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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, July 2020 (pdf), governs ABIM's decision about eligibility for certification. The July 2020 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 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 ABIM Internal Medicine Certification Examination.

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 ABIM Internal Medicine Certification Examination, physicians must have satisfactorily completed, by August 31 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 Collège des médecins du Québec. 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.

Training and Procedure 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 35 days 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.

36* 30
  • Procedures are essential to internal medicine training; to be eligible for certification, all residents must perform procedures during training.
  • Not all residents need to perform all procedures.
  • Program directors must attest to general competence in procedures at end of training.
  • At the completion of training, residents must have demonstrated effective consent discussions, standard or universal precautions, establishment of a sterile field, and application of local anesthetic as applicable to most procedures a resident may perform.
  • Residents must have the opportunity to develop competence in procedures which will further their development as fellows in their chosen subspecialty, or as independent practitioners in their intended fields if entering practice after residency.

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 4 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.

Procedures Required for Internal Medicine

The exposure to the performance of, and the opportunity to develop competence in, invasive procedures by residents is essential for internal medicine residents’ preparation for their subsequent subspecialty fellowship or chosen career path.

As of the 2019-2020 academic year, residents must meet the requirements outlined in the table above to be admitted to the Internal Medicine Certification Examination. Internal medicine graduates will likely perform some invasive procedures in the course of their future training or practice; however, the specific procedures will vary based on subsequent subspecialty, hospitalist or general career path taken. The performance of all invasive procedures requires the ability to facilitate an effective discussion with patients regarding risk and benefit of the procedure before obtaining consent, a critical task that all internists must effectively perform. Internists who perform any invasive procedures must be able to initiate a standardized preparation beforehand including hand washing, donning of sterile gloves, preparation of the procedural field, and application of some form of anesthetic. Procedural competence need not be determined solely by a minimum number of successfully completed procedures but may be customized as appropriate through simulation, direct observation, and other criteria determined by the program director and clinical competency committee.

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 verification of residents' clinical competence from an ABIM certified program director (other ABMS Board and Canadian certification is acceptable, if applicable). Program directors must also 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. In addition, residents must receive satisfactory ratings in each of the six ACGME/ABMS Competencies 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 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

Credit in Lieu of Standard Training for Internal Medicine Candidates

Training Completed Prior to Entering Internal Medicine Residency

ABIM may grant credit for up to 12-months of the 36 month internal medicine training requirement 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 internal medicine training. Before being proposed, the candidate should have been observed by the proposer for a minimum of three months.

  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:
    • The internal medicine training occurred under the direction of a program director of an accredited internal medicine program.
    • The training occurred in an institution accredited for training internal medicine residents.
    • 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:
    • Month-for-month credit for the internal medicine rotations that meet the criteria listed under (1) above PLUS
    • Maximum of six months' credit for the training in a family medicine or a pediatrics program or
    • 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.
    • Include a non-refundable Special Candidate fee of $300.
  4. Up to 12 months may be granted for three or more years of training completed abroad prior to entering accredited training in the United States or Canada.
    • Must demonstrate satisfactory overall clinical competence as an internist.
    • Must complete a minimum of 18 months of direct patient responsibility.
    • Must have either a standard certificate from the Educational Commission for Foreign Medical Graduates (ECFMG) without expired examination dates or comparable credentials from the Medical Council of Canada at the time of application for admission to the Certification Examination in Internal Medicine.
    • Include a non-refundable Special Candidate fee of $300.


    Proposals for credit in lieu of standard training may be emailed to AcademicAffairs@abim.org and must:

    • Document the reasons the proposer feels the candidate merits special consideration.
    • Include letters from the program directors where prior training was completed documenting the training.
    • Exact from-to dates of training.
    • A brief description of the training.
    • Confirmation of the candidate's satisfactory clinical competence in the program. Please note that ABIM does not accept certificates of completion of training or certification by other certifying boards as fulfilling this requirement.
    • Include a copy of the candidate's curriculum vitae and bibliography.
    • If applicable, include documentation of certification by an ABMS member board in another clinical specialty.
    • Include the candidate's date of birth and Social Security/social insurance number.

    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 Internal Medicine Certification Examination 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.

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.