The following policy was developed to assist program directors and fellowship candidates in generating training proposals that would allow dual certification in pediatric subspecialties in as little as four years of fellowship training. These are written to be used across subspecialties. The Credentials Committees of both pediatric subspecialties must approve the training proposals prospectively. Dual subspecialty training in four years may not be feasible in some pediatric subspecialties. Specifically, dual training in Pediatric Critical Care Medicine paired with any other subspecialty must be five years in duration. It is recommended that program directors and fellowship candidates contact the ABP to inquire about length of dual training required in the specific subspecialties of interest before preparing a proposal.
Dual Training Requirements
Both fellowship programs must be in the same institution; separation would not allow the integration necessary.
Both programs must be accredited by the Pediatrics Review Committee of the Accreditation Council for Graduate Medical Education.
The requests for dual subcertification must be prospective, before beginning dual training. Candidates who are in the first three to six months of training in one of the subspecialties may petition the subboards for waiver of this policy. A candidate who is beyond six months of training may not apply because integration of the two subspecialty training programs would not then be possible.
The application for dual training must be approved by both subboards.
The dual subspecialty training proposal must include a proposed program training outline signed by both fellowship training directors and submitted to the subboards for approval.
The duration of clinical training will be dependent on the pediatric subspecialties. Consideration must be given to, among other areas, the body of knowledge, technical skills, and importance of longitudinal assessment in each subspecialty area. The Credentials Committees of both pediatric subboards must approve the training proposal, which includes the training outline indicating the clinical training experiences.
Dual certification pathways must provide integration of training and core material to be able to compress mastery of common areas. The integration of core material must be demonstrated by the training programs involved in the dual pathway. The degree of integration must be approved by the Credentials Committees of both subboards. Consideration should be given to block assignments as well as outpatient clinic assignments during the training period. Night and weekend call experiences should be interspersed throughout the four years in each subspecialty and should not count toward meeting the clinical time requirement.
Scholarly activity will remain a requirement for candidates in the dual certification pathway. The research or scholarly activity need not be related to both areas of training, although that would be the most appropriate scenario. If meaningful research had been demonstrated prior to entry into this pathway (e.g., possession of a PhD), approval of both subboards would be needed to acknowledge satisfaction of the requirement. Fulfillment of this requirement would not, however, allow additional shortening of the training.
Candidates who apply for the dual certification pathway must have their research or scholarly project discussed with and approved by both training program directors.
Dual subspecialty certification is not available to internal medicine/pediatrics graduates who desire dual subcertification in both pediatrics and internal medicine. Refer to the Guidelines for Combined Training in Adult and Pediatric Subspecialties for information on subcertification by both ABP and ABIM.
An individual who has already completed three years of training in one subspecialty with verification in clinical competence, has met the requirement for meaningful accomplishment in research or scholarly activity, and now wishes to become certified in another subspecialty must complete two years of training in that second subspecialty, of which at least one year must be broad-based clinical training.
Candidates and program directors in any of the subspecialties that have achieved ACGME accreditation may apply for the dual pathway, but it will be up to the subboards of those specialties to decide whether the combination is feasible. Primary considerations will be the clinical training requirements for both subspecialties and whether a four-year duration of training will allow successful completion of all requirements.
Procedure to Submit a Proposal
Proposals must be submitted before the training begins or during the first three to six months of training and signed by both program directors and:
- 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 in each subspecialty will be completed by the individual; and
- 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.