Internal Medicine & Subspecialty Policies

The information provided on ABIM's website and in ABIM's print publication, Policies and Procedures for Certification, December 2025 (pdf), governs ABIM's decision about eligibility for certification. The December 2025 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).

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 U.S. 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 or (2) comparable credentials from the Medical Council of Canada.

Graduate Medical Education (GME)

To be admitted to the ABIM Internal Medicine Certification Examination, physicians must have satisfactorily completed 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 by August 31 of the year of examination. 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 accredited internal medicine residency training must be reported in 12-month intervals according to the Clinical Competence Requirement training tables (see below). No credit is granted for unsatisfactory training that requires repetition of a training year 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.

The total months of training required, including specific clinical months, and requisite procedures are outlined below:

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 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. Include up to three months of leave for vacation time. (see “Leave of Absence and Vacation Policy”)
   
   For deficits of 35 days or less 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 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 2019-20 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 or general career path pursued. 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 handwashing, donning of sterile gloves, preparing the procedural field and applying 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.

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
6. Systems-based practice

Through its tracking process, FasTrack^®, ABIM requires verification of residents' clinical competence to come from a program director who is certified by ABIM in the discipline for which they are program director (other ABMS Member Board or Canadian certification is acceptable, if applicable).

As outlined in the Program Director Ratings of Clinical Competence table below, all residents must receive satisfactory ratings in overall clinical competence in each year of training. 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 must demonstrate satisfactory development of the knowledge, skills and attitudes/behaviors needed to advance in training. The trainee must also demonstrate a learning trajectory that anticipates the achievement of competency for unsupervised practice, which includes the delivery of safe, effective, patient-centered, timely, efficient and equitable care.

The resident/fellow must demonstrate satisfactory development of the knowledge, skills and attitudes/behaviors needed to advance in training. The trainee must also demonstrate a learning trajectory that anticipates the achievement of competency for unsupervised practice, which includes the delivery of safe, effective, patient-centered, timely, efficient and equitable care.

Overall Clinical Competence

This rating represents the assessment of the resident/fellow's development of overall clinical competence during this year of training:

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.The proposer should observe the candidate for a minimum of three months before proposing them for credit.

Completed Partial Training in Another ABMS Specialty

For trainees who have satisfactorily completed some accredited training in a non–internal medicine specialty in the U.S. or Canada, ABIM may grant credit according to the following criteria, all of which must be met for each type of rotation:

1. Internal Medicine Rotations
   • 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 completed by the residents enrolled in the accredited internal medicine residency program.
2. Non–Internal Medicine Rotations
   • Maximum of six months' credit for the training in a family medicine or a pediatrics residency
   • Maximum of three months' credit for training in a non-internal medicine specialty residency other than family medicine or pediatrics

Proposal Materials:

1. Letter 1: From the program director of the accredited U.S. or Canadian internal medicine residency program
   • The proposer should document the reasons why the candidate merits credit and how much credit they wish to propose on the candidate’s behalf.
2. Letter 2: From the program director of the other ABMS specialty in which prior training was completed that includes:
   • Exact start and end 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 completion of training certificates in place of this letter.
3. Letter 3 (if applicable): From the internal medicine program director at the institution where training in the other ABMS specialty was completed
   • Must identify which rotations, if any, were identical to those completed by categorical internal medicine residents in the institution’s accredited medicine program.
4. The most recent copy of the candidate's curriculum vitae
5. The candidate's date of birth and last four digits of Social Security/Social Insurance number so that an ABIM ID can be established

Complete proposals may be emailed to AcademicAffairs@abim.org.

Certified by Another ABMS Board

Up to 12 months' credit may be granted for completion of at least three years of accredited training in another specialty in the U.S. or Canada and certification by the ABMS Member Board in that specialty.

Proposal Materials:

1. A letter from the internal medicine program director of the accredited U.S. or Canadian training program
   • The proposer should document the reasons why the candidate merits credit and how much credit they wish to propose on the candidate’s behalf. 
2. Documentation of certification by an ABMS Member Board in another specialty
3. The most recent copy of the candidate's curriculum vitae
4. The candidate's date of birth and last four digits of Social Security/Social Insurance number so that an ABIM ID can be established
5. A nonrefundable Special Candidate fee of $300

Proposals may be emailed to AcademicAffairs@abim.org. The $300 check must be payable to the American Board of Internal Medicine and mailed to:

American Board of Internal Medicine
Attn: Academic Affairs Department
510 Walnut Street, Suite 1700
Philadelphia, PA 19106

Completed Internal Medicine Residency Abroad

Up to 12 months’ credit may be granted for three or more years of training that was satisfactorily completed abroad prior to entering an accredited training program in the U.S. or Canada. Eligible candidates must:

1. Demonstrate satisfactory overall clinical competence as an internist
2. Complete a minimum of 18 months of direct patient responsibility
3. 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 Internal Medicine Certification Examination.

Proposal Materials:

1. A letter from the internal medicine program director of the accredited U.S. or Canadian training program
   • The proposer should document the reasons why the candidate merits credit and how much credit they wish to propose on the candidate’s behalf. 
2. A letter from the program director of the internal medicine residency abroad in which prior training was completed that includes:
   • Exact start and end 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 completion of training certificates in place of this letter.
3. The most recent copy of the candidate's curriculum vitae
4. The candidate's date of birth and last four digits of Social Security/Social Insurance number so that an ABIM ID can be established
5. A nonrefundable Special Candidate fee of $300

Proposals may be emailed to AcademicAffairs@abim.org. The $300 check must be payable to the American Board of Internal Medicine and mailed to:

American Board of Internal Medicine
Attn: Academic Affairs Department
510 Walnut Street, Suite 1700
Philadelphia, PA 19106

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. While the ABIM Research Pathway requires core clinical training, it mainly 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.