In 2019, the American Board of Internal Medicine (ABIM) revised its procedural training requirements, stating that internal medicine (IM) residents should have the chance to gain competence in procedures relevant to their intended subspecialty, rather than requiring all residents to master every procedure. The purpose of this survey was to identify which procedures fellowship directors believe incoming residents should understand, have limited experience with, or demonstrate competence in before starting the fellowship. To better understand subspecialty expectations, we surveyed fellowship directors (FDs) regarding which procedures they believe incoming fellows should be familiar with or competent to perform. Using the ACGME website, we identified 1,463 FDs across 15 IM subspecialties and invited them by email to complete a REDCap survey. The survey, developed by the study authors, included demographic items, a list of common procedures, Likert-scale questions about the value of procedural training in residency, and an open-ended item on perceptions of the ABIM changes. For each procedure, FDs indicated whether trainees should (1) understand the procedure, (2) have limited experience without competence, or (3) demonstrate competence. A total of 424 FDs responded, representing all 15 subspecialties. In 8 of the 15 subspecialties, most directors preferred that incoming fellows be competent in 1–10 of the 19 listed procedures (average of 5), though the specific procedures varied by specialty. Additionally, 100 free-text responses were analyzed and categorized into thematic groups. These findings can help IM residency program directors and residents align procedural training with subspecialty-specific expectations.
