A “grandfather” pathway does exist; this will be reviewed in a subsequent article.

American Board of Surgery (ABS) – Surgical Critical Care (SCC) Fellowship

In April 2012, the ABMS approved emergency medicine residency graduates to enter SCC fellowships. This is quite different from the cosponsorship relationship with ABIM. In this case, the ABS merely broadened the entrance criteria for SCC fellowships to include emergency medicine residency graduates.

The ABS will issue the subspecialty certificate. In this pathway, a residency graduate is required to complete a modified, advanced preliminary year at the same institution as the SCC fellowship. During the preliminary year, the residency graduate will be treated as a more senior surgery resident, gaining experience in managing recent postoperative patients and gaining advanced surgical clinical experiences.

Following completion of this advanced preliminary year, the graduate will immediately enter the 12-month SCC fellowship. Upon successful completion, the graduate is permitted to sit for the SCC certification examination. Again, the emergency medicine physician must be an ABEM diplomate meeting the requirements of the ABEM MOC program when applying to take this subspecialty examination.

Emergency medicine residency graduates can begin the modified, advanced preliminary year July 2013. There is no “grandfather” pathway available for SCC.

American Board of Anesthesiology (ABA) – Critical Care Medicine

The ABA and ABEM have agreed to cosponsor subspecialty certification in Anesthesiology Critical Care Medicine (ACCM). The ABMS Board of Directors unanimously approved this cosponsorship on June 26, 2013. According to the agreement, emergency medicine residency graduates must have at least four months of CCM experience (such as in a MICU or SICU) during their residency training prior to enrollment in the ACCM fellowship.

The graduate must then complete a total of 24 months of additional training. The first 12 months must be under the auspices of the ACCM Fellowship. During the first six months, there will be three rotations that have a focused surgical emphasis (such as acute care surgery or trauma surgery). The second 12 months will consist of the ACGME-accredited ACCM fellowship.

Of the total 24 months of experience, these must be 12 months aggregate exposure to surgical conditions. This includes time in the surgical critical care unit, surgical rotations (i.e., acute care surgery, etc.) or clinical rotations with a significant surgical component. Finally, there will be a minimum of nine months of CCM rotations.

The emergency medicine physician must be an ABEM diplomate meeting the requirements of the ABEM MOC program when applying to take the ACCM certification examination.