Candidate Information Booklet

RETAIN THIS BOOKLET FOR YOUR FILES Recognition of Focused Practice in Hospital Medicine Candidate Information Booklet Examinations Wednesday, May 16, 2012 or Monday, October 29, 2012 American Board of Family Medicine 1648 McGrathiana Parkway, Suite 550 Lexington, Kentucky 40511-1247 (888) 995-5700

TABLE OF CONTENTS Introduction... 1 Your Password... 2 Personal Information... 2 Email... 2 Examination Fee... 3 Refund Policy... 3 Physician Specific Information... 3 Requirements... 4 Application Requirements... 4 Demographics... 8 Special Testing Accommodations... 8 Agreement Page of Application... 10 Approval of Application and Selection of Exam Date/Location... 10 How to Schedule Your Test Center... 11 Reschedule or Withdraw from the Exam... 11 Practice Exam/Tutorial... 12 Study Materials... 12 Description of the Examination... 12 How is a Test Center Set Up?... 13 Exam Day Schedule... 13 When Should I Arrive? - What If I Arrive Late?... 14 What Happens When I Arrive At the Test Center?... 14 Identification... 15 What is Not Permitted in the Testing Room?... 15 Comfort Aids... 16 How Will the Exam Start?... 16 What Happens During the Exam?... 17 What are Examples of Irregular Behavior... 17 How Are the Exams Scored?... 18 When Can I Expect My Results?... 18 Period of Recognition... 18 Re-examination... 18 Revocation... 19 Verification Acknowledgement/Agreement... 20

Schedule for May 16, 2012 Exam Application Registration Period November 11, 2011 February 7, 2012 $1,300 fee December 15, 2011 ABIM begins sending confirmation letters to candidates regarding test center registration February 7, 2012 Last Day to Submit Online Application ($1,300) February 7, 2012 February 10, 2012 February 10, 2012 February 15, 2012 Last Day to Submit Special Testing Accommodations Documentation Last Day to Clear All Application Deficiencies. There will be no exceptions to this deadline. Last Day to Make Official Name Change with ABFM for Exam Last Day to Select Test Center by Contacting Prometric 30 Days Prior to Last Day to Withdraw from Exam without late cancellation fee ($35) Scheduled Exam Must Contact ABFM to Withdraw 5 Days Prior to Last Day to Withdraw from Exam without Seat Fee ($150) Scheduled Exam Must Contact ABFM to Withdraw 48 Hours Prior to Last Day to Change Test Center by Contacting Prometric Scheduled Exam Wednesday May 16, 2012 Examination Date Candidates will be notified of application approval or of any deficiencies immediately after the application is submitted. Any application that remains deficient after February 10, 2012 will be declared ineligible and a partial refund will be issued. A new application and full fee will be required for any future examination.

Schedule for October 29, 2012 Application Registration Period February 16, 2012 August 7, 2012 $1,300 fee May 15, 2012 ABIM begins sending confirmation letters to candidates regarding test center registration August 7, 2012 Last Day to Submit Online Application ($1,300) August 7, 2012 August 10, 2012 August 10, 2012 August 15, 2012 Last Day to Submit Special Testing Accommodations Documentation Last Day to Clear All Application Deficiencies. There will be no exceptions to this deadline. Last Day to Make Official Name Change with ABFM for Exam Last Day to Select Test Center by Contacting Prometric 30 Days Prior to Last Day to Withdraw from Exam without late cancellation fee ($35) Scheduled Exam Must Contact ABFM to Withdraw 5 Days Prior to Last Day to Withdraw from Exam without Seat Fee ($150) Scheduled Exam Must Contact ABFM to Withdraw 48 Hours Prior to Last Day to Change Test Center by Contacting Prometric Scheduled Exam Monday October 29, 2012 Examination Date Candidates will be notified of application approval or of any deficiencies immediately after the application is submitted. Any application that remains deficient after August 10, 2012 will be declared ineligible and a partial refund will be issued. A new application and full fee will be required for any future examination.

INTRODUCTION This information booklet has been prepared by the American Board of Family Medicine for use by its Diplomates who are interested in applying for the Recognition of Focused Practice in Hospital Medicine. The American Board of Family Medicine (ABFM) has joined the American Board of Internal Medicine (ABIM), in establishing a pilot program for Recognition of Focused Practice in Hospital Medicine pursuant to the directives of the American Board of Medical Specialties (ABMS) Board of Directors. Participation in the five year pilot is voluntary. The pilot program assesses, sets standards for, and recognizes the specific knowledge, skills and attitudes of internists and family physicians that focus their practice in the care of hospitalized patients. ABIM and the ABFM will be using the same eligibility requirements, exam content and scoring process. The first examination was administered by ABIM on October 25, 2010. The exam will be offered on May 16, 2012 and October 29, 2012 and twice a year thereafter. This booklet provides schedules and information for both the May and October exams. Once you have had an opportunity to read the specific requirements in this booklet, and feel that you would qualify for the Recognition of Focused Practice in Hospital Medicine Examination, you may request an application link by logging into the ABFM website: www.theabfm.org and your Physician Portfolio. Upon entry of your ID/Username and Password you will access the main page of your Physician Portfolio. On the left side you can click Request an Application to access the online application. Applications for the Recognition of Focused Practice in Hospital Medicine Examination will be made available within your Physician Portfolio on the ABFM website during the specific registration periods listed in the front of this booklet. Should you need assistance in obtaining an application or for additional information you may contact our Support Center by calling 877 223-7437 or by emailing help@theabfm.org. It is the sole responsibility of an ABFM candidate to be aware of and comply with registration deadlines. In fairness to all candidates, the Board adheres firmly to its published deadlines for registration. Candidates are encouraged to apply early in the registration period to avoid late fees (if applicable) or other problems. Issues arising from one s inability to log on to the ABFM application system (e.g. forgotten ID/Password, computer technical difficulties or operator error) must be resolved and all components of the application completed prior to 11:59 pm Eastern Time on the deadline date. The ABFM staff and Support Center make every effort to assist with these issues promptly; however, candidates are responsible for contacting the ABFM for assistance well in advance of the deadline. 1

COMPLETING THE APPLICATION YOUR PASSWORD The password provided to you for accessing your Physician Portfolio should always be treated as confidential. Once you have used the password initially provided, we strongly urge you to change it to something known only to you. There is a link in your Physician Portfolio that allows you to change the password. If you allow someone else access to your password they will have gained access to all secure information pertaining to you on our website. Keep in mind that your exam results will be accessible only on our website by using your ID and Password. PERSONAL INFORMATION Confirm all your personal information on this page. Fields that cannot be edited include your name, ABFM ID number, gender, degree, birthdate, and last four digits of your social security number. If any of this information is incorrect, you will need to contact the ABFM Records Department to have it revised. If you have a legal name change, we require a copy of the legal document (marriage, divorce, etc.) before we can officially change your name. Keep in mind that your name on record with the ABFM should be the same as the ID that you will present for admittance to the exam. Any discrepancy in your name will potentially delay or prevent your being admitted to the exam. All name issues should be resolved by the deadline to clear application deficiencies. If you need assistance with this, contact our Records Department. Please verify, update, or enter your primary mailing address in this section. The additional address lines are provided only if your address contains more than one line (e.g. an apartment number, P.O. Box, or building name). Remember, you may update your address information through your Physician Portfolio at any time by clicking the Update My Contact Information link. All fields marked with an asterisk (*) are required. E-MAIL Always make sure we have your current email address, as this is how we will correspond with you. You can update this information on our website at any time. ABFM policy does not permit staff to make changes to your contact information on your behalf. It is your responsibility to keep all of your contact information up to date in your portfolio. We will ask you to reply to our email confirmation during the registration process. Doing this verifies that the email currently on file is accurate. If your email changes or the email account becomes inactive and you have not updated with the ABFM, you need to be aware that many email services do not acknowledge to the sender that an email was received or rejected; therefore, we would be unaware that our communications were not reaching you in the event of such change. Once you have confirmed your email address, you will need to go back to your application and complete all remaining pages. 2

EXAMINATION FEE In order to expedite the processing of your application, you are encouraged to pay the exam fee of $1,300.00 (which includes a non-refundable $200.00 application processing fee) online with your credit card by the deadline (February 7, 2012 for spring exam or August 7, 2012 for fall exam.) When you pay by credit card online and complete all sections of your application and have no deficiencies, we will notify ABIM that you are eligible to select your test center. The online payment option of the American Board of Family Medicine utilizes Secure Sockets Layer (SSL) technology to encrypt the personal and financial information being sent over the internet. Your browser will display the icon of a locked padlock near the bottom of the window to indicate that SSL encryption is being used. Consequently, you may rest assured that the easy-to-use online payment process is a highly secure payment option. Should you prefer to submit your credit card number in writing or pay by check, you will be required to print a payment page to complete and send with your payment. Once the ABFM has processed your credit card or check sent by postal mail, you will be able to complete your application and move on to select a test center. Those who pay by credit card should be certain that the daily limit on the card is sufficient to permit charging the examination fee. If the credit card is declined or a check is returned by the bank, your fee must be resubmitted for the original amount plus a bounced money fee of $50.00 and must be paid by certified check or money order. Any candidate whose credit card is declined or check is returned will have their testing appointment cancelled, and he/she will not be able to reschedule until all fees have been paid. No candidate will be allowed to take the examination until all fees are paid and all requirements have been satisfactorily met. REFUND POLICY If you are registered for the May 2012 exam and find that you are unable to complete the application requirements by the deadline or need to postpone, please return to your Physician Portfolio and click on the link Recognition of Focused Practice. By indicating you want to defer your participation to the next examination, we will move your exam fee to the next examination. However, you will need to submit an application once registration opens. If you change your mind and decide to request a refund before the exam, please note that the refundable amount of your exam fee will be computed by taking the amount paid, less any late fee paid, less the $200 application processing fee and any seat fees incurred by late cancellation. Board Policy directs that the application processing fee ($200) and any late fee incurred due to filing a late application are non-refundable. Candidates requiring a refund will receive it within 2-3 weeks of notification of withdrawing from the exam. Please remember the application processing fee ($200) and any late fees paid (if applicable) are non-refundable. Furthermore any cancellation or seat fee incurred due to late withdraw will be withheld from the refundable amount of exam fee. PHYSICIAN SPECIFIC INFORMATION In this section you will select your qualifying plan (Direct Patient Care Pathway or Clinical/Systems Pathway) and indicate if special testing accommodations (Americans with Disabilities Act) are needed. Special testing 3

accommodations will be considered only with appropriate documentation. Please refer to that section of the booklet for details and specific information. REQUIREMENTS Current primary certification in family medicine in order to apply Possession of a current, valid and unrestricted license to practice medicine in the U.S. or Canada Confirmation of at least three years of unsupervised Hospital Medicine practice experience in the U.S. or Canada which fully meets the requirements of one of the qualifying pathways Possession of a current Advanced Cardiac Life Support (ACLS) certification Completion of a formal application including the full examination fee for Recognition of Focused Practice in Hospital Medicine Attestation by the Diplomate and an approved hospital officer at the practicing hospital verifying active clinical practice in the hospital setting and the required patient encounters within a given time period and participation in a hospital medicine fellowship program, if this option is being used to partially meet the patient volume requirement Completion of six (6) approved MC-FP Hospital Medicine related activities in the last ten (10) years, of which four (4) activities must have been completed in the last three (3) years with one being an approved Part IV activity Successful performance on the one-day computer-based Recognition of Focused Practice in Hospital Medicine Examination APPLICATION REQUIREMENTS Current Diplomate Status To submit an application for the Recognition of Focused Practice in Hospital Medicine Examination, a family physician must be currently certified by the American Board of Family Medicine (primary certification). Primary certification in Family Medicine must be held at the time of application and examination as well as throughout the entire designated time for holding such recognition. Satisfactory Documentation of Practice Experience in Hospital Medicine Family Physician Diplomates can apply for the Hospital Medicine Examination via one of the two practice pathways listed below. In order to participate in the RFPHM you and an approved officer of the hospital(s) at which you practice will need to attest that you meet one of the following thresholds for practice: Direct Patient Care Pathway (i.e., full-time hospital practice) Requires that the Diplomate demonstrate having spent at least three years of unsupervised Hospital Medicine practice experience in the U.S. or Canada that meet the following criteria: a minimum of 1000 Hospital patient encounters (limited to one encounter per patient per day) per year in the last 3 years, or 3000 in the last 3 years submission of Hospital Practice Verification Form signed by supervisor at hospital(s) where employed to attest to 3000 hospital patient encounters in the last 3 years 4

Completion of one year formal training in a Hospital Medicine Fellowship program can be counted for a maximum of 1000 patient encounters when applying through the Direct Patient Care Pathway. Clinical /Systems Pathway (i.e., full-time hospital medicine professional activity with part-time hospital practice) Requires that the Diplomate demonstrate having spent at least three years of unsupervised Hospital Medicine practice experience in the U.S. or Canada that meet the following criteria: a minimum of 250 hospital patient encounters (limited to one encounter per patient per day ) per year in the last three years or 750 in the last three years these encounters must comprise at least 75% of total clinical activity, and at least 50% of the remaining non-clinical professional time must be directed toward improving the care of hospitalized patients Both the Direct Patient Care Pathway and Clinical/Systems Pathway require substantiation of all hospital practice experience by submission of the Verification of Hospital Medicine Practice Experience Form. This verification form will be presented within the online application. For either of the pathways, the three-year practice threshold requires that you have not been in a residency or fellowship training program (other than a fellowship in Hospital Medicine) in the last three years prior to seeking recognition of focused practice in Hospital Medicine. The ABFM will randomly audit the attestation process via communication with the selected officer of the hospital and your enrollment is your agreement to this audit process. Furthermore, you will be required to submit another attestation as to the practice thresholds each and every three-year period after initial recognition. Verification of Hospital Medicine Practice Experience Within the application there will be a form that candidates must print out, and indicate the name of the hospital, range of dates and number of patient encounters that comprise the required practice experience necessary to meet the requirements of the pathway chosen. This Verification of Hospital Medicine Practice Experience Form should then be given to an approved officer of the hospital to have him/her attest to having direct knowledge of your three years of unsupervised hospital medicine experience. This form must be signed by the appropriate officer at the hospital where you obtained your patient encounters to attest to your practice levels and could be one of the following: Board of Directors Chair Person or Board of Directors President, Chair of Family Medicine, Chief Executive Officer, Chief Medical Officer, Division Director, Section Chief, Service Line Chief, or Medical Director. For those applying via the Direct Patient Pathway, there is also a form for verifying any hospital medicine fellowship completed. One year of hospital medicine fellowship can be counted for a maximum of 1000 patient encounters when applying through the Direct Patient Pathway. If your hospital practice experience was acquired at more than one hospital, a form should be provided to each hospital for their attestation. By clicking on the links below you can view a copy of the attestation form required for each of the pathways: 2012 Verification of Hospital Medicine Practice Experience - Clinical/Systems Pathway 2012 Verification of Hospital Medicine Practice Experience - Direct Patient Care Pathway 5

ACLS Certification All candidates for the RFPHM examination must hold a current Advanced Cardiac Life Support (ACLS) certification and submit a copy to ABFM as part of the application process. This copy can be faxed to (859) 335-7501 or scanned and emailed to Jodi Johns (jjohns@theabfm.org). Three Years Since Residency or Fellowship Physicians may not have participated in a residency or fellowship training program in the last three (3) years prior to applying for the RFPHM examination. Please note - this does not apply to formal training in a Hospital Medicine Fellowship. Licensure All candidates and Diplomates must hold a currently valid, full and unrestricted active license to practice medicine in the United States or Canada. All licenses held by a physician, in any state or territory of the United States or province of Canada must be currently valid, full and unrestricted, whether or not the physician practices in the state, territory or province. Candidates shall be required to maintain a full and unrestricted medical license in the United States or Canada even if they are out of the country for extended periods of time. Any action (including Non-Disciplinary actions and/or actions against a temporary or training/educational license) by a licensing authority potentially places a physician in jeopardy of losing Diplomate status and /or eligibility for certification or recertification. Should a physician be uncertain about the status of a medical license relative to ABFM policy, a written inquiry should be made to the Board prior to attempting an application. A violation of ABFM policy on licensure can be any action by a state licensing agency, agreement between a licensing agency and a physician, or voluntary action by a physician that revokes, restricts or suspends the physician s medical license. In cases where a physician has changed his/her residence deliberately to avoid prosecution, loss of license, or disciplinary action by a state licensing agency, the Board reserves the right to revoke or suspend Diplomate status and/or prohibit application for certification. Should a license be revoked, restricted, or suspended following the submission of an application but prior to the examination, the application will be invalidated and the candidate will be prevented from taking the examination. A partial refund of fees will apply. Unrestricted licenses which have become inactive (e.g., expired, nonrenewal) are not a violation of the Board s policy on licensure, as long as the physician maintains at least one other current, full, valid, and unrestricted medical license in the U.S. or Canada. Should a license be revoked, restricted, or suspended following the examination but prior to the notification of examination results, the application and certification will be simultaneously invalidated. The full examination fee will be forfeited. If and when the physician's revoked, restricted, or suspended license is reinstated in full (with no restrictions) and official written documentation of reinstatement is provided, the ABFM will honor the remainder of the current certificate and the Diplomate will not be required to be re-examined. If the current certificate has expired prior to the reinstatement of the license, the physician may make application for the next annual examination. Successful compliance with all application requirements in effect at that time will be expected. The ABFM will verify the license status of all candidates through the Federation of State Medical Boards. However, it is the responsibility of family physicians to inform the Board in writing immediately following action by a licensing authority. 6

Applicants should respond "YES" to the question concerning revocation, modification, or restriction of your license, if there has been any actions taken. You will be required to provide specific information regarding the action, which will temporarily delay the processing/approval of your application until the issue has been resolved. Questions about licensure should be presented to the Board in writing. Hospital Medicine Focused Practice Recognition Module Requirements Physicians must complete six (6) approved MC-FP Hospital Medicine related activities in the last ten (10) years, of which four (4) activities must have been completed in the last three (3) years with one of the four being an approved Part IV activity. Three years will be determined by the three year period just prior to application date. The self assessment modules (SAM s) and performance-in-practice (PPM) Part IV activity requirements are not required to be completed prior to the exam, however in order to be listed on the ABFM website with the Recognition of Focused Practice in Hospital Medicine, you must pass the exam and have completed the six (6) required modules in the last ten (10) years. The following are acceptable American Board of Family Medicine MC-FP activities for meeting the Hospital Medicine Module requirements: SAM s (Part II) Asthma Cerebrovascular Disease Coronary Artery Disease Diabetes Heart Failure Hypertension Pain Management PPM s (Part IV) Asthma Coronary Artery Disease Diabetes Heart Failure Hypertension MIMM s (Part IV) Information Management Methods in Medicine Cultural Competency Methods in Medicine The following are acceptable modules provided by other organizations: American Academy of Family Physicians (AAFP) METRIC - Diabetes American Academy of Family Physicians (AAFP) METRIC - Asthma American Academy of Family Physicians (AAFP) METRIC - Coronary Artery Disease American Academy of Family Physicians (AAFP) METRIC - Chronic Obstructive Pulmonary Disease American Academy of Family Physicians (AAFP) METRIC - Hypertension National Committee for Quality Assurance (NCQA) Physician Recognition Programs - Diabetes National Committee for Quality Assurance (NCQA) Physician Recognition Programs - Heart Disease/Stroke Illinois Academy of Family Physicians (IAFP) module - Managing Childhood Asthma in Primary Care American College of Physicians (ACP) modules ACOVEprime - Closing the Gap: Diabetes Care and Cardiovascular Risk Novant Health module Ambulatory Care Diabetes Performance Improvement CME American Board of Medical Specialties (ABMS) Patient Safety Improvement Program 7

There will be a random audit of Hospital Medicine applicants to verify the information submitted is accurate. DEMOGRAPHICS This section of the application must be completed as accurately as possible. The information will enable us to have more complete data on the scope of practice, geographical distributions, and interests of ABFM candidates. SPECIAL TESTING ACCOMMODATIONS The American Board of Family Medicine (ABFM) provides reasonable accommodations in accordance with the Americans with Disabilities Act (ADA) and the ADA Amendments Act of 2008 (ADAAA) for individuals with documented disabilities who demonstrate a need for accommodation. In accordance with these Acts, ABFM does not discriminate against individuals with disabilities in providing access to its examination program. For the purpose of requesting test accommodations, the ADA Amendments Act of 2008 defines a person with a disability as someone with a physical or mental impairment that substantially limits one or more major life activities such as walking, standing, seeing, hearing, eating, sleeping, speaking, breathing, learning, reading, concentrating, thinking, communicating or working. The purpose of accommodations is to provide equal access to ABFM examinations for all individuals. Accommodations match up with the identified functional limitation so that the area of impairment is relieved by means of an auxiliary aid or an adjustment to the testing procedure. Functional limitation refers to the aspects of a disability that interfere with an individual s ability to function in some capacity on a regular and continuing basis. The purpose of documentation is to validate that an applicant for test accommodations is a disabled individual as defined by the ADAAA and to provide guidance in determining effective accommodations. Comprehensive information by a qualified professional is necessary to allow ABFM to understand the nature and extent of the applicant s disability and the resulting functional impairment that limits access to its examinations. It is essential that an applicant s documentation provide a clear explanation of the functional impairment and a rationale for the requested accommodation. No candidate shall be offered an accommodation that would compromise the ABFM examination s ability to test accurately the skills and knowledge it purports to measure and no auxiliary aid or service will be provided which will fundamentally alter the examination or will result in an undue burden to ABFM. General Guidelines for all Disabilities The following guidelines are provided to assist the applicant in documenting a need for accommodation based on an impairment that substantially limits one or more major life activities. The examinee must personally initiate a request for accommodations within the on-line application, or for release of information relative to an accommodations request. Documentation submitted in support of a request may be referred by the ABFM to experts in the appropriate area of disability for a fair and impartial professional review. Accommodations requests by a third party (such as an evaluator or a program director) cannot be honored. Documentation of disability assists the ABFM in determining reasonable accommodations and/or services, which are provided on a case-by-case basis. If the submitted documentation is incomplete or does not 8

support the request, the applicant will be asked to provide additional documentation. The cost of obtaining all documentation is borne by the applicant. The documentation submitted should be as comprehensive as possible in order to allow the ABFM to make an informed decision on the accommodation request and to avoid delays in the decision-making process. Documentation in support of a request for accommodations should be submitted to the ABFM early enough to allow sufficient time to review the request and implement reasonable accommodations and/or services. Documentation must be provided by a licensed or otherwise properly credentialed professional who has undergone appropriate and comprehensive training, has relevant experience, and has no personal relationship with the individual being evaluated. The individual making the diagnosis must be qualified to do so (e.g., an orthopedic limitation might be documented by a physician, but not a licensed psychologist). Documentation should be typed or printed on official letterhead with the name, title, professional credentials, address, phone number, and signature of the evaluator, as well as the date of the report. The documentation should be current. Because the provision of reasonable accommodations is based on an assessment of the current impact of the applicant s disability on the testing activity, it is important that the individual provide recent documentation. As the manifestations of a disability may vary over time and in different settings, it is expected that an evaluation will have been conducted within the past three years. Certain conditions such as some physical and psychiatric conditions are subject to change and should be updated for current functioning. To support a request for test accommodations, please submit a detailed, comprehensive written report from your treating professional describing your disability and its impact on your daily functioning. The report should also explain the need for the requested accommodations relative to your impairment. The report and accompanying documentation should clearly state the following: A specific, professionally recognized diagnosis of the disability using diagnostic codes from the Diagnostic and Statistical Manual of Mental Disorders (DSM) or other professionally recognized formulation. A description of the functional limitations resulting from the diagnosed disability, including the identification of the major life activity that is limited by the disability, and how that major life activity is impacted. A description of the specific diagnostic criteria and names of the diagnostic tests used, including date(s) of evaluation, specific test results and a detailed interpretation of the test results. This description should include the results of diagnostic procedures and tests utilized and should include relevant educational, developmental, and medical history. Specific test results using standard scores should be reported to support the diagnosis. Diagnostic methods used should be appropriate to the disability and current professional practices within the field. Any additional informal or non-standardized evaluation procedures should be described in enough detail that other professionals could understand their role and significance in the diagnostic process. Copies of records relating to and documenting the candidate s disability, including a complete educational, developmental, and/or medical history relevant to the disability for which testing accommodations are being requested. A recommendation of specific accommodations and/or assistive devices for the ABFM examinations including a detailed explanation of why these accommodations or devices are needed and how they will reduce the impact of the identified functional limitations. Identification of the professional credentials of the evaluator that qualify him/her to make the particular diagnosis, including information about license or certification and specialization in the area of the diagnosis. 9

The evaluator should present evidence of comprehensive training and direct experience in the diagnosis and treatment of adults in the specific area of disability. If accommodations have not been requested previously, provide a detailed explanation as to why no accommodations were sought in the past and why accommodations are needed now. Send your documentation to: Accommodations Coordinator American Board of Family Medicine 1648 McGrathiana Parkway, Ste. 550 Lexington, KY 40511-1247 Or by fax to: 859-335-7501 All required documentation must be received by the final deadline for submitting an application. The last day to approve requests for special testing accommodations is the final deadline for clearing application deficiencies. After that date, requests that are lacking information or are incomplete for any reason will not be processed and the candidate will be required to take the exam under normal testing conditions or defer to a future examination. For further information regarding Special Testing Accommodations, specifically disabilities such as learning and cognitive disorders, ADHD, physical disabilities, vision disabilities, and psychiatric disabilities, please refer to the Policy Statement for Americans with Disabilities Act (ADA) Compliance available on our website. Decisions on whether to grant ADA accommodations will be made by the candidate s Sponsoring Board; however specific accommodations will be subject to the approval of the Administrative Board. Physicians who require testing over multiple days due to an approved special accommodations request can expect their exam to be administered within the following date range: Spring Exam - May 14-18 2012; or Fall Exam - November 12-16, 2012. AGREEMENT PAGE OF APPLICATION On this page of the online application, you are asked to attest to having read the Candidate Information Booklet including the full Agreement at the end of the Candidate Information Booklet, and are agreeing to be bound by the conditions therein. You are also confirming that all the information provided in the application is complete and true. Your full name and ABFM ID number will be presented to identify that you are the person signing the agreement. You are asked to electronically sign the agreement by clicking, Yes I Agree and by providing the last four digits of your social security number. APPROVAL OF APPLICATION AND SELECTION OF EXAM DATE/LOCATION Once all components of your application are completed and all deficiencies are cleared, we consider you as approved for the exam and the ABFM will notify the ABIM that you are eligible to select your testing date and location. We strongly urge candidates to select a testing location as early as possible. Please note that you must select a testing location no later than the published deadline for selection of an exam site. Be advised that not all test centers are available on all exam dates. 10

HOW TO SCHEDULE YOUR TEST CENTER Shortly after your application is approved, we will notify the American Board of Internal Medicine (ABIM) of your eligibility. Since ABIM is responsible for the administration of the examination, they will send you a letter (referred to as an Seat Scheduling Letter) with instructions for contacting Prometric to schedule your exam appointment. You will not be able to schedule an exam until receipt of the Seat Scheduling Letter which ABIM will start sending as of December 15, 2011 for the spring exam or May 15, 2012 for the fall exam. Remember, appointments are scheduled on a first-come, first-served basis. The final deadline for scheduling an exam is: February 15, 2012 for the spring exam or August 15, 2012 for the fall exam. For a listing of available Prometric testing centers, please visit: www.prometric.com/abim. Schedule Online: To schedule a seat appointment, go to http://prometric.com/abim You will be required to provide your ID which will be the letters ABFM followed by your six digit ABFM ID number (i.e. ABFM123456) After scheduling, you will immediately receive an email confirmation notice. This notice will contain your confirmation number, which will be needed if you wish to reschedule your exam date. Schedule by telephone: Call Prometric at (866) 846-6292, Monday through Friday, 7am to 7pm Eastern Time. Tell the Prometric representative that you wish to register for the American Board of Internal Medicine Exam for Hospital Medicine Provide the Prometric representative with your ID which will be the letters ABFM followed by your six digit ABFM ID number (i.e. ABFM123456) The Prometric representative will give you a confirmation number verbally and will follow-up with an email confirmation. This confirmation number will be needed if you wish to reschedule your exam date. Two weeks prior to your exam date, you will receive a reminder email from ABIM. reminder email from Prometric 2 days before your exam date. You will also get a International Testing Locations While international sites are offered by ABIM/Prometric, should you choose one of these sites you will owe an additional $500 payable to the American Board of Family Medicine immediately upon selection of the international test site. An International testing fee is charged by Prometric; the testing vendor, and passed on to us from Internal Medicine. This $500 fee is an additional cost beyond the normal application fee and is applicable only if you select an international site. Please submit a check or money order in the amount of $500 to the American Board of Family Medicine as soon as you select an international test site. Along with your check or money order, enclose a note with your ID, name, address, the international site you have selected, and the exam you are taking (Recognition of Focused Practice in Hospital Medicine). RESCHEDULE OR WITHDRAW FROM THE EXAM Reschedule Exam Should you wish to change your test center; you will need to contact Prometric directly. Do not contact the ABFM to request a change in test center. You may reschedule an exam appointment at no cost if done at least 30 days or more prior to your scheduled exam date. Rescheduling within 29 to 5 days prior to your 11

scheduled exam will result in a reschedule fee of $35. Any reschedule within 4 days to 48 hours prior to your scheduled exam will result in a reschedule fee of $60. The deadline to reschedule an exam is 48 hours prior to your scheduled exam appointment. All reschedule fees will be payable to Prometric at the time of reschedule. To reschedule use the same website for Prometric: http://prometric.com/abim or call (866) 846 6292. Cancelling Exam If you choose to withdraw from the exam, you must do so on the ABFM website. Do not contact Prometric directly to cancel your exam. In order to prevent a cancellation fee you must withdraw 30 days or more prior to your scheduled exam date. Cancelling or withdrawing from the exam within 29 to 5 days prior to your scheduled exam date will incur a cancellation fee of $35. Any cancellation/withdraw less than 5 days prior to your scheduled exam date will result in a seat fee of $150. The $150 seat fee is a cost incurred from Prometric due to late cancellations. Email notification or phone calls to cancel an examination that are made to ABFM after the withdraw deadline are considered a no show and will be subject to the $150 seat fee regardless of the circumstances for cancellation. Please refer to our Refund policy for additional information regarding a refund. PRACTICE EXAM/TUTORIAL The ABIM has developed a tutorial for this exam which can be found on their website and the ABFM strongly urges candidates to access the online tutorial at home PRIOR to exam day. Familiarity with the computer-based exam will greatly improve your efficiency on exam day. The tutorial takes about 20-30 minutes and offers you the opportunity to practice: ~ Answering questions ~ Changing answers ~ Making notes electronically ~ Accessing the table of normal laboratory values ~ Marking questions for review To view the online tutorial explaining the computer testing process: Go to: www.abim.org/exam, select Take the Exam and Prepare for the Exam: Take the Tutorial. STUDY MATERIALS The Board does not provide bibliographies or review materials. However, you may find it helpful to read a section on our website titled Exam Preparation. This can be found on our website: www.theabfm.org by clicking on Certification/Recertification and then selecting Exam Preparation. Here you will find videos as well as documents regarding study tips. The choice of media is up to the candidate and will depend on the format that the candidate has found most helpful in preparing for tests in the past. DESCRIPTION OF THE EXAMINATION The Recognition of Focused Practice in Hospital Medicine (RFPHM) Examination will be a comprehensive one-day computer based examination of multiple-choice questions in the single-best-answer format with an absolute standard for passing. The RFPHM Examination blueprint will be posted on the ABIM website in early April. ABIM refers to the exam on their website as Hospital Medicine Maintenance of Certification Exam. 12

Go to www.abim.org Select Take the exam Select ABIM Maintenance of Certification Exam Select Dates, Blueprints, Scoring Select Hospital Medicine Focused Practice HOW IS A TEST CENTER SET UP? The Prometric testing sites offers a professional testing environment in a small setting that averages from 8 to 25 private workstations. Each testing center has an administrator workstation, waiting room, proctor workstation and testing room as well as at least two certified test administrators. Prometric administers examinations for a variety of clients. Consequently, ABFM Diplomates and candidates may be testing with people from other organizations who are required to use the computer keyboard to type their answers. Any noise due to keyboard clicking can be minimized by use of ear plugs or headphones available at the exam. EXAM DAY SCHEDULE Detailed information about the format of the exam can be found on the ABIM website. The interim letter you will receive will have additional information on where to find more information on the format of the exam. The total time for your exam is ten hours, but you may finish earlier. The schedule includes registration, tutorial, instructions, exam sessions, optional breaks, and an optional survey. The breakdown of time is as follows: Registration of Candidates Time Varies Tutorial Approximately 20 minutes Instructions and Pledge of Honesty Up to 10 minutes First Session Up to two hours Morning Break Optional, up to 100 minutes (divided between 3 breaks) ** Second Session Up to two hours Lunch Break Optional, up to 100 minutes (divided between 3 breaks) ** Third Session Up to two hours Afternoon Break Optional, up to 100 minutes (divided between 3 breaks) ** Fourth Session Up to two hours Optional Survey Optional, Up to 10 minutes Total Approximately 10 hours Note: each session will contain a maximum of 60 multiple choice, single best answer questions. ** Taking scheduled breaks is optional. You will have 100 minutes total break time to use during your examination day. The amount of break time you use after each test session will be subtracted from the amount of available break time. For instance, if you take a 10 minute break after session one, the amount of break time remaining for the remainder of the exam will be reduced to 90 minutes. You can decline a break and immediately begin the next two-hour exam session, if you choose. Unused break time cannot be applied to testing time. 13

WHEN SHOULD I ARRIVE? - WHAT IF I ARRIVE LATE? Your confirmation email will specify an appointment time. Arrive 30 minutes prior to your appointment time. Candidates arriving late will not be admitted to the exam. Make certain that you know the location of the test center, parking facilities and nearby restaurants prior to exam day. The confirmation email will provide driving directions to the test center, and ABIM recommends that you review a map to confirm these directions. WHAT HAPPENS WHEN I ARRIVE AT THE TEST CENTER? The staff at each Prometric Center will follow standardized procedures to ensure that the operation of the test center meets the ABFM, ABIM, and Prometric testing criteria. The information below describes the process that will occur when you arrive at the test center. 1. You will present your two (2) personal identifications, as described below. 2. An electronic fingerprint, signature, and photograph will be taken. You cannot take the exam without having your fingerprint, signature, and picture taken. 3. Personal items are not permitted in the testing room. You will be required to leave your personal belongings outside the testing room, including your cell phone, PDA, watch, wallet, and/or purse. (See What is not permitted in the Testing Room? ) A secure individual storage locker will be provided for these items. Storage space is limited, however, so you should plan accordingly. The ABFM, ABIM and Prometric assume no responsibility for candidates personal belongings. While the temperature in the exam room should be comfortable, dressing in layers is recommended. Outerwear (jackets, coats, etc.) are not permitted; however, sweaters are permitted. Sweaters or clothing removed cannot be hung on the back of your chair but must be placed in the storage locker. 4. You will be asked to read an ABIM Candidate Rules Checklist agreeing to the security terms of the administration of the exam. 5. The test administrator will provide a scratch paper pad that may be replaced as needed during testing. (Note: you also will be able to type and save notes in a pop-up box that accompanies each exam question.) 6. If you are easily distracted by noise, you may request earplugs or headphones from the test administrator. Other than those provided by the testing center, headphones and electronic devices are not permitted in the test center. If desired, you may bring your own disposable earplugs into the test room. 7. The testing administrator will give you a short orientation and then escort you to a computer terminal/testing station in the testing room. 14

IDENTIFICATION When you arrive at the test center, you will need to present the (2) required identifications listed below: Primary ID: A current government-issued form of ID that contains a recent photograph of you and your signature. A valid driver s license, passport, or state identification card is acceptable. The name that appears must be the same as the name the Board has on record for you. AND Secondary ID: A form of ID that includes your signature, but not necessarily a photograph. For example, valid credit card, or ATM card is acceptable as well as items listed as acceptable for Primary ID. Note: Candidates without both a valid primary and secondary ID will not be admitted to the exam room. The name that appears on your ID must match the name on record with ABFM. If the name on your ID does not match the name on file you will not be admitted to the exam. WHAT IS NOT PERMITTED IN THE TESTING ROOM? In order to maintain the security of the exam, the following items are prohibited in the testing room: Electronic devices, including cellular phones, cameras, recording devices, calculators, hand-held computers/personal digital assistants (PDAs), pagers, or beepers. Watches or timepieces of any kind The test time remaining will be displayed on your computer screen. Calipers, nomograms, or other interpretive aids. Study materials, reference materials, texts, articles, books, notes, scratch paper (except provided by Prometric), etc. Pens, pencils, highlighters, or other writing instruments The test administrator will provide scratch note paper and pen which must be turned in to the test administrator after the exam. In addition, notes may be made electronically in the Notes section of each question. Both the scratch paper and the Notes section of each question are provided for only your convenience and will not be considered in the evaluation of your exam. Personal items, such as luggage, briefcases, or backpacks. Wallets or purses. Tobacco products. Food and drinks. You may bring lunch to the test center, but there is no access to refrigeration or lounge facilities. Water fountains are available at most test centers. You may also bring bottled water to store in your secure locker. Certain essential medical items (e.g. nitroglycerin, asthma inhalers, diabetic supplies) may be brought into the testing room with prior approval of ABIM. You should submit your written request to bring these items well in advance of exam day. In addition, friends or relatives who accompany you to the test center will not be permitted to wait in the test center or to contact you while you are taking the exam. Candidates who fail to adhere to these policies are subject to disciplinary action which could lead to dismissal from the exam, invalidation of the exam, disqualification from future exams, or other sanctions deemed appropriate by ABFM/ABIM. 15