General Pediatrics Training Irregularities

To apply for certification by the American Board of Pediatrics (ABP), an individual must meet the training requirements as specified in the eligibility criteria.

Credit for Previous Training

A physician transferring to pediatric residency training from another accredited residency (e.g., family medicine, internal medicine, transitional year) must contact the ABP to determine whether partial credit can be awarded for this training. Credit is usually applied to the R-1 year of training. Requests for credit must be submitted either by the candidate or the pediatric residency program director before the candidate enters pediatric residency training. Training completed more than 24 months prior to the request requires additional review and may not be credited.


Waiver of Accredited Training

The ABP has established requirements for a physician who has had at least three years of general comprehensive pediatric training in programs not accredited by the ACGME or RCPSC (i.e., international training or training in accredited osteopathic programs in the US) who wishes to apply for a waiver of training. The interested physician, department chair or program director must write to the ABP before training begins to receive approval.

The individual must provide documentation of the successful completion of at least three years of general pediatric residency training that includes the actual beginning and ending dates of the training and that is signed by the residency program director. The individual must also provide a copy of his or her medical school diploma and ECFMG certificate. Upon review and confirmation by the ABP of this information, the individual may have one year of accredited training waived. If a waiver is granted, 24 months of general pediatrics training must be completed in a program accredited by the ACGME or RCPSC. As of 2016, the individual must enter training at the R-1 level, but at the discretion of the program director, may be advanced to the R-2 level based upon the program director’s assessments of competence. A full year at the R-3 level must be completed. (The training must be completed in general pediatrics; subspecialty training may not be substituted.) Refer to Suggested Training for Individuals Who Waive Accredited Training Policy provided below.

The director of the residency program that the individual enters will decide whether the one year of waived training will be accepted by the program. Individuals should investigate the licensure requirements in the state in which they wish to seek permanent licensure to ensure they meet the requirements if they choose to shorten pediatric training completed in the United States.

Suggested Training for Individuals Who Waive Accredited Training

The ABP Nonaccredited Training Policy allows an individual to waive up to one year of accredited general pediatric residency training on the basis of having successfully completed at least three years of non-accredited training in pediatrics. Of the remaining two years of required accredited training, one full year must be at the R-3 level in order to be eligible to apply for the certifying exam offered by the ABP. It is at the discretion of the accredited pediatric residency program that he/she enters whether the program will accept this waiver of training. Once the individual enrolls in the program, the program director is also expected to judge the adequacy of clinical skills and acculturation to the training program in determining whether two years of training will be sufficient or if a third year will be required.

On occasion individuals who have met the requirements of the Nonaccredited Training Policy (usually International Medical Graduates) have sought permission to alternate assignments in the general pediatrics training program with those in a subspecialty fellowship training program. Although part-time training is allowed, the ABP strongly discourages fragmentation of the general pediatrics training. It is important that residents participate in a coherent educational program with continuity of patient care. Residents and program directors should communicate with the ABP regarding any proposed deviation from two years of training in general pediatrics prior to the start of the training program in order to ensure that the eligibility requirements for certification will be met.

Although the ABP does not prescribe the curriculum of the two years of accredited training, with the exception that one year must be at the R-3 level, the ABP has been asked to provide suggestions for training of individuals who have received a waiver of training.

Given the diversity of training offered in non-accredited training programs, the ABP feels that an individual who wishes to be eligible for certification by the ABP should successfully complete a broad tapestry of general pediatric experiences with increasing supervisory responsibility that would prepare her/him for the competent, independent care of children. The program director may wish to perform an assessment for readiness for supervision during the first period of training.

To this end the ABP suggests the following experiences for those who have completed 3 years of non-accredited training in general pediatrics without additional subspecialty training.


Educational Unit*

Emergency Medicine & Acute Illness

3 (with at least 2 in ED)

Developmental-Behavioral Pediatrics


Adolescent Medicine


Term Newborn


Inpatient Pediatrics (non-ICU)

5 (no maximum)

Ambulatory Experiences to include community pediatrics and child advocacy






**Additional Subspecialty

4 (minimum)

General Pediatric Continuity Clinic

36.5 day/week per year for the entire training period

Supervisory Responsibility

4 months

*(Educational Unit = 4 weeks or 1 month OR outpatient longitudinal experience of 32 half-day sessions OR inpatient longitudinal experience of 200 hours)

**Additional Subspecialty includes 3 units from 3 different subspecialties from the following list:

  • child abuse
  • medical genetics
  • pediatric allergy and immunology
  • pediatric cardiology
  • pediatric dermatology
  • pediatric endocrinology
  • pediatric gastroenterology
  • pediatric hematology-oncology
  • pediatric infectious diseases
  • pediatric nephrology
  • pediatric neurology
  • pediatric pulmonology
  • pediatric rheumatology

Additional 1 unit of single or combined subspecialties from the list above or below:

  • child and adolescent psychiatry
  • hospice and palliative medicine
  • neurodevelopmental disabilities
  • pediatric anesthesiology
  • pediatric dentistry
  • pediatric ophthalmology
  • pediatric orthopaedic surgery
  • pediatric otolaryngology
  • pediatric rehabilitation medicine
  • pediatric radiology
  • pediatric surgery
  • sleep medicine
  • sports medicine

Individuals who have completed subspecialty training or those who have interrupted fellowship training to complete general pediatrics requirements should not complete additional experiences in that subspecialty during the general pediatrics residency. For instance, an individual who has completed 12 months of clinical neonatology fellowship should not take more than suggested NICU experience in the table above.

  • No more than three months of subspecialty training may be completed in any one subspecialty.
  • No more than two months of elective experiences may be taken outside of the accredited program.
  • Leave in excess of one month/year must be made up.

Continuity of care experience should be emphasized for individuals who have missed accredited categorical pediatric training, allowing some leeway for program directors to determine how much additional experience is needed.

Established 6/2000
Rev. 6/2003
Edited 1/2010
Revised 2/15/2013


Absences from Training

In order to meet the training requirements to apply for certification by the ABP, an individual must train in a program accredited by the Accreditation Council for Graduate Medical Education (ACGME) in the United States or the Royal College of Physicians and Surgeons of Canada (RCPSC), and the program director must verify that the individual has successfully met the training requirements.

The duration of accredited training as required by the ACGME or RCPSC varies by pathway. For general pediatrics categorical residency and most core pediatric fellowship training, it is 36 months. All pathways, though, allow for one month of absence each year for time away from training which can be used for vacation, illness, or family leave.

Consistent with our long-standing policy, individuals in three-year core training programs are allowed up to a total of eight weeks of additional parental, medical, or caregiver leave once over their training period. Similarly, effective July 1, 2021, individuals in nonstandard* and combined** pathways will be allowed up to a total of six weeks of additional parental, medical, or caregiver leave once over their training period. The additional leave time is over the entire duration of training and is not allocated annually.

The total amount of leave time offered to the trainee is at the discretion of the institution. Programs have the flexibility to grant longer periods of leave time, but training must be extended to make up for any absences greater than what is allowed by the policy for vacation, parental, medical, or caregiver leave for a given residency or fellowship pathway. Trainees who experience an interruption in residency for greater than 24 continuous months or in fellowship for greater than 12 continuous months and who wish to re-enter training must petition the ABP to determine whether credit may be awarded for prior training. To qualify for the additional absence from training, outside of the standard one month per year, all of the following requirements must be met for an individual trainee:

  • The absence is due to parental, medical, or caregiver leave;
  • The trainee is deemed competent by the Program Director and Clinical Competency Committee;
  • All training requirements must be met except for elective training or research time as determined by the pathway; and
  • The scholarly activity requirement must be met if the trainee is a fellow.

The ABP encourages trainees to take yearly vacation and strongly discourages "banking" vacation from year to year as it can negatively affect trainees' health and well-being. The ABP views educational leave, which includes attendance at training-related seminars, as bona fide educational experiences, and it need not be counted as time away from training. All trainees must have satisfactory performance in all core domains of competence to complete their training. In addition, trainees must complete all required experiences as outlined by the training pathway.

The ABP recognizes that leave policies vary from institution to institution and expects the program director to apply local requirements within these guidelines to ensure trainees have completed the requisite training period. This policy applies to ABP eligibility requirements for initial certification and does not supersede institutional or program policies and applicable laws.

The revised ABP policy will be effective July 2021 and affect trainees who graduate in 2022 or later.

*Nonstandard pathways include:

  • Pediatrics-Neurology
  • Pediatrics-Neurodevelopmental Disabilities
  • Waiver of Accredited Training due to prior non-accredited pediatric training
  • Non-Pediatric Credited Training
  • Accelerated Research Pathway (ARP)
  • Combined Adult and Pediatric Subspecialty Fellowship
  • Dual Integrated Pediatric Subspecialty Fellowship
  • The second subspecialty fellowship of Dual Sequential Subspecialty Fellowship
  • Subspecialty Fasttracking

**Combined pathways at this time include Medicine-Pediatrics, Pediatrics-Medical Genetics, and Pediatrics-Psychiatry/Child and Adolescent Psychiatry. The policy for Pediatrics-Emergency Medicine, Pediatrics-Anesthesiology, and Pediatrics-Physical Medicine and Rehabilitation is under review and will be determined at a later date.



Training Disruptions Due to COVID-19 for Residents and Fellows Graduating in 2021

Residents and fellows who are concerned about training disruptions secondary to the pandemic should contact their program directors and coordinators.
In response to inquiries about decisions by the ABP regarding Absences from Training secondary to disruptions related to the COVID-19 pandemic, please see our letter (PDF) to graduate medical education program leaders.
Please do not hesitate to contact us through the Program Portal with any questions.


Interruption in Training

Residents who experience an interruption in general pediatrics training, medicine-pediatrics, or other combined training for greater than 24 continuous months and who wish to re-enter residency training in general pediatrics must petition the ABP to determine whether credit may be awarded for prior training. The request for credit must be submitted by the candidate or the residency program director before the candidate re-enters residency training in general pediatrics.


Nonaccredited Training Experience

No more than a total of six months of the required three years of residency training may be taken outside of an accredited pediatrics residency program. These elective experiences must be approved by the program director, must have goals and objectives for training, and must provide an evaluation of the resident's performance.

The ABP has developed guidelines for training in global health. Please refer to Global Health in Pediatric Education: An Implementation Guide for Program Directors.

Formal graduate or postgraduate school courses that do not carry the essential ingredient of responsibility for patient care cannot fulfill the ABP's training requirement in general pediatrics.


Military Service

Military service, unless as a pediatric resident in a military training program that is accredited by ACGME, cannot be substituted for training requirements. Qualified individuals with GI Bill benefits from the Veterans Administration, however, might be reimbursed for some of their educational expenses. See the VA website for details of this benefit.