Eligibility for Certification and Board Policies
The information provided on ABIM's website and in ABIM's print publication, Policies & Procedures for Certification, November 2024(pdf), governs ABIM's decision about eligibility for certification. The November 2024 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 Adult Congenital Heart Disease, physicians must:
- At the time of application, be previously certified by ABIM in Cardiovascular Disease or by the American Board of Pediatrics in Pediatric Cardiology;
- Satisfactorily complete formal training or requisite practice experience;
- Demonstrate clinical competence and moral and ethical behavior in the clinical setting;
- Hold a valid, unrestricted and unchallenged license to practice medicine; and
- Pass the Adult Congenital Heart Disease Certification Examination.
Adult congenital heart disease fellowship training must be accredited by the Accreditation Council for Graduate Medical Education (ACGME), the Royal College of Physicians and Surgeons of Canada (RCPSC) or the Collège des médecins du Québec, 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.
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.
Practice Experience Requirements
For the first three Adult Congenital Heart Disease Certification Examinations (2015, 2017 and 2019), ABIM offered two pathways for admission: a Practice Pathway and a Training Pathway.
Practice Pathway
The Practice Pathway was available only to candidates who completed the training required for certification in Cardiovascular Disease prior to July 1, 2016. For the Fall 2015 examination, training in adult cardiovascular disease or pediatric cardiology must have been completed on or before July 1, 2012.
For the first five years and three examinations (2015, 2017 and 2019), ABIM diplomates in Cardiovascular Disease and American Board of Pediatrics (ABP) diplomates in Pediatric Cardiology who have not completed formal training in adult congenital heart disease will be eligible to apply for the Adult Congenital Heart Disease Certification Examination if they can demonstrate having fulfilled the practiced thresholds of one of the following pathways and possessing the relevant clinical competencies below:
Pathway A (for Full-Time Physicians)
Candidates must have demonstrated that for at least three out of the past five years, including the year prior to application for the examination, they spent either 40% of their post-training clinical practice time or 25% of their total post-training professional time in the clinical practice of adult congenital heart disease (ACHD).
Examples:
- A physician who works 40+ hours per week as a clinician would have sought admission to the examination via Practice Pathway A under the 40% threshold.
- A physician who works 40+ hours per week as a clinician and faculty member in an ACHD training program would have applied to the examination via Practice Pathway A under the 25% threshold.
- A physician who works 40+ hours per week as an ACHD researcher would have sought admission to the examination via Practice Pathway A under the 25% threshold.
- A physician who works 40+ hours per week as an ACHD administrator (e.g., clinic director) would have applied to the examination via Practice Pathway A under the 25% threshold.
Pathway B (for Part-Time Physicians)
Candidates must have demonstrated that for at least three out of the past five years, including the year prior to application for the examination, they spent either 16 hours of clinical practice time per week (40% of full-time clinical practice) or 10 hours of professional time per week (25% of total professional time) in the clinical practice of adult congenital heart disease (ACHD).
Examples:
- A physician who works <40 hours per week as a clinician would have sought admission to the examination via Practice Pathway A under the 16 hours/week threshold.
- A physician who works <40 hours per week as a clinician and faculty member in an ACHD training program would have applied to the examination via Practice Pathway A under the 10 hours/week threshold.
- A physician who works <40 hours per week as an ACHD researcher would have sought admission to the examination via Practice Pathway A under the 10 hours/week threshold.
- A physician who works <40 hours per week as an ACHD administrator (e.g., clinic director) would have applied to the examination via Practice Pathway A under the 10 hours/week threshold.
Candidates for the Practice Pathway (Pathway A and Pathway B) must have also documented their clinical competence in the practice of ACHD in the following areas:
- Having a specialized knowledge base in the anatomy and physiology or congenital heart disease in both repaired and unrepaired states
- Demonstrating clinical competence in the care of patients with ACHD, including the management of the following:
- Congenital heart disease in both repaired and unrepaired states
- Acquired heart disease as it complicates congenital heart disease anatomy and physiology
- Acquired internal medicine diagnoses as they relate to congenital heart disease anatomy, physiology and outcomes (e.g., diabetes, peripheral vascular disease, renal disease)
- Appropriate diagnostic study interpretation to inform treatment plans for ACHD patients
- Cardiac care of ACHD patients in the outpatient, inpatient and perioperative settings
- Demonstrating competence in the coordination of and communication with multidisciplinary care involving both specialists (such as electrophysiologists and cardiac surgeons) and primary care clinicians
- Demonstrating moral and ethical behavior in the clinical setting
The above practice experience and clinical competencies must be electronically attested to by the program director of an accredited training program in cardiovascular disease or pediatric cardiology affiliated with the hospital where they spend the majority of their clinical time or by the chief of cardiology (or equivalent) in the hospital where they spend the majority of their clinical time.
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 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. |
||
| 24* | 18 | No required procedures |
The Training Pathway involves satisfactory completion of the training required for certification in Cardiovascular Disease or Pediatric Cardiology, plus 24 months of adult congenital heart disease (ACHD) fellowship training*, including 18 months of full-time clinical training that meets the following criteria:
- As anticipated, accreditation for adult congenital heart disease (ACHD) fellowship programs became available through the Accreditation Council for Graduate Medical Education (ACGME) on or after July 1, 2019. ACHD training started on or after July 1, 2019, must be accredited by the ACGME, the Royal College of Physicians and Surgeons of Canada (RCPSC) or the Collège des médecins du Québec, or recognized as an Area of Focused Competency by the RCPSC in order to count toward the requirements for ABIM certification in Adult Congenital Heart Disease. ACHD training started before July 1, 2019, must have been affiliated with an accredited cardiovascular disease fellowship training program in the department (i.e., Medicine or Pediatrics) which sponsors the ACHD program. Training should also be consistent with the sample curriculum (pdf) provided in the approved proposal for Adult Congenital Heart Disease certification.
*Note: ACHD fellowship training cannot be used to fulfill the requirements for admission to the certification examination through the Training Pathway if that training has been credited toward the requirements for another ABIM examination, such as Cardiovascular Disease.
More About Training
If you are planning to apply for the examination under the Training Pathway, you must complete the minimum training requirements described in the Training and Procedure Requirements chart above. ABIM will make no exceptions to this requirement. If your formal fellowship training in adult congenital heart disease (ACHD) was shorter than two years, or you completed less than 18 months of clinical training, then you should not apply for certification as a Training Pathway candidate.
Clinical training in ACHD could have been applied toward the requirements of the Practice Pathway as long as it was at least six months in duration and hadn't already been used for another certification. For example, if you had completed a one-year clinical fellowship in ACHD, that would be the equivalent of spending 50% of your time in the clinical practice of ACHD over a two-year period, which could have met the practice thresholds (40% or 25%, respectively) of Practice Pathway A or Practice Pathway B. To have been eligible to apply for the examination through the Practice Pathway, you would have also needed to meet the minimum time-in-practice and practice competency requirements described in the Practice Pathway section on this page.
In most cases, clinical fellows who completed less than two years of ACHD training could have eventually qualified for ABIM certification through the Practice Pathway without having had to complete additional training.
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 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, skill 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.
| 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:
| 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. 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.
Information for Candidates Certified by the American Board of Pediatrics (ABP)
The policy information above applies to both ABIM and ABP candidates for ABIM certification in Adult Congenital Heart Disease. To apply for the examination, candidates from ABP will need to contact ABIM and secure an ABIM candidate number secure an ABIM candidate number. Candidates from ABP are encouraged to note relevant deadlines and plan accordingly to allow for adequate time to apply for the examination.