(A) Comparison of traditional training pathway for a cardiovascular medicine specialist with the American Board of Internal Medicine’s (ABIM’s) competency-based pilot in internal medicine (IM) and cardiology (Pilot). (B) Structure of third-year IM residency during the ABIM’s Pilot. Four unique clinical rotations added in the third year of IM residency include echocardiography, vascular medicine, stress testing, and preventive cardiology. Unlike electives during IM residency, these 4 clinical rotations qualify for ABIM requirements for both IM and cardiovascular board certification. EKG = electrocardiography.