Special Training Policies

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Disclosure of Performance Information

Trainees planning to change programs must direct requests to their current program and to ABIM to send written evaluations of past performance to the new program. These requests must be made in writing and in a timely manner to ensure that the new program director has the performance evaluations for review before offering a position. In addition, a new program director may request performance evaluations from previous programs and from ABIM concerning trainees who have joined the new program. ABIM will respond to written requests from trainees and program directors by providing any performance evaluations it has in its possession and the total credits accumulated toward ABIM's training requirements for Board Certification. This information will include any comments provided with the evaluation.

Due Process for Evaluations

The responsibility for the evaluation of a trainee's clinical competence and moral and ethical behavior rests with the program, not with ABIM. ABIM is not in a position to re-examine the facts and circumstances of an individual's performance. As required by ACGME in its Essentials of Accredited Residencies in Graduate Medical Education, the educational institution must provide appropriate due process for its decisions regarding a trainee's performance.

Leave of Absence and Vacation

Up to 5 weeks (35 days) per academic year are cumulatively permitted over the course of the training program for time away from training, which includes vacation, illness, parental or family leave, or pregnancy-related disabilities. For example, a resident could take 105 days of leave during a three-year internal medicine residency without needing to extend training. Training must be extended to make up any absences exceeding 5 weeks (35 days) per year of training unless the Deficits in Required Training Time policy is used. Vacation leave is essential and should not be forfeited or postponed in any year of training and cannot be used to reduce the total required training period. ABIM does not establish how much time per year should be used for vacation and recognizes that leave policies vary from institution to institution. Program Directors may apply their local requirements within these guidelines to ensure trainees have completed the requisite period of training with adequate vacation over the total training duration.

ABIM considers activities such as attendance at training-related seminars, courses, interviews for subsequent training positions or jobs, etc., as bona fide educational experiences or duties essential for the continuity of education in internal medicine and its subspecialties. These activities need not be counted as part of the allocation for leave time in the academic year for purposes of tracking training time for ABIM. Similarly, ABIM does not require that this time be counted among the educational experiences of the training program; rather, the program director has the discretion to apply this policy to ensure the balance of time needed to assure competency in the discipline is achieved at the end of training.

This policy, along with ABIM's Deficits in Required Training Time policy, provides for time away from training in excess of the minimum requirements of the ABMS Leave Policy, as revised in July 2021. Under the ABMS policy, “Member Boards with requirements that allow for more than six weeks of time away from training for any purpose including parental, caregiver and medical leave are in compliance with the above policy.” (ABMS Leave Policy, Appendix, ¶ 3.) ABIM’s policies allow for more than six weeks of time away from training for any purpose.

Should training need to be extended, candidates may still be eligible for certification the year of graduation provided that they complete the training requirements by the August 31^st (for internal medicine) or October 31^st (for subspecialties) deadlines.

Deficits in Required Training Time

This policy applies to internal medicine residency and subspecialty fellowships in all ABIM disciplines.

ABIM recognizes that delays or interruptions may arise during training such that the required training cannot be completed within the standard total training time for the training type. In such circumstances, if the trainee's program director and clinical competency committee attest to ABIM that the trainee has achieved required competence with a deficit of less than 5 weeks (35 days), extended training may not be required. Only program directors may request that ABIM apply the Deficits in Required Training Time policy on a trainee's behalf, and such a request may only be made during the trainee's final year of training. Program directors may request a deficit in training time when submitting evaluations for the final year of standard training via FasTrack, subject to ABIM review.

The Deficits in Required Training Time policy is not intended to be used to shorten training before the end of the academic year.

Examples:

• A rheumatology trainee beginning training on July 1, 2022 anticipates a completion date by June 30, 2024. A six week medical leave in the F-1 year causes the total cumulative leave over the 24-month training period to exceed the 70 days of permitted leave by ten days and extending the completion date until July 10, 2024.
• An internal medicine trainee beginning training on July 27, 2021 (27 days off-cycle due to a visa delay) anticipates a completion date by July 26, 2024.

In each example, the trainee may complete training on June 30 if:

• The program attests to the trainee's achieving the required competence on June 30, 2024,
• The program documents the reason for the deficit in training on the trainee's final year FasTrack^® evaluation, and
• ABIM approves the program director's request to apply the Deficits in Required Training Time policy.

The Deficits in Required Training Time policy is not intended to be used to shorten training before the end of the academic year.

Example:

• An internal medicine trainee who initiated training on July 1, 2021 and anticipated completion by June 30, 2024 may not use the Deficits in Required Training Time policy in an effort to truncate their training (e.g., to enter a fellowship prior to July 1, 2024).

Additional resources and examples of the use of these polies can be found here:

• Time Away from Training FAQ - AAIM
• ACGME Answers: Resident Leave Policies
• Annals of Internal Medicine – Misinterpretation of ABIM Leave Policies

Definition of Full-Time Training

Full-time training is defined as daily assignments for periods of no less than one month to supervised patient care, educational or research activities designed to fulfill the goals of the training program. Full-time training must include formative and summative evaluation of clinical performance, with direct observation by faculty and senior trainees.

Transition to the ACGME/AOA Single GME Accreditation System

Beginning in July 2015, for residents and fellows who begin training in an AOA-accredited program which receives ACGME accreditation before graduation, all satisfactorily completed years of training will be accepted towards ABIM's initial certification eligibility requirements. To be granted admission to an ABIM Certification Examination, candidates must meet all applicable training, licensure, professional standing and procedural requirements.

Through its tracking process, FasTrack^®, ABIM requires verification of trainees' initial certification eligibility criteria from an ABIM certified program director (other ABMS Member Board and Canadian certification is acceptable, if applicable). In support of the Single GME Accreditation System, ABIM recognized the need for a change in eligibility policies to allow program directors of newly accredited programs to become certified by ABIM and for a transition period to allow them to do so. That period has been extended through 2023. If the program director of a program achieving accreditation through the Single GME Accreditation System is not currently certified by ABIM in the discipline for which they are program director, there is a Special Consideration Pathway which will allow the program director to become certified by ABIM.

Through the end of 2023, ABIM will accept attestations for ABIM initial certification eligibility criteria from those who are program directors through the Single GME Accreditation System, but who have not yet become ABIM certified in the discipline of their program. Beginning in 2024, all attestations of ABIM initial certification eligibility criteria will need to come from program directors who are ABIM certified in the discipline of their program. For additional information, please see the “Clinical Competence Requirements” section under each certification area.

Interrupted Full-Time Training

ABIM approval must be obtained before initiating an interrupted training plan. Interrupted full-time training is acceptable, provided that no period of full-time training is less than one month. In any 12-month period, at least six months should be spent in training. During training periods, patient care responsibilities should be maintained in a continuity clinic consistent with ACGME program requirements for the discipline. Part-time training, whether or not continuous, is not acceptable.

Qualifying Board

A Qualifying Board is an ABMS Member Board whose diplomates may apply for a subspecialty certificate through another Member Board and, if successful, participate in their continuing certification program. Once certified in the subspecialty, the diplomate of the Qualifying Board becomes a diplomate of the sponsoring Board for the subspecialty and must meet all of the sponsoring Board’s requirements for initial certification and Maintenance of Certification (MOC) in the discipline. The physician's original board no longer manages their certification and MOC for the subspecialty.

Competency-Based Medical Education Pilots

The American Board of Internal Medicine (ABIM) does not approve program-level CBME pilots; however, ABIM is pleased to coordinate with the Accreditation Council for Graduate Medical Education (ACGME) Advancing Innovation in Residency Education (AIRE) program by prospectively reviewing proposals to determine how they may affect eligibility for initial certification in ABIM disciplines.

Requests for an ABIM letter of support for an ACGME AIRE proposal can be sent to AcademicAffairs@abim.org.