The Alternate Route residency to the AiCVD Diploma exam allows those unable to join a Formalized or Individualized Residency Program to start training and take the AiCVD Diploma exam. In AR, candidates receive part-time training in different institutions under an AiCVD Diplomate's supervision.

Alternate route residents need to spend at least 250 days in observation and supervised study at the training institution, with more than 50% of the time spent on clinical cases. They must submit an annual progress report and credentials, including a case log, activity log, presentation log, a detailed description of two cases, and two publications in peer-reviewed journals.

Before starting, AR programs must be presented to and approved by the Education Committee.