Policies and Procedures for Certification - College of Medicine
Policies and Procedures for Certification - College of Medicine
Policies and Procedures for Certification - College of Medicine
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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 <strong>and</strong> to maintainexamination confidentiality.ABIM examinations are confidential, in addition to being protectedby federal copyright <strong>and</strong> trade secret laws. C<strong>and</strong>idates <strong>and</strong>diplomates 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. C<strong>and</strong>idates <strong>and</strong>diplomates further acknowledge that disclosure or any other use <strong>of</strong>examination content may expose them to criminal as well as civilliability, <strong>and</strong> may also result in sanctions by ABIM.With respect to ABIM’s Maintenance <strong>of</strong> <strong>Certification</strong> (MOC)products, including without limitation its Self-Evaluation ProcessMedical Knowledge Modules <strong>and</strong> Practice Improvement Modules(PIMs), c<strong>and</strong>idates 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 <strong>of</strong> such materials in any manner; <strong>and</strong> will not assistsomeone else in the infringement or misuse <strong>of</strong> these or any otherABIM-copyrighted works.
TABLE OF CONTENTSRequirements <strong>for</strong> <strong>Certification</strong> in Internal <strong>Medicine</strong> 2Requirements <strong>for</strong> <strong>Certification</strong> in Subspecialties 6<strong>Certification</strong> Using the Research Pathway 9Special Training <strong>Policies</strong> 10Other <strong>Policies</strong> 11INTRODUCTIONThe American Board <strong>of</strong> Internal <strong>Medicine</strong> (referred to throughoutthis document as “ABIM”) was established in 1936 <strong>and</strong> is a private,not-<strong>for</strong>-pr<strong>of</strong>it corporation. Board members are elected by the Board<strong>of</strong> Directors <strong>and</strong> serve two-year terms.ABIM receives no public funds <strong>and</strong> has no licensing authority orfunction. ABIM’s mission is to enhance the quality <strong>of</strong> health careby certifying internists <strong>and</strong> subspecialists who demonstrate theknowledge, skills, <strong>and</strong> attitudes essential <strong>for</strong> excellent patient care.<strong>Certification</strong> is not a requirement to practice internal medicine,<strong>and</strong> ABIM does not confer privileges to practice. ABIM doesnot intend either to interfere with or to restrict the pr<strong>of</strong>essionalactivities <strong>of</strong> a licensed physician based on certification status.ABIM administers the certification process by: (1) establishingrequirements <strong>for</strong> training <strong>and</strong> self-evaluation; (2) assessing thepr<strong>of</strong>essional credentials <strong>of</strong> c<strong>and</strong>idates; (3) obtaining substantiationby appropriate authorities <strong>of</strong> the clinical competence <strong>and</strong>pr<strong>of</strong>essional st<strong>and</strong>ing <strong>of</strong> c<strong>and</strong>idates; <strong>and</strong> (4) developing <strong>and</strong>conducting examinations <strong>and</strong> other assessments.All ABIM certifications issued in 1990 (1987 <strong>for</strong> critical caremedicine <strong>and</strong> 1988 <strong>for</strong> geriatric medicine) <strong>and</strong> thereafter arevalid <strong>for</strong> 10 years. Dates <strong>of</strong> validity are noted on the certificates.To remain valid, these certifications must be renewed throughABIM’s Maintenance <strong>of</strong> <strong>Certification</strong> program. <strong>Certification</strong>sissued be<strong>for</strong>e these dates are valid indefinitely, although ABIMstrongly recommends such certificate holders recertify as well.For in<strong>for</strong>mation about the Maintenance <strong>of</strong> <strong>Certification</strong> program,visit ABIM’s website, www.abim.org, or contact ABIM,1-800-441-ABIM.A c<strong>and</strong>idate’s eligibility <strong>for</strong> certification is determined by the policies <strong>and</strong> procedures described in this document <strong>and</strong> on ABIM’s website,www.abim.org. This edition <strong>of</strong> <strong>Policies</strong> <strong>and</strong> <strong>Procedures</strong> <strong>for</strong> <strong>Certification</strong> supersedes all previous publications. ABIM reserves the rightto make changes in its fees, examinations, policies, <strong>and</strong> procedures at any time without advance notice. Admission to ABIM’scertification process is determined by the policies in <strong>for</strong>ce at the time <strong>of</strong> 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 <strong>of</strong> patients, meet the licensure <strong>and</strong>procedural requirements, <strong>and</strong> pass the <strong>Certification</strong> Examination inInternal <strong>Medicine</strong>.Predoctoral Medical EducationC<strong>and</strong>idates who graduated from medical schools in the UnitedStates or Canada must have attended a school that was accredited atthe date <strong>of</strong> graduation by the Liaison Committee on MedicalEducation (LCME), the Committee <strong>for</strong> Accreditation <strong>of</strong> CanadianMedical Schools, or the American Osteopathic Association.Graduates <strong>of</strong> international medical schools must have one <strong>of</strong> thefollowing: (1) a st<strong>and</strong>ard certificate from the EducationalCommission <strong>for</strong> Foreign Medical Graduates without expired examinationdates; (2) comparable credentials from the Medical Council<strong>of</strong> Canada; or (3) documentation <strong>of</strong> training <strong>for</strong> those c<strong>and</strong>idateswho entered graduate medical education training in the UnitedStates via the Fifth Pathway, as proposed by the American MedicalAssociation.Content <strong>of</strong> TrainingThe 36 calendar months <strong>of</strong> full-time internal medicine residencyeducation:(1) Must include at least 30 months <strong>of</strong> training in generalinternal medicine, subspecialty internal medicine <strong>and</strong>emergency medicine. Up to four months <strong>of</strong> the 30 monthsmay include training in areas related to primary care, such asneurology, dermatology, <strong>of</strong>fice gynecology, or <strong>of</strong>ficeorthopedics.(2) May include up to three months <strong>of</strong> other electives approvedby the internal medicine program director.(3) Includes up to three months <strong>for</strong> vacation time.See “Leave <strong>of</strong> Absence <strong>and</strong> Vacation” policy on page 11.In addition, the following requirements <strong>for</strong> direct patientresponsibility must be met:(1) At least 24 months <strong>of</strong> the 36 months <strong>of</strong> 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 <strong>Certification</strong> Examination in Internal<strong>Medicine</strong>, physicians must have satisfactorily completed, byAugust 31 <strong>of</strong> the year <strong>of</strong> examination, 36 calendar months,including vacation time, <strong>of</strong> graduate medical education accreditedby the Accreditation Council <strong>for</strong> Graduate Medical Education(ACGME), the Royal <strong>College</strong> <strong>of</strong> Physicians <strong>and</strong> Surgeons <strong>of</strong>Canada, or the Pr<strong>of</strong>essional Corporation <strong>of</strong> Physicians <strong>of</strong> Quebec.Residency or research experience occurring be<strong>for</strong>e completion <strong>of</strong>the requirements <strong>for</strong> the MD or DO degree cannot be creditedtoward the requirements <strong>for</strong> certification.(2) At least six months <strong>of</strong> the direct patient responsibility oninternal medicine rotations must occur during the R-1 year.Clinical Competence RequirementsABIM requires documentation that c<strong>and</strong>idates <strong>for</strong> certification ininternal medicine are competent in: (1) patient care (medicalinterviewing, physical examination, <strong>and</strong> procedural skills); (2)medical knowledge; (3) practice-based learning <strong>and</strong> improvement;(4) interpersonal <strong>and</strong> communication skills; (5) pr<strong>of</strong>essionalism;<strong>and</strong> (6) systems-based practice.The 36 months <strong>of</strong> residency training must include 12 months <strong>of</strong>accredited internal medicine training at each <strong>of</strong> three levels: R-1,R-2, <strong>and</strong> R-3. No credit is granted <strong>for</strong> training repeated at the samelevel or <strong>for</strong> 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 <strong>for</strong>internal medicine residents. A c<strong>and</strong>idate may be excluded from anABIM examination if the required components <strong>of</strong> clinical competenceare not satisfactorily documented by the training program.2
PROGRAM DIRECTOR RATINGS OF CLINICAL COMPETENCECOMPONENTS <strong>and</strong> RATINGSR-1 <strong>and</strong> R-2 R-3 Fellows (any year)Overall Clinical CompetenceSatisfactory or SuperiorFull creditFull creditFull creditMarginalFull credit <strong>for</strong> one marginal yearRepeat one year if both R-1<strong>and</strong> R-2 are marginalNot ApplicableNot ApplicableUnsatisfactoryNo credit, must repeat yearNo credit, must repeat yearNo credit, must repeat yearMoral <strong>and</strong> Ethical BehaviorSatisfactoryFull credit Full credit Full creditUnsatisfactoryNo credit, must repeat year or, at the request <strong>of</strong> theprogram director <strong>and</strong> at ABIM’s discretion, a successfulperiod <strong>of</strong> observation can be arranged in lieu <strong>of</strong>repeating the year to be granted creditNo credit, must repeat year or, at the request <strong>of</strong> theprogram director <strong>and</strong> at ABIM’s discretion, a successfulperiod <strong>of</strong> observation can be arranged in lieu <strong>of</strong>repeating the year to be granted creditNo credit, must repeat year or, at the request <strong>of</strong> theprogram director <strong>and</strong> at ABIM’s discretion, a successfulperiod <strong>of</strong> observation can be arranged in lieu <strong>of</strong>repeating the year to be granted creditEvaluation <strong>of</strong> Individual General Competencies*Satisfactory or SuperiorFull credit Full credit Full creditUnsatisfactoryFull creditNo credit, must repeat yearMust repeat year if during finalyear <strong>of</strong> required training* The six required competencies are: (1) patient care (which includes medical interviewing, physical examination, <strong>and</strong> procedural skills); (2) medical knowledge;(3) practice-based learning <strong>and</strong> improvement; (4) interpersonal <strong>and</strong> communication skills; (5) pr<strong>of</strong>essionalism, <strong>and</strong> (6) systems-based practice.As outlined in the table above, all residents must receive satisfactoryratings in overall clinical competence <strong>and</strong> moral <strong>and</strong> ethicalbehavior in each year <strong>of</strong> training. In addition, residents mustreceive satisfactory ratings in each <strong>of</strong> the components <strong>of</strong> clinicalcompetence during the final year <strong>of</strong> required training. It is theresident's responsibility to arrange <strong>for</strong> any additional trainingneeded to achieve a satisfactory rating in each component <strong>of</strong> clinicalcompetence.<strong>Procedures</strong> Required <strong>for</strong> Internal <strong>Medicine</strong>Safety is the highest priority when per<strong>for</strong>ming any procedure on apatient. ABIM recognizes that there is variability in the types <strong>and</strong>numbers <strong>of</strong> procedures per<strong>for</strong>med by internists in practice.Internists who per<strong>for</strong>m any procedure must obtain the appropriatetraining to safely <strong>and</strong> competently per<strong>for</strong>m that procedure. It is alsoexpected that the internist be thoroughly evaluated <strong>and</strong> credentialedas competent in per<strong>for</strong>ming a procedure be<strong>for</strong>e he or she canper<strong>for</strong>m it unsupervised. For certification in internal medicine,ABIM has identified a limited set <strong>of</strong> procedures in which it expectsall c<strong>and</strong>idates to be competent with regard to their knowledge <strong>and</strong>underst<strong>and</strong>ing. This includes: (1) demonstration <strong>of</strong> competence inmedical knowledge relevant to procedures through their ability toexplain indications, contraindications, patient preparation methods,sterile techniques, pain management, proper techniques <strong>for</strong>h<strong>and</strong>ling specimens <strong>and</strong> fluids obtained, <strong>and</strong> test results; (2) abilityto recognize <strong>and</strong> manage complications; <strong>and</strong> (3) ability to clearlyexplain to a patient all facets <strong>of</strong> the procedure necessary to obtainin<strong>for</strong>med consent.For a subset <strong>of</strong> procedures, ABIM requires all c<strong>and</strong>idates todemonstrate competence <strong>and</strong> safe per<strong>for</strong>mance by means <strong>of</strong>evaluations per<strong>for</strong>med during residency training. The set <strong>of</strong>procedures <strong>and</strong> associated competencies required <strong>for</strong> each arepresented in the table on page 4.3
PROCEDURES REQUIRED FOR INTERNAL MEDICINECompetencyKnow, Underst<strong>and</strong> <strong>and</strong> ExplainIndications; Contraindications;Recognition <strong>and</strong> Management<strong>of</strong> Complications; PainManagement; Sterile TechniquesSpecimen H<strong>and</strong>lingInterpretation <strong>of</strong> ResultsRequirements <strong>and</strong>Knowledge to ObtainIn<strong>for</strong>med ConsentPer<strong>for</strong>m Safely<strong>and</strong> 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 <strong>and</strong> drainage <strong>of</strong>an abscessXXXXLumbar punctureXXXXNasogastric intubationXXXXPap smear <strong>and</strong>endocervical cultureXXXXXPlacing a peripheral venous lineXN/AN/AN/AXPulmonary artery catheter placementXN/AXXThoracentesisXXXXTo help acquire both knowledge <strong>and</strong> per<strong>for</strong>mance competence,ABIM believes that residents should be active participants inper<strong>for</strong>ming 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 theper<strong>for</strong>mance <strong>of</strong> required procedures. In addition, ABIM stronglyrecommends that procedural training be conducted initiallythrough simulations. At the end <strong>of</strong> training, as part <strong>of</strong> theevaluation required <strong>for</strong> admission to the <strong>Certification</strong> Examinationin Internal <strong>Medicine</strong>, program directors must attest to eachresident’s knowledge <strong>and</strong> competency to per<strong>for</strong>m the procedures inthe table above. ABIM does not specify a minimum number <strong>of</strong>procedures to demonstrate competency; however, to assure adequateknowledge <strong>and</strong> underst<strong>and</strong>ing <strong>of</strong> the common procedures ininternal medicine, each resident should be an active participant <strong>for</strong>each procedure five or more times.CREDIT IN LIEU OF STANDARD TRAINING FOR INTERNALMEDICINE CANDIDATESTraining Completed Prior to Entering Internal<strong>Medicine</strong> ResidencyABIM may grant credit <strong>for</strong> some or all <strong>of</strong> the 12-month requirementat the R-1 level <strong>for</strong> training taken prior to entering training ininternal medicine. The program director <strong>of</strong> an accredited internalmedicine residency program must petition ABIM to grant credit inlieu <strong>of</strong> st<strong>and</strong>ard R-1 internal medicine training. C<strong>and</strong>idates whohave already completed 12 months <strong>of</strong> accredited U.S. or CanadianR-1 internal medicine training are not eligible to be petitioned <strong>for</strong>credit. Be<strong>for</strong>e being proposed, the c<strong>and</strong>idate should have beenobserved by the proposer <strong>for</strong> a minimum <strong>of</strong> three months. No creditwill be granted to substitute <strong>for</strong> 24 months <strong>of</strong> accredited R-2 <strong>and</strong>R-3 internal medicine training.4
(1) Month-<strong>for</strong>-month credit may be granted <strong>for</strong> satisfactorycompletion <strong>of</strong> internal medicine rotations taken during aU.S. or Canadian accredited non-internal medicine residencyprogram if all <strong>of</strong> the following criteria are met:(a) the internal medicine training occurred under thedirection <strong>of</strong> a program director <strong>of</strong> an accredited internalmedicine program;(b) the training occurred in an institution accredited <strong>for</strong>training internal medicine residents; <strong>and</strong>(c) the rotations were identical to the rotations <strong>of</strong> theresidents enrolled in the accredited internal medicineresidency program.(1) are proposed by the chair or program director <strong>of</strong> an accreditedinternal medicine residency program;(2) have completed three or more years <strong>of</strong> verified internalmedicine training abroad;(3) hold an appointment at the level <strong>of</strong> Associate Pr<strong>of</strong>essor orhigher at the time <strong>of</strong> proposal; <strong>and</strong>(4) have completed eight years, after <strong>for</strong>mal training, as aclinician-educator or a clinical investigator in internalmedicine with a full-time appointment on a medicalschool faculty.* Requires a fee <strong>of</strong> $300. Guidelines <strong>for</strong> 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-<strong>for</strong>-month credit <strong>for</strong> the internal medicinerotations that meet the criteria listed under (1) above;plus,(b) a maximum <strong>of</strong> six months <strong>of</strong> credit <strong>for</strong> the trainingin family medicine or a pediatrics program; or,(c) a maximum <strong>of</strong> three months <strong>of</strong> credit <strong>for</strong> training in anon-internal medicine specialty program.(3) Up to 12 months <strong>of</strong> credit may be granted <strong>for</strong> at least threeyears <strong>of</strong> U.S. or Canadian accredited training in anotherclinical specialty <strong>and</strong> certification by an ABMS member Boardin that specialty.*(4) Up to 12 months <strong>of</strong> credit may be granted <strong>for</strong> at least threeyears <strong>of</strong> verified internal medicine training abroad.*Training in Combined ProgramsABIM recognizes internal medicine training combined withtraining in the following programs:• Dermatology• Emergency <strong>Medicine</strong>• Emergency <strong>Medicine</strong>/Critical Care <strong>Medicine</strong>• Family <strong>Medicine</strong>• Medical Genetics• Neurology• Nuclear <strong>Medicine</strong>• Pediatrics*• Physical <strong>Medicine</strong> <strong>and</strong> Rehabilitation• Preventive <strong>Medicine</strong>• 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 <strong>of</strong> $300. Guidelines <strong>for</strong> proposals are available atwww.abim.org/certification/policies/special.aspx.Guidelines <strong>for</strong> the combined training programs <strong>and</strong> requirements<strong>for</strong> credit toward the ABIM <strong>Certification</strong> Examination in Internal<strong>Medicine</strong> 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 <strong>for</strong> admission to the <strong>Certification</strong> Examination inInternal <strong>Medicine</strong> if they:5
REQUIREMENTS FOR CERTIFICATIONIN SUBSPECIALTIESGENERAL REQUIREMENTSIn addition to the primary certificate in internal medicine, ABIMcertifies physicians in the following subspecialties:• Adolescent <strong>Medicine</strong>• Advanced Heart Failure <strong>and</strong> Transplant Cardiology• Cardiovascular Disease• Clinical Cardiac Electrophysiology• Critical Care <strong>Medicine</strong>• Endocrinology, Diabetes, <strong>and</strong> Metabolism• Geriatric <strong>Medicine</strong>• Gastroenterology• Hematology• Hospice <strong>and</strong> Palliative <strong>Medicine</strong>• Infectious Disease• Interventional Cardiology• Medical Oncology• Nephrology• Pulmonary Disease• Rheumatology• Sleep <strong>Medicine</strong>• Sports <strong>Medicine</strong>• Transplant HepatologyTo apply <strong>for</strong> 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 <strong>of</strong> patients, meetthe licensure <strong>and</strong> procedural requirements, <strong>and</strong> pass the secureexamination <strong>for</strong> that discipline.To apply <strong>for</strong> certification <strong>and</strong> renewal <strong>of</strong> a certificate in adolescentmedicine, hospice <strong>and</strong> palliative medicine, sleep medicine, <strong>and</strong>sports 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 <strong>and</strong> be eligible <strong>for</strong> renewal <strong>of</strong>a certificate in advanced heart failure <strong>and</strong> transplant cardiology,clinical cardiac electrophysiology or interventional cardiology.Diplomates must maintain a valid underlying certificate ingastroenterology to obtain certification <strong>and</strong> be eligible <strong>for</strong> renewal<strong>of</strong> a certificate in transplant hepatology.Fellowship training must be accredited by the AccreditationCouncil <strong>for</strong> Graduate Medical Education (ACGME), the Royal<strong>College</strong> <strong>of</strong> Physicians <strong>and</strong> Surgeons <strong>of</strong> Canada, or the Pr<strong>of</strong>essionalCorporation <strong>of</strong> Physicians <strong>of</strong> Quebec. No credit will be grantedtoward certification in a subspecialty <strong>for</strong> training completed outside<strong>of</strong> an accredited U.S. or Canadian program.Fellowship training taken be<strong>for</strong>e completing the requirements<strong>for</strong> the MD or DO degree, training as a chief medical resident,practice experience, <strong>and</strong> attendance at postgraduate courses maynot be credited toward the training requirements <strong>for</strong> subspecialtycertification.To be admitted to an examination, c<strong>and</strong>idates must have completedthe required training in the subspecialty, including vacation time, byOctober 31 <strong>of</strong> the year <strong>of</strong> examination.C<strong>and</strong>idates <strong>for</strong> certification in the subspecialties must meet ABIM’srequirements <strong>for</strong> duration <strong>of</strong> training as well as minimum duration<strong>of</strong> 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 <strong>for</strong> full-time clinical training.Educational rotations completed during training may not bedouble-counted to satisfy both internal medicine <strong>and</strong> subspecialtytraining requirements. Likewise, training which qualifies adiplomate <strong>for</strong> admission to one subspecialty examination cannotbe double-counted toward certification in another subspecialty,with the exception <strong>of</strong> the <strong>for</strong>mally approved pathways <strong>for</strong> dualcertification.6
Training <strong>and</strong> Procedural RequirementsThe total months <strong>of</strong> training required, including specific clinicalmonths, <strong>and</strong> requisite procedures <strong>for</strong> each subspecialty are outlinedby discipline in the table below.Minimum Months <strong>of</strong> Training/Clinical Months RequiredSubspecialtyCardiovascular Disease*Gastroenterology*Adolescent <strong>Medicine</strong>Critical Care <strong>Medicine</strong>Endocrinology, Diabetes,<strong>and</strong> MetabolismHematology**Infectious DiseaseMedical Oncology**NephrologyPulmonary DiseaseRheumatologyAdvanced Heart Failure<strong>and</strong> Transplant CardiologyClinical CardiacElectrophysiologyGeriatric <strong>Medicine</strong>Hospice <strong>and</strong> Palliative<strong>Medicine</strong>Interventional CardiologySleep <strong>Medicine</strong>Sports <strong>Medicine</strong>Transplant Hepatology<strong>Procedures</strong> <strong>for</strong> SubspecialtiesTotal Months <strong>of</strong>TrainingClinical Months36* 2436*2412 12* The training requirements <strong>for</strong> admission to the Cardiovascular Disease Examination<strong>and</strong> the Gastroenterology Examination increased to 36 months <strong>of</strong> accredited fellowshiptraining in 1990 <strong>and</strong> 1996 respectively. Beginning with the 2007examinations, 36 months <strong>of</strong> accredited fellowship training are required <strong>of</strong> allfirst-time applicants <strong>for</strong> these examinations, regardless <strong>of</strong> when they trained.** Requires minimum ½ day per week in continuity outpatient clinic.1812Clinical Cardiac ElectrophysiologyElectrophysiologic studies both with a catheter <strong>and</strong> intraoperatively;catheter-based <strong>and</strong> other ablation procedures; <strong>and</strong> implantation <strong>of</strong>pacemakers, <strong>and</strong> cardioverters-defibrillators (a minimum <strong>of</strong> 150intracardiac procedures in at least 75 patients, <strong>of</strong> which 75 arecatheter-based ablation procedures, including post-diagnostictesting, <strong>and</strong> 25 are initial implantable cardioverter-defibrillatorprocedures, including programming). <strong>Procedures</strong> per<strong>for</strong>med duringtraining in cardiovascular disease may be counted toward fulfillingthese requirements provided that they are adequately documented<strong>and</strong> are per<strong>for</strong>med with supervision equivalent to that <strong>of</strong> a clinicalcardiac electrophysiology fellowship.Critical Care <strong>Medicine</strong>Airway management <strong>and</strong> endotracheal intubation; ventilatormanagement <strong>and</strong> noninvasive ventilation; insertion <strong>and</strong> management<strong>of</strong> chest tubes, <strong>and</strong> thoracentesis; advanced cardiac lifesupport (ACLS); placement <strong>of</strong> arterial, central venous, <strong>and</strong>pulmonary artery balloon flotation catheters; calibration <strong>and</strong>operation <strong>of</strong> hemodynamic recording systems; pr<strong>of</strong>iciency in use<strong>of</strong> ultrasound to guide central line placement <strong>and</strong> thoracentesis isstrongly recommended. C<strong>and</strong>idates should know the indications,contraindications, complications, <strong>and</strong> limitations <strong>of</strong> the followingprocedures: pericardiocentesis, transvenous pacemaker insertion,continuous renal replacement therapy (CRRT) <strong>and</strong> hemodialysis,<strong>and</strong> fiberoptic bronchoscopy. Practical experience is recommended.Endocrinology, Diabetes, <strong>and</strong> MetabolismThyroid aspiration biopsy.GastroenterologyDiagnostic <strong>and</strong> therapeutic upper <strong>and</strong> lower endoscopy.Geriatric <strong>Medicine</strong>No required procedures.Adolescent <strong>Medicine</strong>HematologyNo required procedures.Bone marrow aspiration <strong>and</strong> biopsy, including preparation, examination,<strong>and</strong> interpretation <strong>of</strong> bone marrow aspirates <strong>and</strong> touchAdvanced Heart Failure <strong>and</strong> Transplant Cardiologypreparations <strong>of</strong> bone marrow biopsies; interpretation <strong>of</strong> peripheral<strong>Procedures</strong> to be determined.blood smears, including manual white blood cell <strong>and</strong> plateletcounts; administration <strong>of</strong> chemotherapeutic agents <strong>and</strong> biologicalCardiovascular Diseaseproducts through all therapeutic routes; management <strong>and</strong> care <strong>of</strong>Advanced cardiac life support (ACLS), including cardioversion;indwelling venous access catheters; <strong>and</strong> management <strong>of</strong> methods <strong>of</strong>electrocardiography, including ambulatory monitoring <strong>and</strong> exerciseapheresis.testing; echocardiography; arterial catheter insertion; right-heartcatheterization, including insertion <strong>and</strong> management <strong>of</strong> temporaryHospice <strong>and</strong> Palliative <strong>Medicine</strong>pacemakers; <strong>and</strong> left-heart catheterization <strong>and</strong> diagnostic coronaryNo required procedures.angiography.7
Infectious DiseaseMicroscopic evaluation <strong>of</strong> diagnostic specimens including preparation,staining, <strong>and</strong> interpretation; management, maintenance, <strong>and</strong>removal <strong>of</strong> indwelling venous access catheters; <strong>and</strong> administration<strong>of</strong> antimicrobial <strong>and</strong> biological products via all routes.Interventional CardiologyA minimum <strong>of</strong> 250 therapeutic interventional cardiac proceduresduring accredited interventional cardiology fellowship training.Those out <strong>of</strong> interventional cardiology training three years or moreas <strong>of</strong> June 30 <strong>of</strong> the year <strong>of</strong> exam must document post-trainingper<strong>for</strong>mance as primary operator <strong>of</strong> 150 therapeutic interventionalcardiac procedures in the two years prior to application <strong>for</strong> exam.Sleep <strong>Medicine</strong>Ability to interpret results <strong>of</strong> polysomnography, multiple sleeplatency testing, maintenance <strong>of</strong> wakefulness testing, actigraphy, <strong>and</strong>portable monitoring related to sleep disorders.Sports <strong>Medicine</strong>No required proceduresTransplant HepatologyPer<strong>for</strong>mance <strong>of</strong> at least 30 percutaneous liver biopsies, includingallograft; interpretation <strong>of</strong> 200 native <strong>and</strong> allograft liver biopsies;<strong>and</strong> knowledge <strong>of</strong> indications,contraindications, <strong>and</strong> complications<strong>of</strong> allograft biopsies.Medical OncologyBone marrow aspiration <strong>and</strong> biopsy; administration <strong>of</strong> chemotherapeuticagents <strong>and</strong> biological products through all therapeuticroutes; <strong>and</strong> management <strong>and</strong> care <strong>of</strong> indwelling venous accesscatheters.NephrologyPlacement <strong>of</strong> temporary vascular access <strong>for</strong> hemodialysis <strong>and</strong> relatedprocedures; acute <strong>and</strong> chronic hemodialysis; peritoneal dialysis(excluding placement <strong>of</strong> temporary peritoneal catheters); continuousrenal replacement therapy (CRRT); <strong>and</strong> percutaneous biopsy<strong>of</strong> both autologous <strong>and</strong> transplanted kidneys.Pulmonary DiseaseAirway management including endotracheal intubation; fiberopticbronchoscopy <strong>and</strong> accompanying procedures; noninvasive <strong>and</strong>invasive ventilator management; thoracentesis; arterial puncture;placement <strong>of</strong> arterial, central venous <strong>and</strong> pulmonary artery balloonflotation catheters; calibration <strong>and</strong> operation <strong>of</strong> hemodynamicrecording systems; supervision <strong>of</strong> the technical aspects <strong>of</strong>pulmonary function testing; progressive exercise testing; insertion<strong>and</strong> management <strong>of</strong> chest tubes; moderate sedation. Pr<strong>of</strong>iciency inuse <strong>of</strong> ultrasound to guide central line placement is strongly recommended.RheumatologyDiagnostic aspiration <strong>of</strong> <strong>and</strong> analysis by light <strong>and</strong> polarized lightmicroscopy <strong>of</strong> synovial fluid from diarthrodial joints, bursae, <strong>and</strong>tenosynovial structures; <strong>and</strong> therapeutic injection <strong>of</strong> diarthrodialjoints, bursae, tenosynovial structures, <strong>and</strong> entheses.Clinical Competence RequirementsABIM requires documentation that c<strong>and</strong>idates <strong>for</strong> certificationin the subspecialties are competent in: (1) patient care (whichincludes medical interviewing, physical examination, <strong>and</strong>procedural skills); (2) medical knowledge; (3) practice-basedlearning <strong>and</strong> improvement; (4) interpersonal <strong>and</strong> communicationskills; (5) pr<strong>of</strong>essionalism; <strong>and</strong> (6) systems-based practice.Through its tracking process, FasTrack, ABIM requires verification<strong>of</strong> subspecialty fellows’ clinical competence from the subspecialtytraining program director. As outlined in the table on page 3,all fellows must receive satisfactory ratings <strong>of</strong> overall clinicalcompetence <strong>and</strong> moral <strong>and</strong> ethical behavior in each <strong>of</strong> the requiredyears <strong>of</strong> training.In addition, fellows must receive satisfactory ratings in each <strong>of</strong> thecomponents <strong>of</strong> clinical competence <strong>and</strong> the requisite proceduresduring the final year <strong>of</strong> required training. It is the fellow’s responsibilityto arrange <strong>for</strong> any additional training needed to achieve asatisfactory rating in each component <strong>of</strong> clinical competence.Dual <strong>Certification</strong> RequirementsHematology <strong>and</strong> Medical OncologyDual certification in hematology <strong>and</strong> medical oncology requiresthree years <strong>of</strong> accredited combined training which must include: aminimum <strong>of</strong> 18 months <strong>of</strong> full-time clinical training, <strong>of</strong> which atleast 12 months are in the diagnosis <strong>and</strong> management <strong>of</strong> a broadspectrum <strong>of</strong> neoplastic diseases including hematological malignancies,<strong>and</strong> six months are in the diagnosis <strong>and</strong> management <strong>of</strong> abroad spectrum <strong>of</strong> non-neoplastic hematological disorders. If the8
combined training must be taken in two different programs, 24continuous months must be in one institution, <strong>and</strong> both institutionsmust be accredited in both hematology <strong>and</strong> medical oncology.During the entire three years, the fellow must attend a minimum <strong>of</strong>one-half day per week in continuity outpatient clinic. Time spentin continuity outpatient clinic, during non-clinical training, is inaddition to the requirement <strong>for</strong> full-time clinical training.the allergy <strong>and</strong> immunology training program directors <strong>and</strong> byABIM <strong>and</strong> the American Board <strong>of</strong> Allergy <strong>and</strong> Immunology.Admission to either examination requires: (1) certification ininternal medicine; (2) satisfactory clinical competence; <strong>and</strong>(3) completion <strong>of</strong> the entire three-year combined program.C<strong>and</strong>idates seeking dual certification <strong>for</strong> other subspecialtycombinations should contact ABIM <strong>for</strong> in<strong>for</strong>mation.C<strong>and</strong>idates must complete all three years <strong>of</strong> required combinedtraining be<strong>for</strong>e being admitted to an examination in eithersubspecialty. Those who elect to take an examination in onesubspecialty following only two years <strong>of</strong> fellowship training willbe required to complete four years <strong>of</strong> accredited training <strong>for</strong>dual certification.Pulmonary Disease <strong>and</strong> Critical Care <strong>Medicine</strong>C<strong>and</strong>idates seeking dual certification in pulmonary disease <strong>and</strong>critical care medicine must complete a minimum <strong>of</strong> three years <strong>of</strong>accredited combined training, 18 months <strong>of</strong> which must be clinicaltraining.Only c<strong>and</strong>idates certified in a subspecialty following at least twoyears <strong>of</strong> accredited fellowship training (three years <strong>for</strong> cardiovasculardisease <strong>and</strong> gastroenterology) are permitted to take the critical caremedicine examination after completion <strong>of</strong> 12 months <strong>of</strong> accreditedclinical critical care medicine fellowship training. C<strong>and</strong>idatescertified in internal medicine only must complete 24 months <strong>of</strong>accredited critical care medicine fellowship training, including12 months <strong>of</strong> clinical training, to qualify <strong>for</strong> the critical care medicineexamination.Thus, <strong>for</strong> c<strong>and</strong>idates applying <strong>for</strong> dual certification in pulmonarydisease <strong>and</strong> critical care medicine with three years <strong>of</strong> combinedtraining, certification in pulmonary disease must be achieved be<strong>for</strong>ethe c<strong>and</strong>idate is eligible to apply <strong>for</strong> admission to the critical caremedicine examination.Rheumatology <strong>and</strong> Allergy <strong>and</strong> ImmunologyDual certification in rheumatology <strong>and</strong> allergy <strong>and</strong> immunologyrequires a minimum <strong>of</strong> three years <strong>of</strong> training which must include:(1) at least 12 months <strong>of</strong> clinical rheumatology training supervisedby the director <strong>of</strong> an accredited rheumatology training program;(2) 18 consecutive months <strong>of</strong> rheumatology continuity clinic; <strong>and</strong>(3) at least 18 months <strong>of</strong> allergy <strong>and</strong> immunology training supervisedby the training program director <strong>of</strong> an accredited program inallergy <strong>and</strong> immunology. Plans <strong>for</strong> combined training should beprospectively approved in writing by both the rheumatology <strong>and</strong>Special C<strong>and</strong>idates <strong>for</strong> Subspecialties*ABIM diplomates in internal medicine may be proposed <strong>for</strong> specialconsideration <strong>for</strong> admission to a subspecialty examination by theprogram director <strong>of</strong> an accredited fellowship program if they:(1) have completed the full training required by ABIM in thesubspecialty in another country <strong>and</strong> have met all currentapplicable ABIM procedural requirements;(2) are a full-time Associate Pr<strong>of</strong>essor or higher in the specifiedsubspecialty division <strong>of</strong> the Department <strong>of</strong> <strong>Medicine</strong> in anLCME-accredited medical school or an accreditedCanadian medical school;(3) have served eight years, after <strong>for</strong>mal training, as a clinicianeducator or clinical investigator with a full-time appointmenton a medical school faculty.* Proposals require a fee <strong>of</strong> $300. Guidelines <strong>for</strong> proposals areavailable at www.abim.org/certification/policies/special/aspx.CERTIFICATION USING THE RESEARCHPATHWAYThe Research Pathway is intended <strong>for</strong> trainees planning academiccareers as investigators in basic or clinical science. The pathwayintegrates training in clinical medicine with a minimum <strong>of</strong> threeyears <strong>of</strong> training in research methodology. Prospective planning <strong>of</strong>this pathway by trainees <strong>and</strong> program directors is necessary.Program directors must document the clinical <strong>and</strong> 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 <strong>of</strong> accredited categorical internal medicine residencytraining. A minimum <strong>of</strong> 20 months must involve direct patientresponsibility.9
Internal <strong>Medicine</strong> 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 <strong>of</strong> 36 months1/2 day per week6 or 7 years*completion <strong>of</strong> work leading to one or its equivalent. The last year <strong>of</strong>the Research Pathway may be taken in a full-time faculty position ifthe level <strong>of</strong> commitment to mentored research is maintained at 80percent.During internal medicine research training, 20 percent <strong>of</strong> 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 <strong>of</strong> satisfactory clinical per<strong>for</strong>mance must be maintainedannually <strong>for</strong> each trainee in the ABIM Research Pathway.For additional in<strong>for</strong>mation, 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 <strong>for</strong> certification in internal medicine <strong>and</strong> asubspecialty that requires 12 months <strong>of</strong> clinical training is a six-yearprogram. For subspecialties such as cardiovascular disease <strong>and</strong>gastroenterology, which require more than 12 months <strong>of</strong> clinicaltraining, <strong>and</strong> <strong>for</strong> dual certification in hematology/oncology,pulmonary disease/critical care medicine, <strong>and</strong> rheumatology/allergy<strong>and</strong> immunology, the Research Pathway is a full seven-yearprogram, including 36 to 42 months <strong>of</strong> research, depending on thenumber <strong>of</strong> months <strong>of</strong> clinical training completed.Disclosure <strong>of</strong> Per<strong>for</strong>mance In<strong>for</strong>mationTrainees planning to change programs must make requests to theircurrent program <strong>and</strong> to ABIM to send written evaluations <strong>of</strong> pastper<strong>for</strong>mance to the new program. These requests must be made ina timely manner to ensure that the new program director has theper<strong>for</strong>mance evaluations <strong>for</strong> review be<strong>for</strong>e <strong>of</strong>fering a position. Anew program director may also request per<strong>for</strong>mance evaluationsfrom previous programs <strong>and</strong> from ABIM concerning trainees whoapply <strong>for</strong> a new position. ABIM will respond to written requestsfrom trainees <strong>and</strong> program directors by providing any per<strong>for</strong>manceevaluations it has in its possession <strong>and</strong> the total credits accumulatedtoward ABIM’s training requirements <strong>for</strong> certification. Thisin<strong>for</strong>mation will include the comments provided with theevaluation.During the research period, 80 percent <strong>of</strong> time is devoted toresearch <strong>and</strong> 10 to 20 percent <strong>of</strong> time to clinical work. The traineemust attend a minimum <strong>of</strong> one half-day per week in continuityoutpatient clinic. Time spent in continuity outpatient clinic duringnon-clinical training is in addition to the requirement <strong>for</strong> full-timeclinical training.ABIM defines research as scholarly activities intended to developnew scientific knowledge. The research experience <strong>of</strong> traineesshould be mentored <strong>and</strong> reviewed. Unless the trainee has alreadyachieved an advanced graduate degree, training should includeDue Process <strong>for</strong> EvaluationsThe responsibility <strong>for</strong> the evaluation <strong>of</strong> a trainee’s clinicalcompetence <strong>and</strong> moral <strong>and</strong> ethical behavior rests with the program,not with ABIM. ABIM is not in a position to re-examine thefacts <strong>and</strong> circumstances <strong>of</strong> an individual's per<strong>for</strong>mance. As requiredby the ACGME in its Essentials <strong>of</strong> Accredited Residencies inGraduate Medical Education, the educational institution mustprovide appropriate due process <strong>for</strong> its decisions regarding atrainee's per<strong>for</strong>mance.10
Leave <strong>of</strong> Absence <strong>and</strong> VacationsUp to one month per academic year is permitted <strong>for</strong> 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 <strong>of</strong> training.Vacation leave is essential <strong>and</strong> should not be <strong>for</strong>feited or postponedin any year <strong>of</strong> training <strong>and</strong> cannot be used to reduce the totalrequired training period. ABIM recognizes that leave policies varyfrom institution to institution <strong>and</strong> expects the program director toapply his/her local requirements within these guidelines to ensuretrainees have completed the requisite period <strong>of</strong> training.ABIM may provide in<strong>for</strong>mation it has concerning them to otherswhom ABIM judges to have a legitimate need <strong>for</strong> it.ABIM makes academic <strong>and</strong> scientific judgments in its evaluations <strong>of</strong>the results <strong>of</strong> its examinations. Situations may occur, even throughno fault <strong>of</strong> the c<strong>and</strong>idates, that render examination results unreliablein the judgment <strong>of</strong> ABIM. C<strong>and</strong>idates agree that if ABIMdetermines that, in its judgment, the results <strong>of</strong> their examinationare unreliable, ABIM may require the c<strong>and</strong>idates to retake anexamination at its next administration or other time designatedby ABIM.Definition <strong>of</strong> Full-time TrainingFull-time training is defined as daily assignments <strong>for</strong> periods <strong>of</strong> noless than one month to supervised patient care, educational, orresearch activities designed to fulfill the goals <strong>of</strong> the trainingprogram. Full-time training must include <strong>for</strong>mative <strong>and</strong> summativeevaluation <strong>of</strong> clinical per<strong>for</strong>mance, with direct observation byfaculty <strong>and</strong> senior trainees.Interrupted Full-Time TrainingABIM approval must be obtained be<strong>for</strong>e initiating an interruptedtraining plan. Interrupted full-time training is acceptable, providedthat no period <strong>of</strong> 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 <strong>of</strong> the year at a minimum<strong>of</strong> 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 <strong>Certification</strong> 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 <strong>of</strong> <strong>for</strong>mer certificationwill be reported. If certification has been revoked or suspended,ABIM will report that fact, including the date <strong>of</strong> revocationor suspension.On a c<strong>and</strong>idate's written request to ABIM, the following in<strong>for</strong>mationwill also be provided in writing: (1) that an application <strong>for</strong>certification or Maintenance <strong>of</strong> <strong>Certification</strong> is currently in process;<strong>and</strong>/or (2) the year the c<strong>and</strong>idate was last admitted to examination.Representation <strong>of</strong> <strong>Certification</strong> StatusPhysicians must accurately state their ABIM Board <strong>Certification</strong>status at all times. This includes descriptions in curriculum vitae,advertisements, publications, directories <strong>and</strong> letterheads. Pleasenote: ABIM does not authorize the use <strong>of</strong> its logo by others.Diplomates with expired time-limited certification or those whoseABIM’s Evaluations <strong>and</strong> Judgmentscertification is suspended or revoked may not claim ABIM BoardC<strong>and</strong>idates <strong>for</strong> certification <strong>and</strong> Maintenance <strong>of</strong> <strong>Certification</strong> agree<strong>Certification</strong> <strong>and</strong> must revise all descriptions <strong>of</strong> their qualificationsthat their pr<strong>of</strong>essional qualifications, including their moral <strong>and</strong>accordingly. Diplomates who have multiple certifications <strong>and</strong> allowethical st<strong>and</strong>ing in the medical pr<strong>of</strong>ession <strong>and</strong> their competence inone <strong>of</strong> them to lapse should revise their public materials (letterhead,clinical skills, will be evaluated by ABIM, <strong>and</strong> 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 Board<strong>Certification</strong> status, ABIM may suspend or revoke certification,ABIM may make inquiry <strong>of</strong> persons named in c<strong>and</strong>idates’suspend or revoke the physician’s eligibility <strong>for</strong> certification orapplications <strong>and</strong> <strong>of</strong> other persons, such as authorities <strong>of</strong> licensingmaintenance <strong>of</strong> certification, <strong>and</strong> may notify local credentialingbodies, hospitals, or other institutions as ABIM may deembodies, licensing bodies, law en<strong>for</strong>cement agencies <strong>and</strong> others.appropriate with respect to such matters. C<strong>and</strong>idates agree that11
Errors <strong>and</strong> Disruptions in Examination AdministrationOccasionally problems occur in the creation, administration, <strong>and</strong>scoring <strong>of</strong> examinations. For example, power failures, hardware<strong>and</strong> s<strong>of</strong>tware problems, human errors, or weather problems mayinterfere with some part <strong>of</strong> the examination process. When suchproblems occur <strong>and</strong> ABIM determines that they have compromisedthe integrity <strong>of</strong> examination results, ABIM will provide affectedc<strong>and</strong>idates with an opportunity <strong>for</strong> re-examination.Re-examination shall be the c<strong>and</strong>idate's sole remedy. ABIM shallnot be liable <strong>for</strong> inconvenience, expense, or other damage causedby any problems in the creation, administration, or scoring <strong>of</strong> anexamination, including the need <strong>for</strong> retesting or delays in scorereporting. In no circumstance will ABIM reduce its st<strong>and</strong>ards as ameans <strong>of</strong> correcting a problem in examination administration.Confidentiality PolicyABIM considers the certification or recertification status <strong>of</strong> itsc<strong>and</strong>idates <strong>and</strong> diplomates to be public in<strong>for</strong>mation.ABIM provides a diplomate’s certification status <strong>and</strong> personalidentifying in<strong>for</strong>mation, including mailing address, e-mail address<strong>and</strong> social security number, to the Federation <strong>of</strong> State MedicalBoards (FSMB) <strong>and</strong> the American Board <strong>of</strong> Medical Specialties(ABMS) which publishes The Official ABMS Directory <strong>of</strong> BoardCertified Medical Specialists. The FSMB <strong>and</strong> ABMS use personalidentifying in<strong>for</strong>mation, including social security numbers, as aunique internal identifier <strong>and</strong> maintain the confidentiality <strong>of</strong> thisin<strong>for</strong>mation. On request, ABIM provides a diplomate’s <strong>Certification</strong>status <strong>and</strong> address to pr<strong>of</strong>essional medical societies <strong>and</strong> otherorganizations that provide ABIM-sanctioned educational resources<strong>and</strong> products used <strong>for</strong> self-assessment <strong>of</strong> medical knowledge orpractice per<strong>for</strong>mance in the Maintenance <strong>of</strong> <strong>Certification</strong> program.ABIM provides residency <strong>and</strong> fellowship training directors within<strong>for</strong>mation about a trainee’s prior training <strong>and</strong> 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 <strong>for</strong> that area <strong>of</strong>training. ABIM uses examination per<strong>for</strong>mance, training programevaluations, self-evaluations <strong>of</strong> knowledge <strong>and</strong> practice per<strong>for</strong>mance,<strong>and</strong> other in<strong>for</strong>mation <strong>for</strong> research purposes, includingcollaboration with other research investigators <strong>and</strong> scientific publications.In such research, ABIM will not identify specificindividuals, hospitals, or practice associations. All practice per<strong>for</strong>mancedata is HIPAA compliant.ABIM reserves the right to disclose in<strong>for</strong>mation it possesses aboutany individual whom it judges has violated ABIM rules, engaged inmisrepresentation or unpr<strong>of</strong>essional behavior, or shows signs <strong>of</strong>impairment.LicensureC<strong>and</strong>idates <strong>for</strong> certification <strong>and</strong> Maintenance <strong>of</strong> <strong>Certification</strong> mustpossess a valid, unrestricted, <strong>and</strong> unchallenged medical license inthe United States, its territories or Canada. C<strong>and</strong>idates practicingexclusively abroad <strong>and</strong> who do not hold a U.S. or Canadian license,must hold a license where they practice <strong>and</strong> provide documentationfrom the relevant licensing authority that their license is in goodst<strong>and</strong>ing <strong>and</strong> without conditions or restrictions. A c<strong>and</strong>idate 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, <strong>and</strong> stipulated agreements.Disabled C<strong>and</strong>idatesABIM recognizes that some c<strong>and</strong>idates have physical limitationsthat make it impossible <strong>for</strong> them to fulfill the requirement <strong>for</strong>pr<strong>of</strong>iciency in per<strong>for</strong>ming procedures. For such individuals, theprocedural skills requirement may be waived. Program directorsshould write to ABIM <strong>for</strong> an exception be<strong>for</strong>e the individual enterstraining or when the disability becomes established.ABIM is committed to <strong>of</strong>fering suitable examination accommodations<strong>for</strong> all c<strong>and</strong>idates, including individuals with disabilities.When necessary, alternative arrangements under conditionscomparable to those provided <strong>for</strong> other c<strong>and</strong>idates are <strong>of</strong>fered todisabled individuals. C<strong>and</strong>idates who need accommodation <strong>for</strong> adisability during an examination must provide a written request toABIM at the time <strong>of</strong> application <strong>for</strong> examination. ABIM will thenin<strong>for</strong>m the c<strong>and</strong>idate <strong>of</strong> the documentation that must be receivedby ABIM no later than the examination registration deadline.Reapplication <strong>for</strong> special accommodation is not required <strong>for</strong>each examination administration unless a new accommodationis requested. ABIM treats requests <strong>for</strong> accommodations asconfidential. For additional in<strong>for</strong>mation about the process <strong>and</strong>documentation requirements, please contact ABIM at accommodations@abim.org,or refer to the ABIM website, www.abim.org.12
Substance AbuseIf a c<strong>and</strong>idate or a diplomate has a history <strong>of</strong> substance abuse,documentation <strong>of</strong> at least one year <strong>of</strong> continuous sobriety from areliable monitoring source must be submitted to ABIM <strong>for</strong>admission to an examination or to receive a certificate. ABIM treatssuch in<strong>for</strong>mation as confidential.Suspension <strong>and</strong> Revocation <strong>of</strong> <strong>Certification</strong>ABIM 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 <strong>of</strong> a mistakeon the part <strong>of</strong> ABIM. It may also revoke or suspend certification ifthe diplomate fails to maintain moral, ethical, or pr<strong>of</strong>essionalbehavior satisfactory to ABIM, or engages in misconduct thatadversely affects pr<strong>of</strong>essional competence or integrity. It may revokeor suspend the certificate if: (1) the diplomate made any materialmisstatement <strong>of</strong> fact or omission <strong>of</strong> 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, <strong>and</strong> stipulated agreements. Aphysician may petition ABIM <strong>for</strong> admission to the certificationprocess upon restoration <strong>of</strong> unrestricted licensure. If ABIM grantsthe petition, <strong>and</strong> upon such conditions as ABIM may require, thephysician must complete ABIM’s Maintenance <strong>of</strong> <strong>Certification</strong>program. Upon successful completion <strong>of</strong> the Maintenance <strong>of</strong><strong>Certification</strong> program the physician will be granted a newtime-limited certificate consistent with the then current policies<strong>of</strong> ABIM.data <strong>for</strong>ensic techniques that use statistical analyses <strong>of</strong> test-responsedata to identify patterns <strong>of</strong> test fraud, including cheating <strong>and</strong> piracy.ABIM Sanctions <strong>for</strong> Irregular Examination Behavior,Violation <strong>of</strong> its Copyright, or Other Misuse <strong>of</strong>its MaterialsIrregular or improper behavior in examinations that is observed,made apparent by data <strong>for</strong>ensics, statistical analysis, or uncovered byother means will be considered a subversion <strong>of</strong> the certificationprocess <strong>and</strong> will constitute grounds <strong>for</strong> invalidation <strong>of</strong> a c<strong>and</strong>idate'sexamination. In addition ABIM may at its discretion suspend orrevoke certification, exclude c<strong>and</strong>idates from future examinations,<strong>and</strong> in<strong>for</strong>m program director(s), licensing bodies, impaired physiciansadvocacy groups, or law en<strong>for</strong>cement agencies <strong>of</strong> ABIM’sactions. Those who take ABIM examinations have a continuingobligation to maintain examination confidentiality. Disclosure <strong>of</strong>secure examination content, inducement <strong>of</strong> others to disclose suchcontent, violation <strong>of</strong> ABIM’s copyrights or other misuse <strong>of</strong> ABIMmaterial that subverts its processes may constitute grounds <strong>for</strong> any<strong>of</strong> the <strong>for</strong>egoing actions.Competency in TechnologyConsistent with the ABMS/ACGME General Competenciesin Systems-Based Practice, ABIM requires its c<strong>and</strong>idates <strong>and</strong>diplomates to possess sufficient competencies in in<strong>for</strong>mationtechnology, including the use <strong>of</strong> personal computers, the Internet,<strong>and</strong> e-mail, <strong>for</strong> correspondence <strong>and</strong> completion <strong>of</strong> examinations<strong>and</strong> modules throughout their participation in ABIM <strong>Certification</strong><strong>and</strong> Maintenance <strong>of</strong> <strong>Certification</strong> programs.Irregular Behavior on ExaminationsAll ABIM examinations are administered in secure testing centersby test administrators who are responsible <strong>for</strong> maintaining theintegrity <strong>and</strong> security <strong>of</strong> the certification process. Test administratorsare required to report to ABIM any irregular or improperbehavior by a c<strong>and</strong>idate, such as giving or obtaining in<strong>for</strong>mation oraid, looking at the test material <strong>of</strong> 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 <strong>of</strong> the <strong>for</strong>egoing. Inaddition, as part <strong>of</strong> its ef<strong>for</strong>t to assure exam integrity, ABIM utilizesRe-examinationC<strong>and</strong>idates who are unsuccessful on an examination may apply<strong>for</strong> re-examination. To be granted admission, c<strong>and</strong>idates must meetall applicable licensure, pr<strong>of</strong>essional st<strong>and</strong>ing <strong>and</strong> proceduralrequirements. As long as these requirements are met, there is norestriction on the number <strong>of</strong> opportunities <strong>for</strong> re-examination.Schedule <strong>of</strong> ExaminationsThe schedule <strong>of</strong> examination dates, examination fees <strong>and</strong>policies regarding late applications <strong>and</strong> refunds may be found onABIM’s website at www.abim.org. It is the sole responsibility <strong>of</strong> thec<strong>and</strong>idate to be aware <strong>of</strong> <strong>and</strong> comply with registration deadlines.To register <strong>for</strong> 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 in<strong>for</strong>mation provided in this print publication, <strong>Policies</strong> <strong>and</strong> <strong>Procedures</strong> <strong>for</strong> <strong>Certification</strong>, August 2009,<strong>and</strong> on ABIM’s website governs the American Board <strong>of</strong> Internal <strong>Medicine</strong>'s decision about eligibility<strong>for</strong> certification. This edition supersedes all previous publications. ABIM reserves the right to makechanges in fees, examinations, policies <strong>and</strong> procedures at any time without advance notice. Admission toABIM’s certification process is determined by policies in <strong>for</strong>ce at the time <strong>of</strong> application. ABIM is a member<strong>of</strong> the American Board <strong>of</strong> Medical Specialties.510 Walnut Street Suite 1700Philadelphia, PA 19106 - 3699Copyright © August 2009, American Board <strong>of</strong> Internal <strong>Medicine</strong>1.800.441.ABIMwww.abim.orgE47-08-2009 293