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Neurocritical Care Policies

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The Neurocritical Care Certification Program is jointly developed by the American Board of Anesthesiology (ABA), the American Board of Emergency Medicine (ABEM), the American Board of Internal Medicine (ABIM), the American Board of Neurological Surgery (ABNS), and the American Board of Psychiatry and Neurology (ABPN). The examination is administered to candidates from all five Boards at the same time in the same testing centers. ABPN is responsible for administering the examination.

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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 the subspecialty of Neurocritical Care, physicians must:

  • At the time of application, be previously certified by ABIM in Critical Care Medicine, or if pursuing Practice Pathway A, be currently certified by the United Council for Neurologic Subspecialties (UCNS) or Committee on Advanced Subspecialty Training (CAST) in Neurocritical Care;
  • 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 Neurocritical Care Certification Examination.

No credit will be granted toward certification in a subspecialty for training completed outside of an accredited U.S. or Canadian program, except as allowed during the practice pathway or training pathway prior to establishment of ACGME accredited programs.

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, 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. 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 Neurocritical Care (2021, 2023 and 2025), ABIM will offer two pathways for admission, a Practice Pathway and a Training Pathway. During the Practice Pathway, eligible candidates may qualify for the Neurocritical Care Certification Examination if they:

Practice Pathway A
Are actively certified in neurocritical care by the UCNS or CAST

Practice Pathway B
Meet one of the following practice thresholds:

Years in Independent Practice Minimum NCC Clinical Practice Threshold
* This calculation is based on an average work week of 40 hours. Physicians whose total practice exceeds 40 hours per week may still use the 40 hours number as the denominator of their % calculation.
2 years 50% (20 hours a week)*
3 years 33% (13 hours a week)*
4-5 years 25% (10 hours a week)*
6 or more 17% (7 hours a week)*
For Program Directors, Administrators & Researchers 25% (10 hours a week) total professional time for at least 4 years

After the Practice Pathway closes, all first-time applicants for the Neurocritical Care Certification Exam must meet the requirements of the Training Pathway.

The above practice experience and clinical competencies must be electronically attested to by a physician leader in the hospital where the candidate spends majority of clinical time; for example, the program director of an accredited training program in neurocritical care, the chair of the department of medicine (or equivalent), or by the Chief of Critical Care Medicine (or equivalent).

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.

12* 12 To be determined

The Training Pathway requires prior certification in Critical Care Medicine by ABIM and 12 months accredited of clinical neurocritical care fellowship training.

ABIM currently anticipates that accreditation for neurocritical care (NCC) fellowship programs will be available through the Accreditation Council for Graduate Medical Education (ACGME) on or after July 1, 2025. NCC training started on or after this date must be ACGME-accredited in order to count toward the requirements for ABIM certification in Neurocritical Care. NCC training started before then must be affiliated with an accredited UCNS or CAST fellowship training program which sponsors the neurocritical care program.

Note: Neurocritical Care fellowship training cannot be used to fulfill the requirements for certification through the Training Pathway if that training has been credited toward the requirements for another ABIM certification.

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.