About Medical Procedures Required During Residency Training

The American Board of Internal Medicine (ABIM) procedure requirements for eligibility for board certification focus on understanding and being able to explain a number of specific medical procedures, and having the ability to effectively obtain informed consent with patients when applicable. The ABIM also requires actual demonstration of competence and safe performance of a smaller subset of specific procedures through direct observation.

Procedures for which internal medicine trainees should understand and explain include:  

  • Abdominal paracentesis
  • Arterial and central venous line placement
  • Arthrocentesis
  • Electrocardiography
  • Incision and drainage of an abscess
  • Lumbar puncture
  • Nasogastric intubation
  • Pulmonary artery catheter placement
  • Thoracentesis  

Procedures requiring demonstration of competent and safe performance include:

  • Advanced cardiac life support
  • Arterial and venous blood sampling
  • Pap smear and endocervical culture
  • Placement of a peripheral venous line  

Although the ABIM does not specify the exact number of each of the required procedures that must be performed to demonstrate competency, residency training programs are encouraged to teach trainees through initial simulation followed by supervised active participation, with the expectation that trainees should actively perform these supervised procedures at least five or more times.  

Although many internists perform other procedures as part of their practice that are not required for board eligibility, it is expected that for these procedures the principles of informed consent will be applied when indicated, and competence in medical knowledge relevant to each procedure will be demonstrated relative to indications, contraindications, patient preparation methods, sterile technique, pain management, proper techniques for handling specimens and fluids obtained, and recognizing and managing complications. It is also expected that the appropriate information and the results of the procedure will be effectively communicated with the patient.

The program director of the residency training program is required to attest to a candidate’s knowledge and competency to perform the specified procedures in order to be eligible for initial board certification.

It is important to note that hospitals and healthcare systems may have requirements for procedural competencies that are different from those required for initial board certification. If you are planning to enter practice or continue training, you may want to check with the institutions where you will be working to understand their procedure requirements and discuss them with your program director to ensure that you meet those criteria before you finish residency.