Hospice & Palliative Medicine Policies
The Hospice and Palliative Medicine Certification Program is developed by the American Board of Internal Medicine (ABIM), the American Board of Anesthesiology (ABA), the American Board of Emergency Medicine (ABEM), the American Board of Family Medicine (ABFM), the American Board of Obstetrics and Gynecology (ABOG), the American Board of Pediatrics (ABP), the American Board of Physical Medicine and Rehabilitation (ABPMR), the American Board of Psychiatry and Neurology (ABPN), the American Board of Radiology (ABR), and the American Board of Surgery (ABS). The examination is administered to candidates from all Boards at the same time in the same testing centers. The American Board of Internal Medicine is responsible for administering the examination.
Note: This exam was offered for the first time in 2008.
- Eligibility for Certification and Board Policies
- General Requirements
- 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 and in ABIM's print publication, Policies and Procedures for Certification, September 2011 (pdf), governs ABIM's decision about eligibility for certification. The September 2011 edition supersedes all previous publications. 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).
General Requirements
To become certified in the subspecialty of Hospice and Palliative Medicine, physicians must:
- At the time of application, maintain current, valid ABIM certification in Internal Medicine or a subspecialty
- Satisfactorily complete the requisite practice experience or formal training requirements
- Demonstrate clinical competence, and moral and ethical behavior in the clinical setting
- Hold a valid, unrestricted and unchallenged license to practice medicine
- Pass the Hospice and Palliative Medicine Certification Examination
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 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.
NOTE: Candidates from other Boards should contact those Boards for information regarding certification requirements.
Practice Pathway
Note: Practice Pathway A is open to candidates who have been in the practice of hospice and palliative medicine for a minimum of 24 months at the time of application. For the 2012 examination, those who completed training after June 30, 2010 should not apply through Practice Pathway A.
ABIM diplomates who have not completed 12 months of formal fellowship training in hospice and palliative medicine will be eligible to apply for the Hospice and Palliative Medicine Examination in 2012 through the Practice Pathway if, at the time of application for examination, they can demonstrate:
Practice Pathway A
At least 800 hours of clinical involvement in subspecialty-level practice of hospice and palliative medicine during the last five years prior to application for examination, including:
- At least two years of post-training practice experience
- At least 100 hours of participation with a hospice or palliative care team*
- Participation in the active care of at least 50 terminally ill patients or patients requiring palliative care (25 for pediatrics)
*To qualify, interdisciplinary hospice or palliative care teams must have all of the following characteristics: (a) provide active clinical care, (b) hold regular meetings, (c) have regular membership of a physician, nurse and at least one other professional from a psychosocial discipline, and (d) operate in a context in which a substantial number of the team's patients are near the end of life. It is expected that multidisciplinary team members will be appropriately trained and ultimately certified in Hospice and Palliative Medicine.
AND
- Substantiate practice experience on a “Form Attesting Hospice and Palliative Care Practice” signed by the Hospice Medical Director and a member of the interdisciplinary hospice or palliative care team.
OR
Practice Pathway B
- Certification by the American Board of Hospice and Palliative Medicine (ABHPM) expiring December 31, 2007 and after. ABIM will independently verify an applicant's ABHPM certification status.
Training Pathway
The Training Pathway for ABIM candidates requires 12 months of satisfactorily completed clinical hospice and palliative medicine fellowship training* which meets the following criteria:
- Hospice and palliative medicine fellowship training undertaken July 1, 2010 and thereafter must be accredited by the Accreditation Council for Graduate Medical Education (ACGME) or the Royal College of Physicians and Surgeons of Canada. Hospice and Palliative Medicine fellowship training taken prior to July 1, 2010 must be conducted within a program affiliated with an accredited residency or fellowship program.
*Hospice and palliative medicine fellowship training which was credited toward the training requirements for admission to another ABIM examination, e.g., the ABIM Geriatric Medicine Certification Examination or the ABIM Medical Oncology Certification Examination, cannot be used to fulfill the training requirements for admission to the Hospice and Palliative Medicine Examination.
TopTraining 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 |
|---|---|---|
|
* 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. |
||
| 12* | 12 | No required procedures |
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 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 training needed to achieve a satisfactory rating in each component of clinical competence.
Program Director Ratings of Clinical Competence
| Ratings | Fellows (any year) |
|---|---|
| Satisfactory or Superior | Full credit |
| Unsatisfactory | No credit, must repeat year |
| Ratings | Fellows (any year) |
|---|---|
| Satisfactory | Full credit |
| Unsatisfactory | No credit, must repeat year or, at the request of the program director and at ABIM’s discretion, a successful period of observation can be arranged in lieu of repeating the year to be granted credit |
| Ratings | Fellows (any year) |
|---|---|
| * 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. | |
| Satisfactory or Superior | 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.
TopInformation for Candidates Certified by Other Boards
The policy information above applies only to ABIM diplomates who are seeking admission to the Hospice and Palliative 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.