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Clinical Cardiac Electrophysiology 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, August 2018 (pdf), governs ABIM's decision about eligibility for certification. The August 2018 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 clinical cardiac electrophysiology, physicians must:

  • At the time of application, be previously certified by ABIM in cardiovascular disease;
  • Satisfactorily complete the requisite formal training requirements as specified in the descriptions of the training pathway;
  • 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 Clinical Cardiac Electrophysiology Certification Examination.

Clinical cardiac electrophysiology fellowship training must be accredited by the Accreditation Council for Graduate Medical Education (ACGME), the Royal College of Physicians and Surgeons of Canada (RCPSC), the Professional Corporation of Physicians of Quebec or recognized as an Area of Focused Competency by the RCPSC.

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

Clinical cardiac electrophysiology training undertaken July 1, 1998 and thereafter must be accredited by the Accreditation Council for Graduate Medical Education (ACGME).

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 31 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.

Training and Procedural Requirements

Candidates first applying for certification in clinical cardiac electrophysiology in 1998 and thereafter must meet the requirements of the formal training pathway, as outlined below:

  • Three years of cardiovascular disease fellowship training, including 24 months of clinical training, in programs accredited by the Accreditation Council for Graduate Medical Education (ACGME).
  • One or two additional years of acceptable clinical cardiac electrophysiology fellowship training as described in the “Acceptable Training Programs” section.
  • Each year since completion of the required training for ABIM certification in clinical cardiac electrophysiology, commitment of at least 50% of professional time and effort to clinical cardiac electrophysiology, including balanced experience in a variety of clinical settings. Settings may include, but are not limited to, the electrophysiology laboratory (serving as the primary operator or as an assistant closely involved with data collection and analysis), emergency department, coronary care unit, operating room and follow-up clinic.

Note: Candidates who were previously admitted to the examination through the practice pathway and have not yet achieved certification will continue to be admitted to future clinical cardiac electrophysiology examinations. Such candidates must continue to meet ABIM's requirements for licensure and professional standing and document that their commitment to clinical cardiac electrophysiology involves at least 50% of their professional time and effort.

Acceptable Training Programs

Clinical cardiac electrophysiology training taken July 1, 1998 and thereafter must be accredited by ACGME. Training undertaken prior to July 1, 1998 must meet the following criteria:

  • The clinical cardiac electrophysiology training must be conducted in a program that is accredited for training in cardiovascular disease. Training in clinical cardiac electrophysiology must include clinical activity either as the primary physician or as a consultant for/to patients with cardiac arrhythmias. The training must be supervised by a qualified electrophysiologist. The training should provide a balanced experience in a variety of clinical settings including, but not limited to, the electrophysiology laboratory, emergency department, coronary care unit, operating room, and the follow-up clinic.
  • The program must be structured to permit the development of requisite procedural and technical skills, which are the learned manual skills and the associated technical aspects necessary to perform diagnostic and therapeutic procedures. Successful mastery of these essential skills also includes an understanding of the indications for electrophysiologic study, contraindications and complications, and the ability to monitor and interpret the results.

Training and Procedures Requirements Before Academic Year 2017-18

The total months of training required for fellows beginning their electrophysiology fellowship before Academic Year 2017-18, 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 Electrophysiologic studies both with a catheter and intraoperatively; catheter-based and other ablation procedures; and implantation of pacemakers and cardioverters-defibrillators (a minimum of 150 intracardiac procedures in at least 75 patients, of which 75 are catheter-based ablation procedures, including postdiagnostic testing, and 25 are initial implantable cardioverter-defibrillator procedures, including programming). Procedures performed during training in cardiovascular disease may be counted toward fulfilling these requirements provided that they are adequately documented and are performed with supervision equivalent to that of a clinical cardiac electrophysiology fellowship.

Training and Procedural Requirements In or After Academic Year 2017-18

The total months of training required for fellows beginning their electrophysiology fellowship in or after Academic Year 2017-18, including specific clinical months, and requisite procedures are outlined below.

Minimum Months
of Training
Clinical Months
Required
Details

* 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* 24

Fellows in accredited clinical cardiac electrophysiology fellowship programs will be expected to perform the following procedures:

  • 160 catheter ablation procedures, including:
  • 50 supraventricular tachycardia
  • 30 atrial flutter/macro-reentrant atrial tachycardia procedures
  • 50 atrial fibrillation procedures
  • 30 ventricular tachycardia/premature ventricular contraction ablations
  • 100 cardiac implantable electric device (CIED)-related implantation procedures
  • 30 CIED-related replacement/revision procedures
  • 200 CIED-related interrogation or programming procedures
  • 5 tilt-table tests

Procedures performed during training in cardiovascular disease may be counted toward fulfilling these requirements provided that they are adequately documented and are performed with supervision equivalent to that of a clinical cardiac electrophysiology fellowship.

More About Procedures

To assure credible confirmation of proficiency in certain procedural techniques, candidates must perform a minimum of 150 intracardiac procedures in at least 75 patients, of which 75 are catheter ablations (including postdiagnostic testing) and 25 are initial cardioverter-defibrillator implantations (including programming). Participation in diagnostic EP studies (including mapping) is necessary, as is implantation and programming of pacemakers. The candidate may serve as a primary operator or as an assistant closely involved with data collection and analysis.

Performance of the required minimum number of procedures is not a guarantee of proficiency. ABIM will seek substantiation from the training program director that the candidate acquired the requisite skills and is competent to provide comprehensive and specialized medical care in the field of clinical cardiac electrophysiology.

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.