The American Board of Anesthesiology (ABA) The American Board of Emergency Medicine (ABEM) Co-sponsorship of Anesthesiology Critical Care Medicine (ACCM) Subspecialty Certification

On September 15, 2012, the ABA and the ABEM applied to the American Board of Medical Specialties (ABMS) for co-sponsorship of certification in ACCM. This co-sponsorship will provide an opportunity for ABEM diplomates to pursue fellowship training in ACCM and subsequent certification in ACCM. Approval of this co- sponsorship is an ABMS decision that we anticipate will be made by April 2013.  Emergency Medicine (EM) residency graduates must complete five years of postgraduate training to qualify for the ACCM certification examination. Physicians who have successfully completed a three-year Accreditation Council for Graduate Medical Education (ACGME)–accredited EM residency must complete an additional 12 months of ACGME-accredited training (see examples in the FAQs) preceding entry into a one–year ACGME-accredited ACCM fellowship. Alternately, they may complete a two-year ACCM fellowship following completion of a three-year EM residency (see FAQs for details).  ACGME-accredited ACCM fellowship training programs are one year in duration. Some ACCM programs, however, have two-year CCM fellowships (see FAQs for details).

FREQUENTLY ASKED QUESTIONS

1. WHAT ARE THE REQUIREMENTS OF AN ABEM DIPLOMATE TO OBTAIN SUBSPECIALTY CERTIFICATION IN ACCM? Training Pathway  Successful completion of five years of postgraduate medical training.  Successful completion of an ACGME-accredited EM residency.  Successful completion of at least 12 months of an ACGME-accredited ACCM fellowship.  Successful completion of an additional 12 months of ACGME-accredited training, which must be completed anytime preceding entry into the ACCM fellowship, for individuals who have completed a three-year ACGME-accredited EM residency program. This fourth year of training can be in any ACGME-accredited EM subspecialty fellowship program or in any other ACGME-accredited program in a specialty other than EM; for example, one year in an ACGME-accredited internal medicine, anesthesiology, or surgery program.  Successful completion of a three-year ACGME-accredited EM residency program will be sufficient for entry into a two-year ACCM program. The first year of a two-year ACCM program must be accredited by the ACGME, and the second year must be prospectively approved by the ABA.  Successful completion of an ACGME-accredited four-year EM residency program allows an EM resident to directly apply into a one-year ACGME-accredited ACCM fellowship.  EM residency graduates who apply for an ACCM fellowship must have at least four months of CCM experience in an ACGME-accredited program (EM or other) preceding their enrollment in an ACCM fellowship.  The physician must be an ABEM diplomate and must be meeting the requirements of the ABEM Maintenance of Certification (MOC) program when applying for certification in ACCM.

FAQ's: ABA-ABEM Co-sponsorship of Anesthesiology Critical Care Medicine (ACCM) Subspecialty Certification Page | 1 of 3

2. IS THERE A GRANDFATHERING PATHWAY AVAILABLE TO EM DIPLOMATES? WHAT ELIGIBILITY CRITERIA MUST BE MET? The grandfather provision will be available for four years from the date that the ABMS approves the co- sponsorship application. A physician seeking certification under the grandfathering pathway must complete both training and a practice component to be considered for certification. Training Component:  The physician must have successfully completed an ACGME-accredited EM residency program.  The physician must be an ABEM diplomate.  The physician must be meeting the requirements of the ABEM MOC program when applying to take the ACCM certifying examination.  The physician must have successfully completed a one-year ACGME-accredited ACCM fellowship. Practice Component: ABEM diplomates who apply via the grandfathering pathway must also have completed the following practice criteria as of the date they submit their application to ABEM.  For two years prior to submitting an application for certification in ACCM, the applicant must have completed one of the following: o 40% of their post-training clinical practice time in the practice of CCM (≥16 hours/week),* or o 25% of their total post-training professional time in the practice of CCM (≥10 hours/week).** *This calculation is based on an average work week of 40 hours. Physicians whose total practice exceeds 40 hours per week may use the 40 hours number as the denominator of their 40% or 25% calculation. **This approach specifically applies to academic program directors, administrators, or researchers, and provides them a pathway to qualification.

3. WILL ABEM VERIFY THE INFORMATION I PROVIDE ON MY APPLICATION FOR ACCM CERTIFICATION?  ABEM will independently verify satisfactory completion of an ACGME-accredited ACCM fellowship training program from the applicant’s fellowship program director.  For physicians seeking entry via the grandfathering pathway, ABEM will seek independent verification of the physician’s practice in CCM and clinical competence in CCM from the Program Director of the ACGME-accredited CCM fellowship affiliated with the hospital where the physician spends the majority of clinical time. If an ACGME-accredited CCM fellowship is not present at this hospital, ABEM will seek verification by the Chief of Critical Care Medicine in the hospital where the physician spends the majority of CCM clinical time. Should the physician be the Chief of Critical Care, verification can be made by the Chief of Staff, Vice-President of Medical Affairs, or someone in a similar position.

4. WILL ACCM PROGRAM REQUIREMENTS ALLOW EM RESIDENCY GRADUATES TO ENTER ACGME-ACCREDITED FELLOWSHIP TRAINING PROGRAMS? The Residency Review Committee for Anesthesiology has proposed changes to the CCM Program Requirements to allow ACGME-accredited ACCM programs to accept EM residency graduates.

5. I SUCCESSFULLY COMPLETED A THREE-YEAR ACGME-ACCREDITED EM RESIDENCY TRAINING PROGRAM. CAN I SPEND A FOURTH YEAR OF TRAINING IN THE SAME PROGRAM PRIOR TO ENTERING AN ACCM FELLOWSHIP PROGRAM? No. Graduates of a three-year EM program cannot spend a fourth year in EM in the same three-year EM program.

FAQ's: ABA-ABEM Co-sponsorship of Anesthesiology Critical Care Medicine (ACCM) Subspecialty Certification Page | 2 of 3

Further, graduates of a three-year accredited EM program may not complete a fourth year of EM training in a different ACGME-accredited four-year EM program.

6. HOW CAN I BE ASSURED THAT A TWO-YEAR ACCM FELLOWSHIP IS ACCEPTABLE TO FULFILL ENTRY CRITERIA FOR ACCM SUBSPECIALTY CERTIFICATION? The first year of a two-year ACCM fellowship must be ACGME-accredited. The ABA must also prospectively approve the second year of a two-year ACCM fellowship program prior to entry. For prospective approval of a two-year ACCM program, or if there any questions about qualifications prior to entering a training program, please write to the ABA at:

Attention: ABA Secretary The American Board of Anesthesiology 4208 Six Forks Road, Suite 900 Raleigh, NC 27609

7. HOW LONG WILL THE GRANDFATHERING PATHWAY BE AVAILABLE? The grandfathering pathway will be available for four years from the date that the ABMS approves the co-sponsorship application. An ABEM diplomate seeking certification under the grandfathering pathway must complete both the training component and the practice component (as described in FAQ #2) to be considered for certification.

8. I COMPLETED FELLOWSHIP TRAINING IN ANOTHER CCM SUBSPECIALTY (SURGERY OR INTERNAL MEDICINE) PROGRAM. AM I ABLE TO TAKE THE ACCM CERTIFICATION EXAMINATION TO ACHIEVE CERTIFICATION? No. Only graduates of ACGME-approved ACCM programs may take the ACCM certification examination. However, other ACGME-accredited CCM fellowship training may be used as the fourth required post- graduate training year prior to entering a one-year ACCM fellowship program.

9. HOW WILL I APPLY FOR ACCM CERTIFICATION? ABEM diplomates will submit applications to ABEM during the application period. The first application period will be determined upon approval of the co-sponsorship application to the ABMS. ABEM will determine if an EM applicant fulfills the eligibility criteria. Physicians must have an approved, active, ACCM application on file with ABEM if they wish to take the ACCM certification examination.

10. WHEN WILL THE FIRST EXAMINATION IN ACCM CERTIFICATION BE OFFERED TO ABEM DIPLOMATES? The earliest opportunity for ABEM diplomates to take the ACCM examination following the ABMS approval process is anticipated to be in August of 2014. The ABA will administer the subspecialty certification examination in ACCM on an annual basis. It is a one-day examination consisting of approximately 200 multiple choice questions administered using a secure, computerized examination platform. An examination committee convened by the ABA determines the content and scope of the examination. An examination content outline is available at http://www.theaba.org/pdf/ContentOutline_CCM_January-2004.pdf.

11. WHAT ARE THE REQUIREMENTS TO MAINTAIN CERTIFICATION? Physicians certified in ACCM must meet the requirements of ABEM or ABA MOC programs.

12. WHO WILL ISSUE THE CERTIFICATE TO EM ACCM FELLOWS WHO SUCCESSFULLY PASS THE ACCM EXAMINATION? ABEM will issue CCM certificates to its diplomates. FAQ's: ABA-ABEM Co-sponsorship of Anesthesiology Critical Care Medicine (ACCM) Subspecialty Certification Page | 3 of 3