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 will be offered for the first time in the Fall of 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
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 hospice and palliative medicine, physicians must have:
- Been previously certified in internal medicine by ABIM
- Maintain a current underlying certificate in Internal Medicine or an ABIM Subspecialty
- 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 Hospice and Palliative Medicine
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.
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 2008 examination, those who completed training after June 1, 2006 should not apply through Practice Pathway A.
For administration of the first three examinations (2008, 2010, 2012), 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 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 subspecialty level practice in hospice and palliative medicine
- 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 (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 psycho-social 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.
OR
Practice Pathway B
- Documentation of certification by the American Board of Hospice and Palliative Medicine (ABHPM). ABHPM certificates expiring December 31, 2007 and after are acceptable in fulfillment of Practice Pathway B requirements.
Training Pathway
The Training Pathway for ABIM candidates requires 12 months of satisfactorily completed hospice and palliative medicine fellowship training* which meets the following criteria:
- Hospice and Palliative Medicine fellowship training undertaken July 1, 2010, and after must be accredited by the Accreditation Council for Graduate Medical Education (ACGME). Hospice and Palliative Medicine fellowship training taken prior to July 1, 2010, must be conducted within a program affiliated with an ACGME-accredited residency or fellowship program.
- Training experience must be consistent with guidelines established by the Accreditation Council for Graduate Medical Education (ACGME), or, until formal guidelines are developed by ACGME, by the guidelines of the Palliative Medicine Review Committee (PMRC), which is closely modeled after ACGME's Residency Review Committees.
- ABIM will require substantiation by the training program director that the fellow's clinical competence as a hospice and palliative medicine consultant is satisfactory.
* Hospice and Palliative Medicine fellowship training which was credited toward the training requirements for admission to another ABIM examination, e.g., the Geriatric Medicine Examination or the Medical Oncology 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 |
|---|---|---|
| 12 | 12 | No required procedures |
Clinical 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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