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 the subspecialty of pulmonary disease, physicians must:

• At the time of application, be previously certified in internal medicine by ABIM;
• Satisfactorily complete the requisite graduate medical education fellowship training;
• 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 Pulmonary Disease Certification Examination.

Pulmonary disease fellowship training must be 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.

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

Fellowship training undertaken 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 nonclinical 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.

Candidates seeking dual certification in pulmonary disease and critical care medicine must satisfactorily complete a minimum of three years of accredited combined training, 18 months of which must be full-time clinical training.

During the entire three years, the fellow must maintain a continuity outpatient clinic structured in a way that is consistent with ACGME requirements for continuity clinic in the discipline. Time spent in continuity outpatient clinic during non-clinical training is in addition to the requirement for full-time clinical training.

Candidates may take the Pulmonary Disease Certification Examination after two of the three years of combined training are satisfactorily completed. Candidates may then take the Critical Care Medicine Certification Examination after all three years of combined training are satisfactorily completed. Note: Pulmonary Disease Certification does not have to be achieved prior to taking the Critical Care Medicine Certification Examination.

Training and Procedures Requirements Before Academic Year 2026-2027

The total months of training required for fellows who began their pulmonary disease fellowship before July 1, 2027, including specific clinical months and requisite procedures, are outlined below:

The ABIM Pulmonary Disease Specialty Board has approved revised procedures for ABIM certification in Pulmonary Disease. View a summary of the intended competencies and the rationale for inclusion (PDF). The total months of training required for fellows beginning their fellowship on or after July 1, 2027, including specific clinical months and requisite procedures, are outlined below:

• Do Not Require: Training should not be required.
• Knowledge Standard: All fellows must demonstrate knowledge of the indications, contraindications, limitations, complications, alternatives and techniques of this procedure. They are not required to train in performing the procedure.
• Opportunity to Train (OTT): All fellows must demonstrate knowledge of the indications, contraindications, limitations, complications, alternatives and techniques of this procedure. Fellows must have the Opportunity to Train in this procedure to the level of competent and independent performance if they request the training for their future practice*. Not all fellows would be required to perform this procedure to be eligible for certification, but all fellows would be required to meet the knowledge standard as defined above.

*If procedural expertise does not exist within the program to support an OTT, the program should    facilitate external training opportunities as resources allow.

• Perform competently: Required to perform independently at the end of fellowship training

Statement on Procedures Going Beyond Technical Skill: Assessment of competency in many procedures goes beyond the technical skill required to perform the procedure and may include a comprehensive assessment of aspects of peri-procedural patient management, where relevant.

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
6. Systems-based practice

Through its tracking process, FasTrack^®, ABIM requires verification of fellows' 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 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 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 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.

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.