuityoutpatient clinic. Time spent in continuity outpatient clinic duringnon-clinical training is in addition to the requirement for full-timeclinical training.ABIM defines research as scholarly activities intended to developnew scientific knowledge. The research experience of traineesshould be mentored and reviewed. Unless the trainee has alreadyachieved an advanced graduate degree, training should includeDue Process for EvaluationsThe responsibility for the evaluation of a trainee’s clinicalcompetence and moral and ethical behavior rests with the program,not with ABIM. ABIM is not in a position to re-examine thefacts and circumstances of an individual's performance. As requiredby the ACGME in its Essentials of Accredited Residencies inGraduate Medical Education, the educational institution mustprovide appropriate due process for its decisions regarding atrainee's performance.10

Leave of Absence and VacationsUp to one month per academic year is permitted for time away fromtraining, which includes vacation, illness, parental or family leave,or pregnancy-related disabilities. Training must be extended tomake up any absences exceeding one month per year of training.Vacation leave is essential and should not be forfeited or postponedin any year of training and cannot be used to reduce the totalrequired training period. ABIM recognizes that leave policies varyfrom institution to institution and expects the program director toapply his/her local requirements within these guidelines to ensuretrainees have completed the requisite period of training.ABIM may provide information it has concerning them to otherswhom ABIM judges to have a legitimate need for it.ABIM makes academic and scientific judgments in its evaluations ofthe results of its examinations. Situations may occur, even throughno fault of the candidates, that render examination results unreliablein the judgment of ABIM. Candidates agree that if ABIMdetermines that, in its judgment, the results of their examinationare unreliable, ABIM may require the candidates to retake anexamination at its next administration or other time designatedby ABIM.Definition of Full-time TrainingFull-time training is defined as daily assignments for periods of noless than one month to supervised patient care, educational, orresearch activities designed to fulfill the goals of the trainingprogram. Full-time training must include formative and summativeevaluation of clinical performance, with direct observation byfaculty and senior trainees.Interrupted Full-Time TrainingABIM approval must be obtained before initiating an interruptedtraining plan. Interrupted full-time training is acceptable, providedthat no period of full-time training is less than one month. In any12-month period, at least six months should be spent in training.Patient care responsibilities should be maintained in a continuityclinic during the non-training component of the year at a minimumof one-half day per week. Part-time training, whether or notcontinuous, is not acceptable.OTHER POLICIESBoard EligibilityABIM does not use, define, or recognize the term “Board Eligible.”Reporting Certification StatusABIM will routinely report, through its website or by mail, whetherphysicians are certified (including dates) or not certified. If aphysician was previously certified, the dates of former certificationwill be reported. If certification has been revoked or suspended,ABIM will report that fact, including the date of revocationor suspension.On a candidate's written request to ABIM, the following informationwill also be provided in writing: (1) that an application forcertification or Maintenance of Certification is currently in process;and/or (2) the year the candidate was last admitted to examination.Representation of Certification StatusPhysicians must accurately state their ABIM Board Certificationstatus at all times. This includes descriptions in curriculum vitae,advertisements, publications, directories and letterheads. Pleasenote: ABIM does not authorize the use of its logo by others.Diplomates with expired time-limited certification or those whoseABIM’s Evaluations and Judgmentscertification is suspended or revoked may not claim ABIM BoardCandidates for certification and Maintenance of Certification agreeCertification and must revise all descriptions of their qualificationsthat their professional qualifications, including their moral andaccordingly. Diplomates who have multiple certifications and allowethical standing in the medical profession and their competence inone of them to lapse should revise their public materials (letterhead,clinical skills, will be evaluated by ABIM, and ABIM’s good faithbusiness cards, advertisements, etc.) to reflect those certificationsjudgment concerning such matters will be final.that are currently valid. When a physician misrepresents BoardCertification status, ABIM may suspend or revoke certification,ABIM may make inquiry of persons named in candidates’suspend or revoke the physician’s eligibility for certification orapplications and of other persons, such as authorities of licensingmaintenance of certification, and may notify local credentialingbodies, hospitals, or other institutions as ABIM may deembodies, licensing bodies, law enforcement agencies and others.appropriate with respect to such matters. Candidates agree that11

Errors and Disruptions in Examination AdministrationOccasionally problems occur in the creation, administration, andscoring of examinations. For example, power failures, hardwareand software problems, human errors, or weather problems mayinterfere with some part of the examination process. When suchproblems occur and ABIM determines that they have compromisedthe integrity of examination results, ABIM will provide affectedcandidates with an opportunity for re-examination.Re-examination shall be the candidate's sole remedy. ABIM shallnot be liable for inconvenience, expense, or other damage causedby any problems in the creation, administration, or scoring of anexamination, including the need for retesting or delays in scorereporting. In no circumstance will ABIM reduce its standards as ameans of correcting a problem in examination administration.Confidentiality PolicyABIM considers the certification or recertification status of itscandidates and diplomates to be public information.ABIM provides a diplomate’s certification status and personalidentifying information, including mailing address, e-mail addressand social security number, to the Federation of State MedicalBoards (FSMB) and the American Board of Medical Specialties(ABMS) which publishes The Official ABMS Directory of BoardCertified Medical Specialists. The FSMB and ABMS use personalidentifying information, including social security numbers, as aunique internal identifier and maintain the confidentiality of thisinformation. On request, ABIM provides a diplomate’s Certificationstatus and address to professional medical societies and otherorganizations that provide ABIM-sanctioned educational resourcesand products used for self-assessment of medical knowledge orpractice performance in the Maintenance of Certification program.ABIM provides residency and fellowship training directors withinformation about a trainee’s prior training and pass/fail status oncertifying examinations. If a trainee has given permission, ABIMwill provide the program director with the trainee’s score on his/herfirst attempt at the certification examination for that area oftraining. ABIM uses examination performance, training programevaluations, self-evaluations of knowledge and practice performance,and other information for research purposes, includingcollaboration with other research investigators and scientific publications.In such research, ABIM will not identify specificindividuals, hospitals, or practice associations. All practice performancedata is HIPAA compliant.ABIM reserves the right to disclose information it possesses aboutany individual whom it judges has violated ABIM rules, engaged inmisrepresentation or unprofessional behavior, or shows signs ofimpairment.LicensureCandidates for certification and Maintenance of Certification mustpossess a valid, unrestricted, and unchallenged medical license inthe United States, its territories or Canada. Candidates practicingexclusively abroad and who do not hold a U.S. or Canadian license,must hold a license where they practice and provide documentationfrom the relevant licensing authority that their license is in goodstanding and without conditions or restrictions. A candidate whoselicense has been restricted, suspended, revoked, or surrendered inany jurisdiction, cannot be certified, recertified or admitted to acertification examination. Restrictions include but are not limitedto conditions, contingencies, probation, and stipulated agreements.Disabled CandidatesABIM recognizes that some candidates have physical limitationsthat make it impossible for them to fulfill the requirement forproficiency in performing procedures. For such individuals, theprocedural skills requirement may be waived. Program directorsshould write to ABIM for an exception before the individual enterstraining or when the disability becomes established.ABIM is committed to offering suitable examination accommodationsfor all candidates, including individuals with disabilities.When necessary, alternative arrangements under conditionscomparable to those provided for other candidates are offered todisabled individuals. Candidates who need accommodation for adisability during an examination must provide a written request toABIM at the time of application for examination. ABIM will theninform the candidate of the documentation that must be receivedby ABIM no later than the examination registration deadline.Reapplication for special accommodation is not required foreach examination administration unless a new accommodationis requested. ABIM treats requests for accommodations asconfidential. For additional information about the process anddocumentation requirements, please contact ABIM at accommodations@abim.org,or refer to the ABIM website, www.abim.org.12

Substance AbuseIf a candidate or a diplomate has a history of substance abuse,documentation of at least one year of continuous sobriety from areliable monitoring source must be submitted to ABIM foradmission to an examination or to receive a certificate. ABIM treatssuch information as confidential.Suspension and Revocation of CertificationABIM may, at its discretion, revoke or rescind certification if thediplomate was not qualified to receive the certificate at the time itwas issued, even if the certificate was issued as a result of a mistakeon the part of ABIM. It may also revoke or suspend certification ifthe diplomate fails to maintain moral, ethical, or professionalbehavior satisfactory to ABIM, or engages in misconduct thatadversely affects professional competence or integrity. It may revokeor suspend the certificate if: (1) the diplomate made any materialmisstatement of fact or omission of fact to ABIM in connectionwith application or to any third party concerning the diplomate’scertification status; or (2) the diplomate's license to practicemedicine has been revoked, suspended, restricted, or surrendered inany jurisdiction. Restrictions include but are not limited toconditions, contingencies, probation, and stipulated agreements. Aphysician may petition ABIM for admission to the certificationprocess upon restoration of unrestricted licensure. If ABIM grantsthe petition, and upon such conditions as ABIM may require, thephysician must complete ABIM’s Maintenance of Certificationprogram. Upon successful completion of the Maintenance ofCertification program the physician will be granted a newtime-limited certificate consistent with the then current policiesof ABIM.data forensic techniques that use statistical analyses of test-responsedata to identify patterns of test fraud, including cheating and piracy.ABIM Sanctions for Irregular Examination Behavior,Violation of its Copyright, or Other Misuse ofits MaterialsIrregular or improper behavior in examinations that is observed,made apparent by data forensics, statistical analysis, or uncovered byother means will be considered a subversion of the certificationprocess and will constitute grounds for invalidation of a candidate'sexamination. In addition ABIM may at its discretion suspend orrevoke certification, exclude candidates from future examinations,and inform program director(s), licensing bodies, impaired physiciansadvocacy groups, or law enforcement agencies of ABIM’sactions. Those who take ABIM examinations have a continuingobligation to maintain examination confidentiality. Disclosure ofsecure examination content, inducement of others to disclose suchcontent, violation of ABIM’s copyrights or other misuse of ABIMmaterial that subverts its processes may constitute grounds for anyof the foregoing actions.Competency in TechnologyConsistent with the ABMS/ACGME General Competenciesin Systems-Based Practice, ABIM requires its candidates anddiplomates to possess sufficient competencies in informationtechnology, including the use of personal computers, the Internet,and e-mail, for correspondence and completion of examinationsand modules throughout their participation in ABIM Certificationand Maintenance of Certification programs.Irregular Behavior on ExaminationsAll ABIM examinations are administered in secure testing centersby test administrators who are responsible for maintaining theintegrity and security of the certification process. Test administratorsare required to report to ABIM any irregular or improperbehavior by a candidate, such as giving or obtaining information oraid, looking at the test material of others, removing examinationmaterials from the test center, taking notes, bringing unauthorizeditems, including electronic devices (e.g., beepers, pagers, cellphones, etc.), into the examination, failing to comply with timelimits or instructions, talking, or other disruptive behavior.Test administrators may intervene to stop any of the foregoing. Inaddition, as part of its effort to assure exam integrity, ABIM utilizesRe-examinationCandidates who are unsuccessful on an examination may applyfor re-examination. To be granted admission, candidates must meetall applicable licensure, professional standing and proceduralrequirements. As long as these requirements are met, there is norestriction on the number of opportunities for re-examination.Schedule of ExaminationsThe schedule of examination dates, examination fees andpolicies regarding late applications and refunds may be found onABIM’s website at www.abim.org. It is the sole responsibility of thecandidate to be aware of and comply with registration deadlines.To register for an examination, go to www.abim.org.13

ABIM BOARD OF DIRECTORS 2009-10Wendy S. Levinson, MDChairDavid B. Reuben, MDChair-ElectGriffin P. Rodgers, MDSecretary-TreasurerChristine K. Cassel, MDABIM President & CEOCharles S. Abrams, MDLee R. Berkowitz, MDClarence H. Braddock, III, MDMarie T. Brown, MDDavid S. Cooper, MDBarry Egener, MDChristopher E. Forsmark, MDJohn G. Harold, MDDavid P. Huston, MDJ. Larry Jameson, MDDavid H. Johnson, MDGeorge H. Karam, MDTalmadge E. King Jr., MDRosanne M. Leipzig, MDStuart L. Linas, MDCatherine R. Lucey, MDStephen A. Paget, MDNeil R. Powe, MDSue A. Ravenscraft, MDRichard P. Shannon, MDChristine A. Sinsky, MDLawrence G. Smith, MDRobert M. Wachter, MDMichael R. Zile, MDKevin P. High, MDThomas R. Martin, MDThe information provided in this print publication, Policies and Procedures for Certification, August 2009,and on ABIM’s website governs the American Board of Internal Medicine's decision about eligibilityfor certification. This edition supersedes all previous publications. ABIM reserves the right to makechanges in fees, examinations, policies and procedures at any time without advance notice. Admission toABIM’s certification process is determined by policies in force at the time of application. ABIM is a memberof the American Board of Medical Specialties.510 Walnut Street Suite 1700Philadelphia, PA 19106 - 3699Copyright © August 2009, American Board of Internal Medicine1.800.441.ABIMwww.abim.orgE47-08-2009 293