It is a great time to be an emergency medicine resident interested in pursuing Critical Care Medicine fellowship training and subspecialty certification. For more than 30 years, there existed no straightforward pathway for emergency medicine graduates to obtain American Board of Medical Specialties (ABMS) Critical Care Medicine certification. Today, however, three pathways have been fully realized and are available to emergency medicine residency graduates. All share the requirement of an additional 24 months of training following emergency medicine residency graduation (whether the emergency medicine residency is three or four years in duration). To choose the most appropriate route to Critical Care Medicine certification, it’s important to know the current state of Critical Care Medicine fellowship training for emergency medicine residency graduates.

American Board of Internal Medicine (ABIM) Critical Care Medicine Fellowship

In September 2011 the ABMS approved the American Board of Emergency Medicine (ABEM) and ABIM application to co-sponsor subspecialty certification in Internal Medicine-Critical Care Medicine. The IM-CCM fellowship is 24 months, of which 12 months are explicitly defined by program requirements. The remainder can be elective clinical experience or scholarly activity.

For emergency medicine residency graduates to be eligible for this fellowship, they must have completed at least six months of direct patient care experience in Internal Medicine–type rotations (such as ward medicine or cardiology), three months of which must be in the medical intensive care unit (MICU).

Time spent in other intensive care environments, such as surgical, neonatal, or pediatric intensive care units do not count toward this requirement.

If emergency medicine residency graduates have not meet this “3/6” requirement described above, they can complete the necessary prerequisites during their first year of fellowship training.

However, while fulfilling these prerequisites, they are not permitted to supervise Internal Medicine residents. Once these requirements are met, they are then allowed to supervise any resident. The good news is that even if emergency medicine residency graduates did not meet any of the prerequisites, which is highly unlikely, they would still be able to graduate from the fellowship on time. One caveat to be cognizant of: a minimum of 75% of the fellows in the IM-CCM training program must be IM residency graduates.

Finally, the emergency medicine physician must be an ABEM diplomate meeting the requirements of ABEM’s Maintenance of Certification program when applying to take the IM-CCM certification examination.

The first IM-CCM certification examination that emergency medicine residency graduates could take was in November 2012. All 25 emergency medicine candidates passed the examination. Because this is a cosponsorship agreement, ABEM issues the subspecialty certificate.