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TRAINING

Training requirements for eligibility for the certification process of each board will be satisfied by 60 months of approved combined training. A reduction of 12 months over that required for two separate residencies is possible due to the overlap of curriculum and experience inherent in the training in each discipline. The requirement of 36 months of internal medicine training is met by 30 months of training in the internal medicine component of the combined residency, and 6 months of credit granted for training appropriate to internal medicine obtained during the 30 months of dermatology residency. The requirement of 48 months of training in dermatology is met by the 12 months of a first year residency in internal medicine, 30 months of training in the dermatology component of the combined residency, and 6 months of credit for training appropriate to dermatology obtained during the remaining 18 months of residency in internal medicine.

Residents should enter combined training at the PGY-1 level, but may enter as late as the beginning of the PGY-2 level if the PGY-1 year was served in a categorical or preliminary residency in internal medicine in the same institution. Under unusual circumstances and with prior approval of both boards, individuals may be accepted who have trained in other accredited programs. Residents may not enter combined training beyond the PGY-2 level. Transfer between combined programs must have the prospective approval of both boards, and is allowed only once during the five-year training period. In a transfer between combined training programs, residents must be offered and must complete a fully integrated curriculum. A resident transferring from combined training to a straight internal medicine or dermatology program should have the prospective approval of the receiving board.

Credit for transitional year training toward the eligibility requirements for certification by either the American Board of Internal Medicine or the American Board of Dermatology shall not be recognized unless ten months or more of this year have been completed under the direction of a program director of an ACGME-accredited residency in internal medicine.

Training in each discipline must incorporate graded responsibilities throughout the training period and each resident must assume supervisory responsibilities for at least six months during the 30 months of training in each discipline.

FACULTY

The combined residency must be coordinated by a designated full-time director, from either specialty, or co-directors from both specialties, who can devote substantial time and effort to the educational program. If a single training director is appointed, an associate director from the other specialty must be named to insure both integration of the training and supervision in each discipline. The respective training director(s) should be certified by the ABIM or the ABD. The supervising directors from both specialties must embrace similar values and goals for the training, and must document meetings with one another held at least quarterly to monitor the progress of each resident and the overall success of the training.

EVALUATION

There must be adequate, ongoing evaluation of the knowledge, skills and performance of residents. Entry evaluation assessment, interim testing and periodic reassessment, utilizing appropriate evaluation modalities, including in-training examinations, should be employed. There must be a method of documenting the procedures that are performed by the residents. Such documentation must be maintained by the program director, be available for review by the Residency Review Committees in Internal Medicine and Dermatology, the American Board of Internal Medicine, the American Board of Dermatology, and site visitors, and may be used to provide documentation for application for hospital privileges by graduates of these training programs.

The faculty must provide a written evaluation of each resident after each rotation and these must be available for review by the site visitors of Residency Review Committees. Written evaluation of each resident's knowledge, skills, professional growth, and performance, using appropriate criteria and procedures, must be accomplished at least semi-annually and must be communicated to and discussed with the resident in a timely manner.

Residents should be advanced to positions of higher responsibility only on the basis of evidence of their satisfactory progressive scholarship and professional growth.

The program director/s is/are responsible for the maintenance of a permanent record of each resident and its accessibility to the resident and other authorized personnel. The training director and faculty are responsible for provision of a written final evaluation for each resident who completes the program. This evaluation must include a review of the resident's performance during the final period of training, should verify that the resident has demonstrated sufficient professional ability to practice competently and independently and is prepared to apply for the certification processes of both internal medicine and dermatology. This final evaluation should be part of the resident's permanent record and should be maintained by the institution.

The program director/s should anticipate periodic reviews of the combined training programs by site visitors from the ACGME who are reviewing the primary Internal Medicine or Dermatology residency program at the institution where the combined training program is conducted. Such reviews will ordinarily include interviews with the combined training resident/s.

SIXTH YEAR

Both Boards encourage residents to extend their training for an additional sixth year in investigative, administrative or academic pursuits in order to prepare graduates of combined training in dermatology and internal medicine programs for careers in research, teaching, or departmental administration.