Clinical Cardiac Electrophysiology Policies
- Eligibility for Certification and Board Policies
- General Requirements
- Training and Procedural Requirements
- Clinical Competence Requirements
- Candidates for Special Consideration
- Certification Using the Research Pathway
Eligibility for Certification and Board Policies
The information provided on ABIM's website and in ABIM's print publication, Policies and Procedures for Certification, November 2007*, governs the American Board of Internal Medicine's decision about eligibility for certification. The November 2007 edition supersedes all previous publications. The Board reserves the right to make changes in fees, examinations, policies and procedures at any time without advance notice. Admission to the Board's examinations will be determined by policies in force at the time of application. ABIM is a member of the American Board of Medical Specialties (ABMS).
* Located in Reports & Publications
General Requirements
To become certified in the subspecialty of clinical cardiac electrophysiology, physicians must have:
- Been previously certified in internal medicine by ABIM
- Maintained a current underlying certificate in cardiovascular disease by ABIM
- Satisfactorily completed the requisite graduate medical education fellowship training
- Demonstrated clinical competence in the care of patients
- Met the licensure and procedural requirements
- Passed the Certification Exam in Clinical Cardiac Electrophysiology
Clinical cardiac electrophysiology training undertaken July 1, 1998 and thereafter must be accredited by the Accreditation Council for Graduate Medical Education (ACGME).
Fellowship training taken before completing the requirements for the MD or DO degree, training as a chief medical resident, practice experience, and attendance at postgraduate courses may not be credited toward the requirements for subspecialty certification.
To be admitted to an examination, candidates must have completed the required training in the subspecialty, including vacation time, by October 31st of the year of examination.
Candidates for certification in the subspecialties must meet the Board's requirements for duration of training as well as minimum duration of full-time clinical training. Clinical training requirements may be met by aggregating full-time clinical training that occurs throughout the entire fellowship training period; clinical training need not be completed in successive months. Time spent in continuity outpatient clinic, during non-clinical training, is in addition to the requirement for full-time clinical training. Educational rotations completed during training may not be double counted to satisfy both internal medicine and subspecialty training requirements. Likewise, training which qualifies a diplomate for admission to one subspecialty exam cannot be double-counted toward certification in another subspecialty, with the exception of formally approved pathways for dual certification.
Training Pathway
Candidates first applying for certification in clinical cardiac electrophysiology in 1998 and thereafter must meet the requirements of the Formal Training Pathway, as outlined below:
- Three years of cardiovascular disease fellowship training, including 24 months of clinical training, in programs accredited by the Accreditation Council for Graduate Medical Education (ACGME).
- One additional year of acceptable training in clinical cardiac electrophysiology completed July 1, 1992 or after (see the explanation of criteria in the section entitled "Acceptable Training Programs").
- Each year since completion of training, commitment of at least 50% of professional time and effort to clinical cardiac electrophysiology, including balanced experience in a variety of clinical settings. Settings may include, but are not limited to, the electrophysiology laboratory (serving as the primary operator or as an assistant closely involved with data collection and analysis), emergency department, coronary care unit, operating room and follow-up clinic.
Note: Candidates who were previously admitted to the examination through the practice pathway and have not yet achieved certification will continue to be admitted to future clinical cardiac electrophysiology examinations. Such candidates must continue to meet the Board's requirements for licensure and professional standing and document that their commitment to clinical cardiac electrophysiology involves at least 50% of their professional time and effort.
Acceptable Training Programs
Clinical cardiac electrophysiology training taken July 1, 1998 and thereafter must be accredited by ACGME. Training undertaken prior to July 1, 1998 must meet the following criteria:- The clinical cardiac electrophysiology training must be conducted in a program that is accredited for training in cardiovascular disease by ACGME. Training in clinical cardiac electrophysiology must include clinical activity either as the primary physician or as a consultant for/to patients with cardiac arrhythmias. The training must be supervised by a qualified electrophysiologist. The training should provide a balanced experience in a variety of clinical settings including, but not limited to, the electrophysiology laboratory, emergency department, coronary care unit, operating room, and the follow-up clinic.
- The program must be structured to permit the development of requisite procedural and technical skills, which are the learned manual skills and the associated technical aspects necessary to perform diagnostic and therapeutic procedures. Successful mastery of these essential skills also includes an understanding of the indications for electrophysiologic study, contraindications and complications, and the ability to monitor and interpret the results.
Training and Procedural Requirements
The total months of training required, including specific clinical months, and requisite procedures are outlined below.
| Minimum Months of Training |
Clinical Months Required |
Procedures |
|---|---|---|
| 12 | 12 | Electrophysiologic studies both with a catheter and intraoperatively; catheter-based and other ablation procedures; and implantation of pacemakers and cardioverters-defibrillators (a minimum of 150 intracardiac procedures in at least 75 patients, of which 75 are catheter-based ablation procedures, including postdiagnostic testing, and 25 are initial implantable cardioverter-defibrillator procedures, including programming). |
More About Procedures
To assure credible confirmation of proficiency in certain procedural techniques, candidates must perform a minimum of 150 intracardiac procedures in at least 75 patients, of which 75 are catheter ablations (including postdiagnostic testing) and 25 are initial cardioverter-defibrillator implantations (including programming). Participation in diagnostic EP studies (including mapping) is necessary, as is implantation and programming of pacemakers. The candidate may serve as a primary operator or as an assistant closely involved with data collection and analysis.
Performance of the required minimum number of procedures is not a guarantee of proficiency. The Board will seek substantiation from the training program director that the candidate acquired the requisite skills and is competent to provide comprehensive and specialized medical care in the field of clinical cardiac electrophysiology.
TopClinical Competence Requirements
The Board requires documentation that candidates for certification are competent in (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.
Through its tracking process, the Board requires verification of fellows' clinical competence from the training program director.
As outlined in the Program Director Ratings of Clinical Competence table below, all fellows must receive satisfactory ratings of overall clinical competence and moral and ethical behavior in each of the required years of training. In addition, fellows must receive satisfactory ratings in each of the components of clinical competence and the requisite procedures during the final year of required training. It is the fellow's responsibility to arrange for any additional required training.
Program Director Ratings of Clinical Competence
| Ratings | Fellows (any year) |
|---|---|
| Satisfactory | Full credit |
| Unsatisfactory | No credit, must repeat year |
| Ratings | Fellows (any year) |
|---|---|
| Satisfactory | Full credit |
| Unsatisfactory | Repeat year or, at the Board's discretion, a period of observation will be required |
| Ratings | Fellows (any year) |
|---|---|
| * 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. | |
| Satisfactory | Full credit |
| Unsatisfactory | Must repeat year if during final year of required training |
Candidates for Special Consideration
ABIM diplomates in internal medicine may be proposed for special consideration for admission to a subspecialty examination by the program director of an accredited fellowship program if they:
- Have completed the full training required by ABIM in the subspecialty in another country and have met all current applicable ABIM procedural requirements.
- Are a full-time Associate Professor or higher in the specified subspecialty division of the Department of Medicine in an LCME-accredited medical school or an accredited Canadian medical school at the time of proposal.
- Have served eight years, after formal training, as a clinician-educator or clinical investigator with a full-time appointment on a medical school faculty.
- Possess a valid, unrestricted license to practice medicine in a state, territory, commonwealth, province or possession of the United States or Canada.
Guidelines for proposals are available in Proposing Candidates for Special Consideration.
TopCertification Using the Research Pathway
The ABIM Research Pathway is designed to integrate training in research and clinical internal medicine for those physicians who are seriously pursuing careers in basic science or clinical research. The value of the ABIM Research Pathway is that while it requires core clinical training, it concentrates on fostering a research experience that is comprehensive in terms of time, formal curriculum, and structured evaluation and feedback. These components are essential for professional growth and development and to promote continuous quality improvement.
Guidelines for certification using the research pathway are available in Research Pathway.
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