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Internal Medicine / Emergency Medicine Policies

The American Board of Internal Medicine and the American Board of Emergency Medicine offer dual Certification for candidates who have completed at least two and a half years of suitable accredited training in each specialty. A combined residency consists of five years of balanced education in the two disciplines. It is strongly recommended that the participating residencies be in the same academic health center.

To be eligible for dual Certification, the resident must satisfactorily complete 60 months of combined education, which must be verified by the directors of both programs. The certifying examinations cannot be taken until all five years are completed.

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Guidelines

In June 1989, the American Boards of Internal Medicine and Emergency Medicine announced that they will offer dual Certification for candidates (eligible for Certification by each Board) who have completed at least two and a half years of suitable accredited training in each specialty. These guidelines are applicable to residents entering training after July 1989.

Objectives

The objectives of the combined training in Emergency Medicine/Internal Medicine (EM/IM) include the training of physicians for practice or academic careers which address the spectrum of illness and injury from the emergent through the chronic. Graduates of the combined training may function as generalists, practice either discipline, enter subspecialty training, or undertake research. Within an institution, their perspective spanning two specialties has the potential to increase communication and understanding.

Combined programs include components of categorical Emergency Medicine and Internal Medicine residencies which are accredited respectively by the Residency Review Committee for Emergency Medicine (RRC-EM) and by the Residency Review Committee for Internal Medicine (RRC-IM), both of which function under the auspices of the Accreditation Council for Graduate Medical Education (ACGME). While combined programs will not be independently accredited, their accreditation status is determined by that of the parent residencies.

After completion of a combined EM/IM residency program, the graduate will be eligible to sit for boards in each specialty. The Boards will not accept training in a newly established combined program if the accreditation status of the residency in either discipline is probationary. If the residency in either discipline receives probationary accreditation after initiation of the combined training, new residents should not be appointed to the combined training.

General Requirements

A combined EM/IM residency consists of five years of balanced training in the two disciplines which meet the program requirements for accreditation by the RRC-EM and the RRC-IM, respectively.

It is strongly recommended that the participating residencies be in the same academic health center, and documentation of hospital and university commitment to the program, where applicable, must be available in signed agreements. Such agreements must include institutional goals for the combined program. Participating institutions must be located close enough to facilitate cohesion among the program's house staff, attendance at weekly continuity clinics and integrated conferences, and faculty exchanges over curriculum, evaluations, administration and related matters.

Ideally, at least two residents should be enrolled in each year of the five-year program to ensure peer interaction. The total number of residents in combined programs may not exceed the number of residents in the categorical program of either specialty.

At the conclusion of 60 months of training in Emergency Medicine and Internal Medicine, the residents must have had experience and instruction in the prevention, detection and treatment of illness and injury and in the rehabilitation of patients, as well as in the socioeconomics of illness, the ethical care of patients, and in the team approach to the provision of medical care.

The training of residents while on Emergency Medicine rotations is the responsibility of the faculty of Emergency Medicine. Likewise, the training of residents while on Internal Medicine rotations is the responsibility of the Internal Medicine faculty. Prior to the completion of training, each resident must demonstrate some form of acceptable scholarly activity. Scholarly activity may include original research, comprehensive case reports, or review of assigned clinical and research topics.

Vacations, sick leave and leave for meetings must be shared equally by both training programs. Absences from the training program (vacation, maternity/paternity leave, sick leave) exceeding five months in the 60 months must be made up.

Except for the following provisions, combined residencies must conform to the Program Requirements for Accreditation of Residencies in Emergency Medicine and Internal Medicine.

The Resident

Residents should enter a combined program at the R-1 level. A resident may enter a combined program at the R-2 level only if the first residency year was served in an accredited categorical residency in either Emergency Medicine or Internal Medicine. Residents may not enter combined training beyond the R-1 level or transfer between combined training programs in different institutions unless prospectively approved by both Boards. If they transfer between combined training programs, residents must be offered and complete a full-integrated curriculum. A transitional year of training will provide no credit toward the requirements of either Board.

A resident transferring from a combined training program to a straight Emergency Medicine or Internal Medicine program must have prior approval from the receiving Board.

Training in each discipline must incorporate graded responsibility throughout the training period. Each resident must have supervisory responsibility for at least six months during each discipline's 30 months of training.

The combined training must be coordinated by a designated director or co-directors who can devote substantial time and effort to the educational program. An overall program director may be appointed from either specialty, or co-directors may be appointed from both specialties. If a single program director is appointed, an associate director from the other specialty must be named to ensure both integration of the program and supervision of each discipline. An exception to the above requirements would be a single director who is board certified in each discipline and has an academic appointment in each department. The two directors should embrace similar values and goals for their program.

The supervising directors from both specialties must document meetings with one another and the leadership of their respective departments at least twice a year to monitor the success of the program and the progress of each resident.

Length of Training

The training requirements for credentialing for the certifying examination of each Board will be fulfilled in 60 months of the combined program. A shortening of 12 months training from that required for two separate residencies is possible due to appropriate overlap of training requirements.

Core Curriculum Requirements

A clearly described written curriculum must be available to residents, faculty and both Residency Review Committees. There must be 30 months of training in each specialty. The curriculum must assure a cohesive, planned educational experience and not simply comprise a series of rotations between the two specialties. Duplication of clinical experiences between the two specialties should be avoided. Periodic review of the program curriculum must be performed. This review must include the program directors from both departments, as well as faculty and residents.

Six months of training in the first year should be spent under the direction of each specialty. During the final 48 months, continuous assignments to one specialty or the other should be not less than three, nor more than six months in duration.

A joint educational conference involving residents from Emergency Medicine and Internal Medicine is desirable. The joint conference should specifically include the participation of all residents in the combined training program.

Internal Medicine Requirements

During the 30 months of Internal Medicine training, each resident must obtain 20 months of experience with direct responsibility for patients with illnesses in the domain of Internal Medicine. These 20 months must include three months in intensive care units, and at least seven months on non-intensive inpatient rotations. The resident should have significant exposure to cardiology. Both general medical and specialized (i.e., oncology) units are acceptable assignments. A maximum of three months of Emergency Medicine experience can be applied to 20 months of meaningful patient responsibility requirements for Internal Medicine.

At least 33 percent of the 30 months of Internal Medicine experience must involve non-hospitalized patients. This must include a continuity experience for each resident in a half-day per week continuity-care clinic during the 30 months of Internal Medicine training, and block experience in ambulatory medicine for at least two months. These experiences may include work in subspecialty clinics and walk-in clinics, and brief rotations for appropriate interdisciplinary experience in areas such as dermatology, office gynecology and orthopedics. All residents must gain significant exposure to the disciplines of psychiatry and neurology.

Residents are to be encouraged to follow their outpatients during the course of the patient's hospitalizations. The resident need not be scheduled in the continuity-care clinic during Emergency Department and Intensive Care Unit rotations. Health maintenance, prevention and rehabilitation should be emphasized. Residents should work in the clinics with other professionals, such as social workers, nurse practitioners, physician assistants, behavioral scientists and dietitians.

Internal Medicine subspecialty experiences must be provided to every resident for at least four months. Some of this must include experience as a consultant. In addition, all residents must be given experience as a general medical consultant to other services in the institution. Residents must have formal and regular supervised clinical experience in geriatric medicine. This may occur on geriatric inpatient units, geriatric consultation services, long-term facilities, geriatric ambulatory clinics and/or home care settings.

Residents must regularly attend morning report, medical grand rounds, work rounds, and mortality and morbidity conferences when on Internal Medicine rotations.

Emergency Medicine Requirements

Unless otherwise specified, all Program Requirements for training in Emergency Medicine must be met.

Thirty months of training must be provided under the direction of Emergency Medicine faculty and must include at least 12 months of Emergency Department experience.

The Emergency Department experience must provide the resident the opportunity to manage an adequate number of patients of all ages and both sexes with a wide variety of clinical problems. At least three percent of the patient population must present with critical illness or injury.

Two months of the required critical care rotations in Internal Medicine may be credited to training in Emergency Medicine.

Pediatric experience should be at least 16 percent of all resident Emergency Department encounters or four months of full-time-equivalent experience dedicated to the care of infants and children. The program can balance a deficit of patients by offering dedicated rotations in the care of infants and children. The formula for achieving this balance: a one month rotation equals four percent of patients. Although this experience should include the critical care of infants and children, at least 50 percent of the four months should be in an emergency setting.

Clinical experience in emergency medical systems management, and major multiple trauma management must be provided.

Evaluation

There must be adequate, ongoing evaluation of the knowledge, skills and performance of the residents. Entry evaluation assessment, interim testing and periodic reassessment, as well as other modalities for evaluation, should be utilized. There must be a method of documenting the procedures that are performed by the residents. Such documentation must be maintained by the program, be available for review by the RRCs, ABEM, ABIM, and site visitors, and be used to provide documentation for future hospital privileges.

The faculty must provide a verbal and written evaluation of each resident after each rotation, and these must be available for review by the resident and site visitors. Written evaluation of each resident's knowledge, skills, professional growth, and performance, using appropriate criteria and procedures, must be accomplished at least semiannually and communicated to and discussed with the resident in a timely manner.

Residents should be advanced to positions of higher responsibility only on the basis of evidence of their satisfactory progressive scholarship and professional growth.

The training program must maintain a permanent record of evaluation for each resident and make it available to the resident and other authorized personnel. The training director of the EM/IM program is responsible for the provision of a written final evaluation for each resident who completes the program. This evaluation must include a review of the resident's performance during the final period of training and should verify that the resident has demonstrated sufficient professional ability to practice competently and independently. This final evaluation should be part of the resident's permanent record maintained by the institution.

Certification

To meet eligibility for dual Certification, the resident must satisfactorily complete 60 months of combined training, which must be verified by the directors of both programs. Lacking verification in one or both specialties, the resident must satisfactorily complete 36 months of training in either Emergency Medicine or Internal Medicine to meet the eligibility requirements in either specialty. The certifying examinations cannot be taken until all five years of training in both specialties are satisfactorily completed.

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Programs

To add a program or to update program information, e-mail request@abim.org.

Internal Medicine/Emergency Medicine Programs
State Program
California UCLA Medical Center
Jill Klessig, MD
Pamela Dyne, MD
Sepulveda VA Hospital
924 Westwood Boulevard, Suite 300
Los Angeles, CA 90024
(818) 364-3108
(818) 364-3268 (fax)
pdyne@ucla.edu
Delaware Christiana Care Health Services
Charles L. Reese, IV, MD
4755 Ogletown-Stanton Road
Newark, DE 19718
(302) 733-1840
(302) 733-1633 (fax)
creese@christianacare.org
Illinois University of Illinois College of Medicine at Chicago
Carissa J. Tyo, MD
808 S. Wood Street (MC 724)
Suite 470
Chicago, IL 60612-0612
(312) 996-5719
(312) 413-0289 (fax)
ctyo1@uic.edu
Louisiana Louisiana State University Health Sciences Center
Jorge A. Martinez, MD
Rm 436
1542 Tulane Avenue
New Orleans, LA 70112
(504) 568-4713
(504) 568-7884 (fax)
jmarti4@lsuhsc.edu
Maryland University of Maryland
Michael E. Winters, MD
Department of Surgery, Division of Emergency Medicine and Department of Medicine
110 South Paca Street, 6th Floor, Suite 200
Baltimore, MD 21201
(410) 328-8025
(410) 328-8028 (fax)
mwint001@umaryland.edu
Michigan Henry Ford Hospital Program
Nikhil Goyal, MD
2799 West Grand Boulevard, CFP-258
Detroit, MI 48202-2689
(313) 916-1553
(313) 916-7437 (fax)
jowensl@hfhs.org
Minnesota Hennepin County Medical Center Program
Anne Pereira, MD (Internal Medicine)
Marc Martel, MD (IM/Emergency Medicine)
Department of Medicine
701 Park Avenue
ME R7
Minneapolis, MN 55415
(612) 873-4733
(612) 904-4263 (fax)
anne.pereira@co.hennepin.mn.us
New York SUNY Health Science Center at Brooklyn
Jeanne Macrae, MD
Christopher Doty, MD
450 Clarkson Avenue
P.O. Box 1228
Brooklyn, NY 11203-2098
(718) 245-3320
(718) 245-4799 (fax)
em-im.residency@downstate.edu
Long Island Jewish Medical Center
Barbara Barnett, MD
Long Island Jewish Medical Center
270-05 76th Avenue
New Hyde Park, NY 11040
(718) 470-7873
(718) 470-9113 (fax)
bbarnett@lij.edu
North Carolina East Carolina University
Nathan Nehus, MD
Brody School of Medicine
600 Moye Boulevard
Greenville, NC 27834
(252) 744-4184
(252) 744-4125 (fax)
nehusn@ecu.edu
Ohio Ohio State University Wexner Medical Center
Program Director: Eric J. Adkins, MD
Program Co-Director: Daniel R. Martin, MD
Department of Emergency Medicine
760 Prior Hall
376 W. 10th Avenue
Columbus, OH 43210
(614) 293-8305
(614) 293-6570 (fax)
Ellen.Harr-Weatherby@osumc.edu
Pennsylvania Allegheny General Hospital/Medical College of PA
Mara S. Aloi, MD
320 E. North Avenue
Pittsburgh, PA 15212
(412) 359-4905
(412) 359-4963 (fax)
cadelsbe@wpahs.org
Virginia Virginia Commonwealth University Medical Center
Pawan Suri, MD
Frank Zwemer, MD
A.D. Williams Clinic, 2nd Floor
1201 East Marshall Street
P.O. Box 980401
Richmond, VA 23298-0401
(804) 828-5250
(804) 828-4686 (fax)
psuri@mcvh-vcu.edu
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