CERTIFICATION AND MAINTENANCE OF CERTIFICATION
The Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Pediatrics (ABP)
work together to verify the quality of training programs and the quality of physicians, respectively, with the
ultimate goal of ensuring a high quality of care for patients. The ACGME accredits training programs that meet
standards set by the Review Committee (RC) for Pediatrics. The ABP certifies individual fellows for the practice of
subspecialty pediatrics through an initial certification examination at the completion of fellowship training and,
thereafter, through a process for the continuous review of qualifications to maintain certification throughout the
lifetime of one’s practice. This ensures the public of the pediatrician’s competence.
The American Board of Medical Specialties
(ABMS), of which ABP is a member, and the ACGME require that all
graduates of accredited graduate medical education (GME) programs achieve competency in the following six
broad and diverse domains: patient care and procedural skills, medical knowledge, practice-based learning
and improvement, interpersonal and communication skills, professionalism, and systems-based practice.
Upon graduation from an ACGME-accredited training program, an individual candidate is eligible to sit for the
subspecialty certifying examination given by the ABP, provided the candidate meets the prerequisites noted below.
From the time of successful graduation from fellowship, the candidate has 7 years to pass the subspecialty
certifying examination. Once that time expires, a period of supervised practice in the environment of accredited
training will need to be completed for the candidate to regain eligibility to take the certifying exam. Certification is
important to assure the public that an individual possesses the skills and abilities to provide a high standard of care
for children.
Prerequisites for Initial Subspecialty Certification
Fellows seeking initial certification must: 1) have passed the certifying examination in General Pediatrics, 2) complete
an ACGME-accredited or Royal College of Physicians and Surgeons in Canada (RCPSC) training program in a pediatric
subspecialty within the previous 7 years, 3) receive an attestation from the fellowship program director of satisfactory
performance, 4) have met the requirements for scholarly activity, and 5) possess a valid, unrestricted medical
license.
The ABP shares the responsibility for verifying the competence of graduating fellows with the program director. The
responsibility that rests with the fellowship program director has significant impact on the future of the trainee.
In order for a fellow to sit for the subspecialty certification examination, the program director must attest to the
competence of the fellow in each of the six ACGME domains. Unsatisfactory performance in any one area will
require remediation before the fellow can sit for the exam. To help the program director with this responsibility, the
ABP has instituted a tracking process that requires the program director to attest to satisfactory, unsatisfactory,
or marginal performance at the completion of each year of training. This annual review (Fellow Evaluation Roster) is
designed to identify ongoing issues early so as to prevent concerns from being raised for the first time during the
final year of training. In a high-stakes evaluation such as this one, it is only fair that a comprehensive
assessment process be used to inform this decision.
Assessing Performance/Program Director Responsibilities
The American Board of Pediatrics is relying on program directors to make critical decisions on each trainee’s
progress on a yearly basis and ultimately to verify that the fellow has demonstrated competence in all 6
ACGME domains to be eligible to take the ABP subspecialty certifying examination. As noted above, these
domains of competence include patient care and procedural skills, medical knowledge, practice-based learning and
improvement, interpersonal and communication skills, professionalism, and systems-based practice. This process
calls for multiple methods of assessment. The basis of these assessments should be grounded in the direct
observation of the fellows in a variety of settings and performing a variety of patient care tasks, including
demonstration of evidence to support procedural competence. There are many resources available on which to
rely for principles of assessment, as well as tools to carry out the necessary observations. The ABP has a guide
for program directors called Assessment in Graduate Medical Education: A Primer for Pediatric Program Directors
available on its website that may also be useful for fellowship program directors. In addition, the Association of
Pediatric Program Directors (APPD), ACGME, and Academic Pediatric Association (APA), have resources as well.