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Combined Training in Adult and Pediatric Subspecialties

The American Board of Internal Medicine (ABIM) and the American Board of Pediatrics (ABP) have agreed that individuals who are graduates of combined training programs in internal medicine and general pediatrics may complete training in a subspecialty of each board in 1 year less than would be required of full training in both subspecialties. The one-year reduction in total training time is possible by double counting time devoted to scholarly activity that is applicable to and supervised by both the internal medicine and pediatric subspecialty directors.

Although the clinical training requirements in pediatric subspecialties are not specifically delineated, it is understood that a minimum of 1 year of clinical training is required. Some subspecialties of pediatrics (including cardiology and gastroenterology) require more than 1 year of clinical training for a fellow to be able to attain the clinical competencies necessary to practice that subspecialty. At least 12 months of clinical training is required for the internal medicine subspecialties, except that adult gastroenterology requires 18 months and adult cardiovascular disease requires 24 months. Individuals in combined subspecialty training would be expected to meet the same clinical training requirements as those in standard internal medicine or pediatric subspecialty programs.

For most subspecialties (eg, pulmonology, hematology-oncology, rheumatology) a proposal for combined training must include delineation of how longitudinal (continuity clinic) experience will be accomplished in both the pediatric and adult medicine subspecialty.

The boards will not approve programs for combined training; rather, the boards will only consider training proposals for individuals in combined subspecialty training.

To meet the requirements for application for a subspecialty certifying examination in pediatrics an individual must first be certified in general pediatrics. The program directors of both subspecialty programs must verify that the individual has successfully completed the required training and that he/she is recommended to take the certifying exam. The individual must meet the requirement for scholarly activity that results in a Scholarly Activity Work Product guided by the individual’s Scholarship Oversight Committee. Candidates may submit an application for the subspecialty certifying examination during their final year of combined training; however, the certifying examination cannot be taken until all training is completed. 

A proposal for combined subspecialty training of an individual, which includes an outline of training in each specialty, should be submitted to each board for review. The proposal should:

  • include a block diagram of training in each subspecialty
  • provide assurance that the same clinical components, including conferences, continuity clinic, and didactic teaching experiences completed by the usual fellow will be completed by the individual
  • include a detailed description of how the individual will meet the requirement for scholarly activity, including the requirement for a scholarship oversight committee and participation in a core curriculum to support his/her scholarly activity.   

The proposal should be prospective, submitted either before training begins or in the first 3 to 6 months of fellowship training. 

Revised 9/04
Revised 10/14