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Initial Certification indicates that physicians have met rigorous standards through intensive study, accredited training and evaluation and that they have the clinical judgment, skills and attitudes essential for the delivery of excellent patient care.

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For more than 75 years, Certification by ABIM has stood for the highest standard in internal medicine and its 20 subspecialties.

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Adult Congenital Heart Disease Policies

Eligibility for Certification and Board Policies

The information provided on ABIM's website and in ABIM's print publication, Policies and Procedures for Certification, July 2017 (pdf), governs ABIM's decision about eligibility for certification. The July 2017 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 adult congenital heart disease, physicians must:

  • At the time of application, be previously certified by ABIM in Cardiovascular Disease or by the American Board of Pediatrics in Pediatric Cardiology;
  • Satisfactorily complete formal training or requisite practice experience;
  • Demonstrate clinical competence, procedural skills, and moral and ethical behavior in the clinical setting;
  • Hold a valid, unrestricted and unchallenged license to practice medicine; and
  • Pass the Adult Congenital Heart Disease Certification Examination.

No credit will be granted toward certification in a subspecialty for training completed outside of an accredited U.S. or Canadian program.

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.

Practice Experience Requirements

For the first three Certification Examinations in Adult Congenital Heart Disease (2015, 2017 and 2019), ABIM will offer two pathways for admission, a Practice Pathway and a Training Pathway.

Practice Pathway

The Practice Pathway is available only to candidates who complete the training required for certification in Cardiovascular Disease prior to July 1, 2016. For the Fall 2015 examination, training in adult or pediatric cardiology must be completed on or before July 1, 2012.

For the first five years and three examinations (2015, 2017 and 2019), ABIM diplomates in Cardiovascular Disease and ABP diplomates in Pediatric Cardiology who have not completed formal training in adult congenital heart disease will be eligible to apply for the Certification Examination in Adult Congenital Heart Disease if they can demonstrate having fulfilled the practiced thresholds of one of the following pathways and possessing the relevant clinical competencies below:

Pathway A (for full-time physicians)

Demonstrate that for at least three out of the past five years, including the year prior to application for the examination, they spent either 40% of their post-training clinical practice time or 25% of their total post-training professional time in the clinical practice of adult congenital heart disease.

Examples:

  • A physician who works 40+ hours per week as a clinician would seek admission to the examination via Practice Pathway A under the 40% threshold.
  • A physician who works 40+ hours per week as a clinician and faculty member in an Adult Congenital Heart Disease training program, would seek admission to the examination via Practice Pathway A under the 25% threshold.
  • A physician who works 40+ hours per week as an Adult Congenital Heart Disease researcher would seek admission to the examination via Practice Pathway A under the 25% threshold.
  • A physician who works 40+ hours per week as an Adult Congenital Heart Disease administrator (e.g., clinic director) would seek admission to the examination via Practice Pathway A under the 25% threshold.

Pathway B (for part-time physicians)

Demonstrate that for at least three out of the past five years, including the year prior to application for the examination, they spent either 16 hours of clinical practice time per week (40% of full-time clinical practice) or 10 hours of professional time per week (25% of total professional time) in the clinical practice of adult congenital heart disease.

Examples:

  • A physician who works <40 hours per week as a clinician would seek admission to the examination via Practice Pathway A under the 16 hrs/week threshold.
  • A physician who works <40 hours per week as a clinician and faculty member in an Adult Congenital Heart Disease training program, would seek admission to the examination via Practice Pathway A under the 10 hrs/week threshold.
  • A physician who works <40 hours per week as an Adult Congenital Heart Disease researcher would seek admission to the examination via Practice Pathway A under the 10 hrs/week threshold.
  • A physician who works <40 hours per week as an Adult Congenital Heart Disease administrator (e.g., clinic director) would seek admission to the examination via Practice Pathway A under the 10 hrs/week threshold.

Candidates for the Practice Pathway (Pathway A and Pathway B) must also document their clinical competence in the practice of adult congenital heart disease in the following areas:

  • Having a specialized knowledge base in adult congenital heart disease in the following areas:
  • Anatomy and physiology of congenital heart disease in both repaired and unrepaired states
  • Demonstrating clinical competence in the care of patients with adult congenital heart disease, including the management of the following:
  • Congenital heart disease in both repaired and unrepaired states
  • Acquired heart disease as it complicates congenital heart disease anatomy and physiology
  • Acquired internal medicine diagnoses as they relate to congenital heart disease anatomy, physiology and outcomes (e.g., diabetes, peripheral vascular disease, renal disease)
  • Appropriate diagnostic study interpretation to inform treatment plans for Adult Congenital Heart Disease patients
  • Cardiac care of Adult Congenital Heart Disease patients in the outpatient, inpatient and perioperative settings
  • Demonstrating competence in the coordination of and communication with multidisciplinary care involving both specialists (such as electrophysiologists, cardiac surgeons) and primary care clinicians
  • Demonstrating moral and ethical behavior in the clinical setting

The above practice experience and clinical competencies must be electronically attested to by the program director of an accredited training program in cardiovascular disease or pediatric cardiology affiliated with the hospital where they spend the majority of their clinical time or by the Chief of Cardiology (or equivalent) in the hospital where they spend the majority of their clinical time.

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

* 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.

24* 18 To be determined

The Training Pathway involves satisfactory completion of the training required for certification in Cardiovascular Disease or Pediatric Cardiology, plus 24 months of adult congenital heart disease fellowship training, including 18 months of full-time clinical training that meets the following criteria:

  • ABIM currently anticipates that accreditation for adult congenital heart disease (ACHD) fellowship programs will be available through the Accreditation Council for Graduate Medical Education (ACGME) on or after July 1, 2019. ACHD training started on or after this date must be ACGME-accredited in order to count toward the requirements for ABIM certification in Adult Congenital Heart Disease. ACHD training started before then must be affiliated with an accredited cardiology fellowship training program in the department (i.e., Medicine or Pediatrics) which sponsors the adult congenital heart disease program. Training should also be consistent with the sample curriculum (pdf) provided in the approved proposal for Adult Congenital Heart Disease certification.

Note: Adult congenital heart disease fellowship training cannot be used to fulfill the requirements for admission to the certification examination through the Training Pathway if that training has been credited toward the requirements for another ABIM examination, e.g., Cardiovascular Disease.

More about Training

If you are planning to apply for the examination under the Training Pathway, you must complete the minimum training requirements described in the Training and Procedural requirements chart below. ABIM will make no exceptions to this requirement. If your formal fellowship training in adult congenital heart disease (ACHD) was less than two years, or less than 18 months of clinical training, then you should not apply for certification as a Training Pathway candidate.

You can use your clinical training in ACHD toward the requirements of the Practice Pathway, as long as it was at least six months in duration, and hasn't already been used for another certification. For example, if you completed a one-year clinical fellowship in ACHD, that would be the equivalent of spending 50% of your time in the clinical practice of ACHD over a two-year period. You can use your training to meet the practice thresholds (40% or 25%) of Practice Pathway A or Practice Pathway B. To be eligible to apply for the examination through the Practice Pathway, you also need to meet the minimum time-in-practice and practice competency requirements described in the Practice Pathway section on this page.

In most cases, clinical fellows who have completed less than two years of ACHD training could eventually qualify for ABIM certification through the Practice Pathway, without having to complete additional training. In some cases, you may need to wait for a later examination administration until you can fulfill all the Practice Pathway requirements, and in rare cases, additional training may be necessary. ABIM strongly encourages you to contact us to discuss your qualifications before you apply, so you can know what requirements you will need to meet specifically. Please feel free to do so by calling 800-441-2246 or by e-mailing request@abim.org.

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 an ABIM certified program director (other ABMS Board and Canadian certification is acceptable, if applicable).

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.

Program Director Ratings of Clinical Competence

Six ACGME/ABMS Competencies:

The resident/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.

Six ACGME/ABMS Competencies*
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 resident/fellow's development of overall clinical competence during this year of training:

Overall Clinical Competence
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 general 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.

Guidelines for proposals are available in Proposing Candidates for Special Consideration.

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.

Information for Candidates Certified by the American Board of Pediatrics (ABP)

The policy information above applies to both ABIM and ABP candidates for ABIM certification in Adult Congenital Heart Disease. To submit an application for examination, candidates from ABP will need to contact ABIM and secure an ABIM candidate number. Instructions on how to request and receive an ABIM candidate number can be found on the ABIM Certification Exam scheduling section of abim.org. Candidates from ABP are encouraged to note relevant deadlines and plan accordingly to allow for adequate time to submit an application for examination.