Careers in Basic Science or Clinical Research
The ABIM Research Pathway is an integrated program that combines training in research with training in clinical internal medicine and its subspecialties.
This pathway is recommended only for physicians who intend to seriously pursue a career in basic science or clinical research. Physicians who are interested in teaching or practicing internal medicine should pursue the standard three years of internal medicine training.
Prospective planning for the Research Pathway by trainees and program directors is necessary. The training experience of all physicians in this pathway will be documented through ABIM's tracking program, FasTrack®. Because this pathway integrates research and training in internal medicine, with or without subspecialty training, entry implies a commitment to its completion.
Trainees interested in a research career should work with their residency program director and research mentor to design an appropriate training plan that will provide adequate clinical experience and meet ABIM's requirements. Ideally, planning for this pathway should occur during postgraduate year 1 (PGY-1), and ABIM should be notified of a trainee's intention to pursue such training by spring of PGY-2.
Responsibility for Training
The internal medicine program director must be in support of a resident's request to pursue the Research Pathway.
ABIM requires that candidates for certification in Internal Medicine are competent in: (1) patient care and procedural skills, (2) medical knowledge, (3) practice-based learning and improvement, (4) interpersonal and communication skills, (5) professionalism and (6) systems-based practice for both PGY-1 and PGY-2 of training. Furthermore, the internal medicine program director must coordinate plans for the resident's training with a research mentor and, if appropriate, the subspecialty program director.
It must be clear which program director is responsible for the resident's training after PGY-2. If the research experience is to be in a subspecialty, the subspecialty program director should become responsible for training through the Research Pathway beginning in PGY-3. If the research experience is to be in internal medicine, the internal medicine program director should continue to be responsible for training through the Research Pathway.
Training can occur at several institutions as long as the responsible program directors provide coherent, integrated and coordinated training.
Trainees interested in a research career should work with their residency program director and research mentor to design an appropriate training plan that will provide adequate clinical experience and meet ABIM's requirements. Ideally, planning for this pathway should occur during postgraduate year 1 (PGY-1), and ABIM should be notified of a trainee's intention to pursue such training by spring of PGY-2.
Responsibility for Training
The internal medicine program director must be in support of a resident's request to pursue the Research Pathway.
ABIM requires that candidates for certification in Internal Medicine are competent in: (1) patient care and procedural skills, (2) medical knowledge, (3) practice-based learning and improvement, (4) interpersonal and communication skills, (5) professionalism and (6) systems-based practice for both PGY-1 and PGY-2 of training. Furthermore, the internal medicine program director must coordinate plans for the resident's training with a research mentor and, if appropriate, the subspecialty program director.
It must be clear which program director is responsible for the resident's training after PGY-2. If the research experience is to be in a subspecialty, the subspecialty program director should become responsible for training through the Research Pathway beginning in PGY-3. If the research experience is to be in internal medicine, the internal medicine program director should continue to be responsible for training through the Research Pathway.
Training can occur at several institutions as long as the responsible program directors provide coherent, integrated and coordinated training.
Internal Medicine Training
All trainees in the Research Pathway must satisfactorily complete 24 months of accredited categorical internal medicine training. A minimum of 20 months must involve direct patient care responsibility.
Clinical Subspecialty Training
The minimum full-time clinical training required for each subspecialty is also required for certification through the Research Pathway. Specifically:
- 12 months in adolescent medicine; allergy and immunology; critical care medicine; endocrinology, diabetes and metabolism; geriatric medicine; hematology; hospice and palliative medicine; infectious disease; nephrology; medical oncology; pulmonary disease; rheumatology; or sleep medicine
- 18 months in gastroenterology, hematology/medical oncology, pulmonary disease/critical care medicine, or rheumatology/allergy and immunology
- 24 months in cardiovascular disease
- If pursuing a tertiary of a subspecialty, candidates must complete the minimum full-time clinical requirement for certification in the relevant tertiary (see table below).
Research Training
At least three years of research training at 80 percent commitment is required. ABIM defines research as scholarly activities intended to develop new scientific knowledge.
The research experience of trainees should be mentored and reviewed; training should include completion of work leading to a graduate degree (if not already acquired) or its equivalent, if applicable. The last year of the Research Pathway may be undertaken in a full-time faculty position if the level of commitment to mentored research is maintained at 80 percent.
Clinical Experience During Research Year
During internal medicine research training, 20 percent of each year must be spent in clinical experiences, including continuity clinic experiences consistent with the Accreditation Council for Graduate Medical Education (ACGME) requirements for continuity clinic.
During subspecialty research training, at least one half-day per week must be spent in an ambulatory clinic, consistent with ACGME requirements for continuity clinic in the discipline.
Time spent in a continuity outpatient clinic during nonclinical training is in addition to the requirement for full-time clinical training.
Ratings of satisfactory clinical performance must be maintained annually for each trainee in the ABIM Research Pathway.
Internal Medicine Training
All trainees in the Research Pathway must satisfactorily complete 24 months of accredited categorical internal medicine training. A minimum of 20 months must involve direct patient care responsibility.
Clinical Subspecialty Training
The minimum full-time clinical training required for each subspecialty is also required for certification through the Research Pathway. Specifically:
- 12 months in adolescent medicine; allergy and immunology; critical care medicine; endocrinology, diabetes and metabolism; geriatric medicine; hematology; hospice and palliative medicine; infectious disease; nephrology; medical oncology; pulmonary disease; rheumatology; or sleep medicine
- 18 months in gastroenterology, hematology/medical oncology, pulmonary disease/critical care medicine, or rheumatology/allergy and immunology
- 24 months in cardiovascular disease
- If pursuing a tertiary of a subspecialty, candidates must complete the minimum full-time clinical requirement for certification in the relevant tertiary (see table below).
Research Training
At least three years of research training at 80 percent commitment is required. ABIM defines research as scholarly activities intended to develop new scientific knowledge.
The research experience of trainees should be mentored and reviewed; training should include completion of work leading to a graduate degree (if not already acquired) or its equivalent, if applicable. The last year of the Research Pathway may be undertaken in a full-time faculty position if the level of commitment to mentored research is maintained at 80 percent.
Clinical Experience During Research Year
During internal medicine research training, 20 percent of each year must be spent in clinical experiences, including continuity clinic experiences consistent with the Accreditation Council for Graduate Medical Education (ACGME) requirements for continuity clinic.
During subspecialty research training, at least one half-day per week must be spent in an ambulatory clinic, consistent with ACGME requirements for continuity clinic in the discipline.
Time spent in a continuity outpatient clinic during nonclinical training is in addition to the requirement for full-time clinical training.
Ratings of satisfactory clinical performance must be maintained annually for each trainee in the ABIM Research Pathway.
Certification Examination in Internal Medicine
Trainees pursuing Internal Medicine certification via the Research Pathway may be admitted to the Internal Medicine Certification Examination in the summer of PGY-5 after successful completion of four years of training, which must include 24 months of accredited full-time clinical training in internal medicine and 24 months of research training. Documentation that the resident will be in full-time residency training or in a position with 80 percent involvement in mentored research during PGY-5 will be required at the time of application.
Trainees pursuing certification in a subspecialty via the Research Pathway must be certified in Internal Medicine at the time of application to be eligible for certification in a subspecialty. Subspecialty research trainees may be admitted to the Internal Medicine Certification Exam in the summer of PGY-4, as long as two required years of accredited training in internal medicine and 12 months of accredited subspecialty training have been completed satisfactorily.
The ABIM Internal Medicine Certification Examination and ABIM certificate are the same for all ABIM candidates whether they pursue the Research Pathway or standard internal medicine training.
Minimum Training Requirement in the Internal Medicine Research Pathway
Discipline
IM Clinical
Training
SS Clinical
Training
Research
Training (80%)
Total Training
Exam
Administration
Eligibility
Internal Medicine
24 months
N/A
36 months
60 months/5 years
Summer, PGY-5
- Internal medicine training requires 20 months of direct patient responsibility
- Ambulatory clinics during research training: 10% or one half-day per week
- Additional clinical training during research (10%) may be intermittent or block time
Certification Examination in a Subspecialty
The following subspecialty examinations may be taken in the fall of PGY-6: Adolescent Medicine; Allergy and Immunology; Critical Care Medicine; Endocrinology, Diabetes and Metabolism; Geriatric Medicine; Hematology; Hospice and Palliative Medicine; Infectious Disease; Nephrology; Medical Oncology; Pulmonary Disease; Rheumatology; or Sleep Medicine.
The following subspecialty examinations may be taken in the fall of PGY-7: Cardiovascular Disease; Gastroenterology; Hematology/Medical Oncology; Pulmonary Disease/Critical Care Medicine; or Rheumatology/Allergy and Immunology).
At the time of application, ABIM will require documentation that the trainee will be in full-time fellowship training or in a position with 80 percent involvement in mentored research for the duration of the year.
To reiterate, the ABIM subspecialty examinations and ABIM certificates are the same for all ABIM candidates whether they pursue the Research Pathway or standard subspecialty training.
Minimum Training Requirement in the Subspecialty (SS) Research Pathway
Discipline
IM Clinical
Training
SS Clinical
Training
Research
Training (80%)
Total Training
Exam
Administration
Eligibility
Adolescent Medicine
Allergy and Immunology
Critical Care Medicine
Endocrinology, Diabetes and Metabolism
Geriatric Medicine
Hematology
Hospice & Palliative Medicine
Infectious Disease
Nephrology
Medical Oncology
Pulmonary Disease
Rheumatology
Sleep Medicine
24 months
12 months
36 months
72 months/
6 years
Fall, PGY-6
Gastroenterology (GI)
Hematology/Medical Oncology
Pulmonary Disease/Critical Care Medicine
Rheumatology/Allergy and Immunology
24 months
18 months
36 months
78 months/
6.5 years
Fall, PGY-7
Cardiovascular Disease (CVD)
24 months
24 months
36 months
84 months/
7 years
Fall, PGY-7
- Internal medicine training requires 20 months of direct patient responsibility
- Ambulatory clinics during research training: 10% or one half-day per week
- Internal Medicine Certification Examination administration eligibility: Summer PGY-4
- All other standard ABIM requirements for ABIM initial certification eligibility must be met.
Tertiary certification: Add the minimum clinical requirement of the subspecialty to the Research Pathway
Discipline
IM Clinical
Training
SS Clinical
Training
Research
Training (80%)
Total Training
Exam
Administration
Eligibility
Neurocritical Care (NCC)
24 months
24 months
(12 CCM +
12 NCC)
36 months
84 months/7 years
Fall, PGY-7
Transplant Hepatology (T-Hep)
24 months
30 months
(18 GI +
12 T-Hep)
36 months
90 months/
7.5 years
Fall, PGY-8
Advance Heart Failure and Transplant Cardiology (AHFTC)
24 months
36 months
(24 CVD +12 AHFTC)
36 months
96 months/
8 years
Fall, PGY-8
Interventional Cardiology (ICARD)
24 months
36 months
(24 CVD +
12 ICARD)
36 months
96 months/
8 years
Fall, PGY-8
Adult Congenital Heart Disease (ACHD)
24 months
42 months
(24 CVD +
18 ACHD)
36 months
102 months/
8.5 years
Fall, PGY-9
Clinical Cardiac Electrophysiology (CCEP)
24 months
48 months
(24 CVD +
24 CCEP)
36 months
108 months/
9 years
Fall, PGY-9
- Internal medicine training requires 20 months of direct patient responsibility
- Ambulatory clinics during research training: 10% or one half-day per week
- Internal Medicine Certification Examination administration eligibility: Summer PGY-4
- All other standard ABIM requirements for ABIM initial certification eligibility must be met.
During internal medicine research training, 20 percent of each year must be spent in clinical experiences, including continuity clinic experiences consistent with ACGME requirements for continuity clinic.
During subspecialty research training, continuity clinic must be structured in a way that is consistent with ACGME requirements for continuity clinic in the discipline. Ratings of satisfactory clinical performance must be maintained annually for each trainee in the ABIM Research Pathway.
Impact of Changing from the Research Pathway
Internal Medicine
Trainees who change their career path from internal medicine researcher to internal medicine clinician will not be eligible for the ABIM Internal Medicine Certification Examination with less than three years of standard clinical training.
Subspecialties
Trainees who change their career path from subspecialty researcher to subspecialty clinician will not be eligible for the subspecialty certification examination with a shorter duration of training than is required for the standard clinical pathway. Such trainees are strongly encouraged to complete a third year of internal medicine training, and their total clinical training must be equivalent to the total required for standard training in internal medicine and the subspecialties. For example, a cardiovascular disease trainee who switches from the Research Pathway to the clinical pathway will be required to have completed at least six years of training, five of which are clinical training (three in internal medicine and two in cardiovascular disease).
Certification Examination in Internal Medicine
Trainees pursuing Internal Medicine certification via the Research Pathway may be admitted to the Internal Medicine Certification Examination in the summer of PGY-5 after successful completion of four years of training, which must include 24 months of accredited full-time clinical training in internal medicine and 24 months of research training. Documentation that the resident will be in full-time residency training or in a position with 80 percent involvement in mentored research during PGY-5 will be required at the time of application.
Trainees pursuing certification in a subspecialty via the Research Pathway must be certified in Internal Medicine at the time of application to be eligible for certification in a subspecialty. Subspecialty research trainees may be admitted to the Internal Medicine Certification Exam in the summer of PGY-4, as long as two required years of accredited training in internal medicine and 12 months of accredited subspecialty training have been completed satisfactorily.
The ABIM Internal Medicine Certification Examination and ABIM certificate are the same for all ABIM candidates whether they pursue the Research Pathway or standard internal medicine training.
|
Discipline |
IM Clinical |
SS Clinical |
Research |
Total Training |
Exam |
|---|---|---|---|---|---|
|
Internal Medicine |
24 months |
N/A |
36 months |
60 months/5 years |
Summer, PGY-5 |
|
|||||
Certification Examination in a Subspecialty
The following subspecialty examinations may be taken in the fall of PGY-6: Adolescent Medicine; Allergy and Immunology; Critical Care Medicine; Endocrinology, Diabetes and Metabolism; Geriatric Medicine; Hematology; Hospice and Palliative Medicine; Infectious Disease; Nephrology; Medical Oncology; Pulmonary Disease; Rheumatology; or Sleep Medicine.
The following subspecialty examinations may be taken in the fall of PGY-7: Cardiovascular Disease; Gastroenterology; Hematology/Medical Oncology; Pulmonary Disease/Critical Care Medicine; or Rheumatology/Allergy and Immunology).
At the time of application, ABIM will require documentation that the trainee will be in full-time fellowship training or in a position with 80 percent involvement in mentored research for the duration of the year.
To reiterate, the ABIM subspecialty examinations and ABIM certificates are the same for all ABIM candidates whether they pursue the Research Pathway or standard subspecialty training.
|
Discipline |
IM Clinical |
SS Clinical |
Research |
Total Training |
Exam |
|---|---|---|---|---|---|
|
Adolescent Medicine |
24 months |
12 months |
36 months |
72 months/ |
Fall, PGY-6 |
|
Gastroenterology (GI) |
24 months |
18 months |
36 months |
78 months/ |
Fall, PGY-7 |
|
Cardiovascular Disease (CVD) |
24 months |
24 months |
36 months |
84 months/ |
Fall, PGY-7 |
|
|||||
|
Discipline |
IM Clinical |
SS Clinical |
Research |
Total Training |
Exam |
|---|---|---|---|---|---|
|
Neurocritical Care (NCC) |
24 months |
24 months |
36 months |
84 months/7 years |
Fall, PGY-7 |
|
Transplant Hepatology (T-Hep) |
24 months |
30 months |
36 months |
90 months/ |
Fall, PGY-8 |
|
Advance Heart Failure and Transplant Cardiology (AHFTC) |
24 months |
36 months |
36 months |
96 months/ |
Fall, PGY-8 |
|
Interventional Cardiology (ICARD) |
24 months |
36 months |
36 months |
96 months/ |
Fall, PGY-8 |
|
Adult Congenital Heart Disease (ACHD) |
24 months |
42 months |
36 months |
102 months/ |
Fall, PGY-9 |
|
Clinical Cardiac Electrophysiology (CCEP) |
24 months |
48 months |
36 months |
108 months/ |
Fall, PGY-9 |
|
|||||
During internal medicine research training, 20 percent of each year must be spent in clinical experiences, including continuity clinic experiences consistent with ACGME requirements for continuity clinic.
During subspecialty research training, continuity clinic must be structured in a way that is consistent with ACGME requirements for continuity clinic in the discipline. Ratings of satisfactory clinical performance must be maintained annually for each trainee in the ABIM Research Pathway.
Impact of Changing from the Research Pathway
Internal Medicine
Trainees who change their career path from internal medicine researcher to internal medicine clinician will not be eligible for the ABIM Internal Medicine Certification Examination with less than three years of standard clinical training.
Subspecialties
Trainees who change their career path from subspecialty researcher to subspecialty clinician will not be eligible for the subspecialty certification examination with a shorter duration of training than is required for the standard clinical pathway. Such trainees are strongly encouraged to complete a third year of internal medicine training, and their total clinical training must be equivalent to the total required for standard training in internal medicine and the subspecialties. For example, a cardiovascular disease trainee who switches from the Research Pathway to the clinical pathway will be required to have completed at least six years of training, five of which are clinical training (three in internal medicine and two in cardiovascular disease).
Research Training
As research training in both internal medicine and the subspecialties changes to conform more closely to societal needs, the training of basic scientists and clinical investigators must be preserved to ensure continued discovery and scholarly application of knowledge to patient care.
Scientific inquiry and innovation are hallmarks of the research physician, and the range of research undertaken today is wide and varied. ABIM anticipates that the careers of physician researchers increasingly will evolve in two directions: one focusing on basic patient-oriented research (the basic scientist) and one focusing on applied patient-oriented research (the clinical investigator). Although the training for these two research roles includes several unique components, both require a substantive curriculum and comprehensive research experience.
Training of the basic scientist mandates a rigorous and varied curriculum in addition to standard clinical training. The curriculum for the basic scientist requires in-depth study of a basic science (e.g., cell biology, molecular biology, physiology, human genetics or pharmacology, etc.) and its methods of inquiry.
The curriculum requires skill development in the application of:
- Research methods
- Information and data management
- Statistics
- Experimental design
- Grant and manuscript writing
In addition, the curriculum should foster an attitude of inquiry and altruism based on legal and ethical principles. Methods of education for the basic scientist include:
- Formal coursework leading to a Ph.D. degree or equivalent advanced degree in the field of investigation (if not already acquired)
- Experience working under a research mentor in a modern research laboratory
- Completion of investigative work that applies research methods of modern biology to elucidate the mechanisms of human disease and its treatment or other advancement in the science of medicine
Training of the clinical investigator mandates a rigorous and varied curriculum in addition to standard clinical training. The curriculum for the clinical investigator requires an in-depth study of the fundamentals of one or more of the following fields:
- Clinical epidemiology
- Genetic epidemiology
- Pharmacology
- Behavioral sciences
- Medical economics
- Medical outcomes
- Public health or health systems research
Also essential is learning the legal and ethical principles involved in studies on humans. Furthermore, the curriculum should be designed to develop the trainee's skills in:
- Experimental design, implementation and reporting of clinical studies
- The use of sampling methods
- The concepts of sample size
- Analytic methodology
- Statistical methodology
- Grant and manuscript writing
- Expertise in working with institutional research boards
Finally, the curriculum should foster an attitude of inquiry and altruism based on ethical and legal principles. Methods of education for the clinical investigator include:
- Formal coursework leading to a Ph.D. or master’s degree (e.g., MPH, Master of Science in Clinical Research, etc.) if not already acquired.
- Experience working under a research mentor in a modern research setting that involves the use of providers, patients or materials obtained from patients in the investigation of various aspects of disease and where the foci of the research are on the patient, provider or system and at the bedside, in the clinic or in the community.
- Completion of investigative work that applies the research method of the field to the evaluation of either new mechanisms or new treatments of disease or the advancement of the practice or science of medicine.
Defining Research Quality
Assessment of the trainee's research progress can be facilitated through a system based on defined levels of achievement. A three-year, 80% time commitment is the minimum training for basic and/or clinical research. Within that framework, suggested criteria upon which to evaluate research performance are as follows:
- Core elements of research:
- Project/study design
- Development of protocol
- Proficiency in research methodology
- Conceptual and statistical analysis
- Principles of authorship and manuscript preparation
- Scientific integrity
- Use of research competency committee to monitor/confirm performance
- Active participation in regularly scheduled research seminars, journal clubs, laboratory meetings and/or formal coursework
- Acquisition of a graduate degree (if not already acquired)
- Oral or poster presentations at regional, national or international scientific meetings
- Publications, especially those in peer-reviewed journals
- Honors and awards for research quality, such as Best Paper or Young Investigator Award
- Awards in competitive fellowships (e.g., AHA, NIH, HHMI, NRSA, CIDA, etc.) and grants as principal investigator or co-principal investigator
Daily interaction between the research mentor and trainee is essential in both basic and clinical research training. The mentor should be an accomplished investigator with a sustained record of competitive research funding and an active research program.
In addition, the mentor should have a major responsibility for:
- Supervising the trainee;
- Providing assessment and constructive feedback; and
- Documenting the trainee's research progress and performance.
Consequently, the research mentor must work in an environment with sufficient resources to offer trainees an enriching experience throughout fellowship.
Each trainee and mentor should establish research training goals that include quality of performance and mastery of information and technical methods relevant to the research. Progress in achieving these goals should be reviewed regularly by the research mentor, the research committee and the program director.
The research environment for training investigators must be comprehensive as outlined below:
- Adequate funding of research is essential and should include appropriate institutional commitment for trainees' research training.
- A critical mass of productive researchers who can serve as mentors and professional colleagues to trainees is needed. “Productive researchers” can be defined by the number of articles they have published in peer-reviewed journals, the quality of the journals in which their research is published, the frequency of citation of their scientific work in the literature index and the number of research fellows they mentor.
- Quality research training must constitute a broad curriculum with well-defined goals and objectives. Trainees should partake in educational experiences, including formal coursework that is applicable to their preparation for research careers, unless this didactic experience has already occurred as part of a relevant doctorate or other advanced degree completed prior to internal medicine training.
Suggested core lectures or conference series in biomedical research should include the following:
- Critical interpretation of scientific literature
- Research methods, including design of hypothesis-driven experiments and their interpretation
- Data analysis and use of appropriate biostatistics and/or medical informatics
- Responsible use of informed consent
- Research ethics
- Monthly research conferences and literature review sessions (e.g., journal clubs)
- Monitoring patient-oriented research, including protocol, data management, quality control, computer packages, clinical trials, FDA regulations and dissemination of information
- Grant and manuscript writing, abstract presentation and communication skills
- Completion of research project or thesis