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Internal Medicine Policies

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Eligibility for Certification and Board Policies

The information provided on ABIM's website and in ABIM's print publication, Policies and Procedures for Certification, December 2013 (pdf), governs ABIM's decision about eligibility for certification. The December 2013 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).

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General Requirements

To become certified in internal medicine, a physician must complete the requisite predoctoral medical education, meet the graduate medical education training requirements, demonstrate clinical competence in the care of patients, meet the licensure and procedural requirements, and pass the Certification Examination in Internal Medicine.

Predoctoral Medical Education

Candidates who graduated from medical schools in the United States or Canada must have attended a school that was accredited at the date of graduation by the Liaison Committee on Medical Education (LCME), the Committee for Accreditation of Canadian Medical Schools, or the American Osteopathic Association.

Graduates of international medical schools must have one of the following: (1) a standard certificate from the Educational Commission for Foreign Medical Graduates without expired examination dates (2) comparable credentials from the Medical Council of Canada or (3) documentation of training for those candidates who entered graduate medical education training in the United States via the Fifth Pathway, as proposed by the American Medical Association.

Graduate Medical Education (GME)

To be admitted to the Certification Examination in Internal Medicine, physicians must have satisfactorily completed, by August 31st of the year of examination, 36 calendar months, including vacation time, of U.S. or Canadian graduate medical education accredited by the Accreditation Council for Graduate Medical Education (ACGME), the Royal College of Physicians and Surgeons of Canada, or the Professional Corporation of Physicians of Quebec. Residency or research experience occurring before completion of the requirements for the MD or DO degree cannot be credited toward the requirements for certification. The 36 months of residency training must include 12 months of accredited internal medicine training at each of three levels: R-1, R-2 and R-3. No credit is granted for training repeated at the same level or for administrative work as a chief medical resident. In addition, training as a subspecialty fellow cannot be credited toward fulfilling the internal medicine training requirements.

Content of Training

The 36 calendar months of full-time internal medicine residency education:

  1. Must include at least 30 months of training in general internal medicine, subspecialty internal medicine and emergency medicine. Up to four months of the 30 months may include training in areas related to primary care, such as neurology, dermatology, office gynecology or office orthopedics.
  2. May include up to three months of other electives approved by the internal medicine program director.
  3. Includes up to three months of leave for vacation time.(See “Leave of Absence and Vacation Policy”)
  4. 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.

In addition, the following requirements for direct patient responsibility must be met:

  1. At least 24 months of the 36 months of residency education must occur in settings where the resident personally provides or supervises less experienced residents who provide direct care to patients in inpatient or ambulatory settings.
  2. At least six months of the direct patient responsibility on internal medicine rotations must occur during the R-1 year.
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Clinical Competence Requirements

ABIM requires documentation that candidates for certification in internal medicine 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 program directors to complete clinical competence evaluations each year for internal medicine residents. A candidate may be excluded from an ABIM examination if the required components of clinical competence are not satisfactorily documented by the training program.

As outlined in the Program Director Ratings of Clinical Competence table below, all residents must receive satisfactory ratings in overall clinical competence and moral and ethical behavior in each year of training. In addition, residents must receive satisfactory ratings in each of the components of clinical competence during the final year of required training. It is the resident'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

Overall Clinical Competence
Ratings R-1 and R-2 R-3
Satisfactory or Superior Full credit Full credit
Marginal Full credit for one marginal year. Repeat one year if both R-1 and R-2 are marginal Not applicable
Unsatisfactory No credit, must repeat year. No credit, must repeat year.
Moral and Ethical Behavior
Ratings R-1 and R-2 R-3
Satisfactory Full credit 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 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
Evaluation of Individual General Competencies*
Ratings R-1 and R-2 R-3
* 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 Full credit
Unsatisfactory Full credit No credit, must repeat year
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Procedures Required for Internal Medicine

Safety is the highest priority when performing any procedure on a patient. ABIM recognizes that there is variability in the types and numbers of procedures performed by internists in practice. Internists who perform any procedure must obtain the appropriate training to safely and competently perform that procedure. It is also expected that the internist be thoroughly evaluated and credentialed as competent in performing a procedure before he or she can perform a procedure unsupervised.

For Certification in internal medicine, ABIM has identified a limited set of procedures for which it expects all candidates to be competent with regard to their knowledge and understanding. This includes (1) demonstration of competence in medical knowledge relevant to procedures through the candidate's ability to explain indications, contraindications, patient preparation methods, sterile techniques, pain management, proper techniques for handling specimens and fluids obtained, and test results (2) ability to recognize and manage complications and (3) ability to clearly explain to a patient all facets of the procedure necessary to obtain informed consent.

For a subset of procedures, ABIM requires all candidates to demonstrate competence and safe performance by means of evaluations performed during residency training. The set of procedures and associated competencies required for each are listed below.

To help residents acquire both knowledge and performance competence, ABIM believes that residents should be active participants in performing procedures. Active participation is defined as serving as the primary operator or assisting another primary operator. ABIM encourages program directors to provide each resident with sufficient opportunity to be observed as an active participant in the performance of required procedures. In addition, ABIM strongly recommends that procedural training be conducted initially through simulations. At the end of training, as part of the evaluation required for admission to the Certification Examination in Internal Medicine, program directors must attest to each resident's knowledge and competency to perform the procedures. ABIM does not specify a minimum number of procedures to demonstrate competency; however, to assure adequate knowledge and understanding of the common procedures in internal medicine, each resident should be an active participant for each procedure five or more times.

Competency is required in the following procedures:
  Know, Understand and Explain Perform
Safely and
Competently
  Indications;
Contraindications;
Recognition &
Management of
Complications; Pain
Management; Sterile
Techniques
Specimen
Handling
Interpretation
of Results
Requirements
& Knowledge
to Obtain
Informed
Consent
 
Abdominal paracentesis X X X X  
Advanced cardiac life support X N/A N/A N/A X
Arterial line placement X N/A X X  
Arthrocentesis X X X X  
Central venous line placement X X N/A X  
Drawing venous blood X X X N/A X
Drawing arterial blood X X X X X
Electrocardiogram X N/A X N/A  
Incision and drainage of an abscess X X X X  
Lumbar puncture X X X X  
Nasogastric intubation X X X X  
Pap smear and endocervical culture X X X X X
Placing a peripheral venous line X N/A N/A N/A X
Pulmonary artery catheter placement X N/A X X  
Thoracentesis X X X X  
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Credit in Lieu of Standard Training for Internal Medicine Candidates

Training Completed Prior to Entering Internal Medicine Residency

ABIM may grant credit for some or all of the 12-month requirement at the R-1 level for training taken prior to entering training in internal medicine. The program director of an accredited internal medicine residency program must petition ABIM to grant credit in lieu of standard R-1 internal medicine training. Candidates who have already completed 12 months of accredited U.S. or Canadian R-1 internal medicine training are not eligible to be petitioned for credit. Before being proposed, the candidate should have been observed by the proposer for a minimum of three months. No credit will be granted to substitute for 24 months of accredited R-2 and R-3 internal medicine training.

  1. Month-for-month credit may be granted for satisfactory completion of internal medicine rotations taken during a U.S. or Canadian accredited non-internal medicine residency program if all of the following criteria are met:
    1. The internal medicine training occurred under the direction of a program director of an accredited internal medicine program.
    2. The training occurred in an institution accredited for training internal medicine residents.
    3. The rotations were identical to the rotations of the residents enrolled in the accredited internal medicine residency program.
  2. For trainees who have satisfactorily completed some U.S. or Canadian accredited training in another specialty, ABIM may grant:
    1. Month-for-month credit for the internal medicine rotations that meet the criteria listed under (1) above PLUS
    2. Maximum of six months credit for the training in a family medicine or a pediatrics program or
    3. Maximum of three months credit for training in a non-internal medicine specialty program.
  3. Up to 12 months credit may be granted for at least three years of U.S. or Canadian accredited training in another clinical specialty, and Certification by an ABMS member Board in that specialty.*

  4. Up to 12 months credit may be granted for at least three years of verified internal medicine training abroad.*

* Requires a fee of $300. Guidelines for proposals are available in Proposing Candidates for Special Consideration.

Training Completed Abroad By Current Full-time U.S. or Canadian Faculty*

Full-time internal medicine faculty members in an LCME-accredited medical school or an accredited Canadian medical school may qualify for admission to the Certification Examination in Internal Medicine if they:

  1. Are proposed by the chair or program director of an accredited internal medicine residency program.
  2. Have completed three or more years of verified internal medicine training abroad.
  3. Hold an appointment at the level of Associate Professor or higher at the time of proposal.
  4. And have completed eight years, after formal training, as a clinician-educator or a clinical investigator in internal medicine with a full-time appointment on a medical school faculty.

* Requires a fee of $300. Guidelines for proposals are available in Proposing Candidates for Special Consideration.

Training in Combined Programs

ABIM recognizes internal medicine training combined with training in the following programs:

Guidelines for the combined training programs and requirements for credit toward the ABIM Certification Exam in Internal Medicine are available from the links above.

*Combined medicine/pediatrics training initiated July 1, 2007 or after must be undertaken in a combined medicine/pediatrics program accredited by the ACGME. See Internal Medicine/Pediatrics Policies for more details.

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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.