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Time-Limited Eligibility: Plan for Supervised Practice - Subspecialties

Time-Limited Eligibility – Plan for Supervised Practice and Assessment of Competence in a Subspecialty in the Accredited Training Program


The purpose of the requirement is to provide the ABP with an independent assessment of the individual’s contemporary competence to practice a subspecialty without supervision through a supervised practice experience.

  • The supervised practice must involve direct patient care, with hands-on experience, in the environment of an ACGME- (in the US) or an RCPSC- (in Canada) accredited training program that offers a breadth of subspecialty experience.
  • The supervised practice must extend over a minimum of 6 months but the required experiences as detailed below could be spread out over a longer period of time to accommodate personal needs. If a part-time plan is proposed, it must ensure consistency of supervision and continuity of experience.
  • This experience must be under the consistent supervision of attending physicians, as well as more senior fellows if appropriate, with a goal of providing sufficient exposure time per assessor in order to provide a valid assessment of the individual’s contemporary competence to practice the subspecialty unsupervised. There must be a multifaceted method for the objective evaluation and documentation of clinical competence such as a multi-source evaluation (360 degree assessments) in which faculty, residents, fellows, nursing staff, patients, and families provide input.
  • The Program Director of the accredited subspecialty training program must submit the specifics of the planned experiences to the ABP for approval prior to initiation and then verify the individual’s clinical competence at the conclusion of the supervised practice.

Specific Requirements:

The ABP will not delineate specific, detailed experiences for each subspecialty. The supervised practice must consist of core clinical experiences in the subspecialty, pursuant to the usual ACGME requirements. The Program Director should incorporate experiences that will allow assessment of the breadth of competence in the subspecialty. Neither research nor advanced subspecialty experiences are sufficient to fulfill this requirement.

  • For intensive care subspecialties and emergency medicine, the candidate should spend sufficient time in the intensive care unit or in the emergency medicine department so that faculty can judge the candidate’s clinical competence. If less than 6 months is spent in the intensive care unit or emergency department, other relevant experiences are allowed.
  • For procedural subspecialties, the candidate should undergo sufficient direct observation to allow the program director to assess competence. The number of procedures is not specified. 
  • In certain subspecialties, sufficient time must be allotted for continuity experiences that will allow continued care of the chronically ill child.    
  • If the site of practice is in the community and not at an academic institution with a fellowship training program, up to 1 month of supervised practice may take place in the practice site, if agreed to by the Program Director. This must include review of 10 de-identified case records by the Program Director and 360 degree assessments by at least 2 physicians and 2 nurses in the practice and 10 patients/families submitted to the Program Director for review.  Alternatively, an experience within the accredited fellowship training program is at the discretion of the Program Director and the candidate.  It may address areas of interest or deficiency.


  • At the time the candidate applies for certification, the Program Director must submit documentation that that clinical competency was assessed and verified based on evaluations from faculty and from practice site observers, if applicable, after the completion of a minimum of 6 months of supervised practice.   Evaluations should be made available to the ABP if requested. If competence is not verified by the program director, the individual must enter an accredited subspecialty fellowship program and complete 2 years of training in order to regain eligibility. The requirement for scholarly activity is waived.
  • Following the satisfactory completion of the 6 months of supervised practice, the candidate will have 7 years to become certified.  When applying or re-applying for certification, the applicant must meet the requirements for acceptance in effect at that time. 
  • If unsuccessful in becoming certified in the next 7 years, the candidate must enter an accredited subspecialty fellowship program and complete 2 years of training in order to regain eligibility. The requirement for scholarly activity is waived.


Edited 5/26/16