Critical Care Medicine Policies
The Critical Care Medicine Certification Program is developed by the American Board of Internal Medicine (ABIM) and the American Board of Emergency Medicine (ABEM). The examination is administered to candidates from both Boards at the same time in the same testing centers. ABIM is responsible for administering the examination.
- Eligibility for Certification and Board Policies
- General Requirements
- Dual Certification Requirements - Pulmonary Disease and Critical Care Medicine
- Training and Procedural Requirements
- Clinical Competence Requirements
- Candidates for Special Consideration
- Certification Using the Research Pathway
- Information for Candidates Certified by Other Boards
Eligibility for Certification and Board Policies
The information provided on ABIM's website governs ABIM's decision about eligibility for certification. ABIM reserves the right to make changes in fees, examinations, policies and procedures at any time without advance notice. Admission to ABIM's certification process is determined by policies in force at the time of application. ABIM is a member of the American Board of Medical Specialties (ABMS).
To become certified in the subspecialty of Critical Care Medicine, physicians must:
- At the time of application, be previously certified in Internal Medicine by ABIM
- Satisfactorily complete the requisite formal training requirements as specified in the descriptions of the pathways for admission
- Demonstrate clinical competence, procedural skills, and moral and ethical behavior in the clinical setting
- Hold a valid, unrestricted and unchallenged license to practice medicine
- Pass the Critical Care Medicine Certification Examination
Critical care medicine training undertaken July 1, 1991 and after must be accredited by the Accreditation Council for Graduate Medical Education (ACGME) or by the Royal College of Physicians and Surgeons of Canada. Training completed prior to July 1, 1991 must have been completed in a program associated with an accredited residency in internal medicine in the United States or Canada.
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 the examination. Critical care medicine training must be conducted in a fellowship program within the Department of Medicine.
No credit will be granted toward certification for training that is not accredited by the ACGME, the Royal College of Physicians and Surgeons of Canada, or the Professional Corporation of Physicians of Quebec.
Candidates for certification in the subspecialties must meet ABIM'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.
Pathways for Admission
Diplomates may apply for admission to the critical care medicine examination under one of the three pathways.
- Two years of accredited fellowship training in a subspecialty of internal medicine (three years for cardiovascular disease and gastroenterology), including the care of patients in critical care units
- Certification by ABIM in the subspecialty
- One year of accredited clinical fellowship training in critical care medicine within the Department of Medicine.
*ABIM Diplomates who are also certified in neurology by the American Board of Psychiatry and Neurology may apply through Pathway A provided neurology training included the care of patients in critical care units and the additional year of accredited critical care medicine fellowship training is sponsored by a department of internal medicine.
- Two years of accredited fellowship training in critical care medicine (including twelve months of full-time clinical training) within the Department of Medicine.
- Two years of fellowship training in advanced general internal medicine that includes at least six months of critical care medicine
- One year of accredited fellowship training in critical care medicine within the Department of Medicine
If you take the Critical Care Medicine Examination after completing two years of training in critical care medicine and before certifying in a subspecialty, you will be required to take two additional years of fellowship training in the subspecialty (three years for cardiovascular disease and gastroenterology) to take the subspecialty examination. No credit will be granted toward certification for training that is not accredited by the ACGME, the Royal College of Physicians and Surgeons of Canada, or the Professional Corporation of Physicians of Quebec.Top
Dual Certification Requirements - Pulmonary Disease and Critical Care Medicine
Candidates seeking dual certification in pulmonary disease and critical care medicine must complete a minimum of three years of accredited combined training, 18 months of which must be clinical training.
Only candidates certified in a subspecialty that requires at least two years of accredited fellowship training (three years for cardiovascular disease and gastroenterology) are permitted to take the critical care medicine examination after completion of 12 months of accredited clinical critical care medicine fellowship training. Candidates certified in internal medicine only must complete 24 months of accredited critical care medicine fellowship training, including 12 months of clinical training, to qualify for the critical care medicine examination.
Thus, for candidates applying for dual certification in pulmonary disease and critical care medicine with three years of combined training, certification in pulmonary disease must be achieved before the candidate is eligible to apply for admission to the critical care medicine examination.Top
Training and Procedural Requirements
The total months of training required, including specific clinical months, and requisite procedures are outlined below.
* For deficits of less than one month in required training time, ABIM will defer to the judgment of the program director and promotions or competency committee in determining the need for additional training. With program director attestation to ABIM that the trainee has achieved required competence, additional training time will not be required. Trainees cannot make a request to ABIM on their own behalf.
A &C - 12*
Airway management and endotracheal intubation; ventilator management and noninvasive ventilation; insertion and management of chest tubes, and thoracentesis; advanced cardiac life support (ACLS); placement of arterial, central venous, and pulmonary artery balloon flotation catheters; calibration and operation of hemodynamic recording systems; proficiency in use of ultrasound to guide central line placement and thoracentesis is strongly recommended.
Candidates should know the indications, contraindications, complications, and limitations of the following procedures: pericardiocentesis, transvenous pacemaker insertion, continuous renal replacement therapy (CRRT) and hemodialysis, and fiberoptic bronchoscopy. Practical experience is recommended.
B - 24*
More About Training
Training in critical care medicine must include at least twelve months (up to one month vacation allowed) of appropriately supervised clinical activity directly related to the care of critically ill patients. Clinical activity refers to time spent in meaningful responsibility in the care of patients either as the primary physician, or as a supervising fellow. All twelve months of clinical activity must be devoted to Critical Care Medicine training. It must provide a balanced experience in a variety of critical care settings, and must be broader in scope than the training for any single subspecialty of internal medicine.
In certain circumstances, when critical care medicine training is combined with training in a subspecialty of internal medicine, clinical training experience in critical care medicine that occurs during subspecialty training can be applied to requirements for admission to both the subspecialty and the Critical Care Medicine Certification examinations. The subspecialty and critical care medicine training can be done at one or more than one institution, at the discretion of the subspecialty and critical care medicine program directors.
For certification in pulmonary disease and critical care medicine or cardiovascular disease and critical care medicine, up to six months of clinical critical care medicine experience can be applied to the clinical requirements for admission to both examinations. In nephrology and critical care medicine or infectious disease and critical care medicine, four and two months respectively of clinical critical care medicine experience may be applied to the clinical requirements for admission to both examinations. Such dual application of credit is at the discretion of the subspecialty and critical care medicine program directors.
In cases of dual certification, the minimum total full-time clinical training is 18 months for the combination of certification in critical care medicine/pulmonary disease; it is 20 months for critical care medicine/nephrology, 22 months for critical care medicine/infectious disease, and 30 months for critical care medicine/cardiovascular disease. The total training time will not be reduced and remains four years for certification in critical care medicine and cardiovascular disease or gastroenterology and three years for certification in critical care medicine and any other subspecialty of internal medicine.
ABIM and ACGME RRC-IM Exception for Training in Critical Care Medicine
This exception for training leading to certification by ABIM in Critical Care Medicine applies only to physicians eligible for ABIM certification. Other physicians eligible for certification in Critical Care Medicine should consult their co-sponsoring Board with any questions.
The American health care system needs more specialists in Critical Care Medicine. Physicians who are certified in Critical Care Medicine by ABIM meet training requirements through completion of Accreditation Council on Graduate Medical Education (ACGME) accredited training in Critical Care Medicine.
The ACGME accredits three types of fellowship programs in Critical Care Medicine: 1) Two-year Critical Care Medicine programs (for internal Medicine graduates); 2) One-year Critical Care Medicine programs (for subspecialty program graduates); and, 3) Combined Pulmonary and Critical Care Medicine programs. As of November 2006, there were 130 combined Pulmonary and Critical Care Medicine programs and 28 "stand-alone" or "straight" Critical Care Medicine programs accredited by the ACGME.
Currently there are a small number of internal medicine and subspecialty graduates who wish to pursue certification in Critical Care Medicine but not Pulmonary Medicine. In order to accommodate these trainees, the ACGME Residency Review Committee in Internal Medicine (RRC-IM) will now permit accredited three-year combined Pulmonary and Critical Care Medicine programs to train occasional stand-alone Critical Care Medicine fellows; and ABIM will recognize stand-alone training completed in an ACGME-accredited combined Pulmonary-Critical Care Medicine program.
If combined Pulmonary and Critical Care Medicine programs accept an occasional critical care medicine fellow (i.e. no more than one fellow every two years), then the RRC-IM willl not require prior approval of a separate track in Critical Care Medicine. If Pulmonary and Critical Care Medicine combined programs plan to accept more than one straight Critical Care Medicine fellow every other year, such programs should obtain RRC-IM approval for Critical Care Medicine tracks (i.e. one-year, two-year, or both) within the combined program.
In all cases, stand-alone Critical Care Medicine training should be based on a curriculum or educational plan that is separate from the curriculum of the combined Pulmonary and Critical Care program, and that fulfills the program requirements for Critical Care Medicine.
At all times, programs must stay within their approved complement of fellow positions. The RRC-IM will grant temporary increases (via Web-ADS) to accommodate an occasional additional stand-alone Critical Care Medicine trainee. If the program offers more than an occasional stand-alone Critical Care Medicine position (i.e. no more than one fellow every two years), then the program should request a permanent complement increase and obtain approval for a Critical Care Medicine track.
Although this policy was developed for occasional stand-alone Critical Care training within Pulmonary and Critical Care Medicine programs, the same principles will apply to stand-alone Pulmonary training within Pulmonary and Critical Care Medicine programs, as well as to stand-alone training in either specialty in combined Hematology-Oncology programs.Top
Clinical Competence Requirements
ABIM requires documentation that candidates for certification are competent in: (1) patient care and procedural skills, (2) medical knowledge, (3) practice-based learning and improvement, (4) interpersonal and communication skills, (5) professionalism and (6) systems-based practice.
Through its tracking process, FasTrack®, ABIM 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. In addition, fellows must receive satisfactory ratings in each of the six ACGME/ABMS Competencies and the requisite procedures during the final year of required training. It is the fellow's responsibility to arrange for any additional training needed to achieve a satisfactory rating in each of the six ACGME/ABMS Competencies and overall clinical competence.Top
Program Director Ratings of Clinical Competence
Six ACGME/ABMS Competencies
The fellow is demonstrating satisfactory development of the knowledge, skill, and attitudes/behaviors needed to advance in training. S/he is demonstrating a learning trajectory that anticipates the achievement of competency for unsupervised practice that includes the delivery of safe, effective, patient-centered, timely, efficient and equitable care.
|Components and Ratings||Residents/Fellows: Not Final Year of Training||Residents/Fellows: Final Year of Training|
* The six required competencies are: (1) patient care and procedural skills, (2) medical knowledge, (3) practice-based learning and improvement, (4) interpersonal and communication skills, (5) professionalism and (6) systems-based practice.
† At the discretion of the program director, training in the final year may be extended as necessary to achieve satisfactory ratings in overall clinical competence and/or the six ACGME/ABMS competencies.
|Yes||Full credit||Full credit|
|Conditional on Improvement||Full credit||No credit; must achieve satisfactory rating before receiving credit †|
|No||Full credit||No Credit; must repeat year|
Overall Clinical Competence
This rating represents the assessment of the fellow's development of overall clinical competence during this year of training:
|Components and Ratings||Residents/Fellows: Not Final Year of Training||Residents/Fellows: Final Year of Training|
|* At the discretion of the program director, training in the final year may be extended as necessary to achieve satisfactory ratings in overall clinical competence and/or the six ACGME/ABMS competencies.|
|Satisfactory or Superior||Full credit||Full credit|
|Conditional on Improvement||Full credit||No credit; must achieve satisfactory rating before receiving credit*|
|Unsatisfactory||No credit; must repeat year||No credit; must repeat year|
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.Top
Certification 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.Top
Information for Candidates Certified by Other Boards
The policy information above applies only to ABIM diplomates who are seeking admission to the Critical Care Medicine Certification Examination via ABIM. Candidates from co-sponsoring Boards should contact their primary certification Boards with any questions regarding certification policies or eligibility to apply for admission to the examination.