HPM Exam Format | Course Contents | Outline | Syllabus | Objectives

HPM Exam Syllabus & Study Guide

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The information below reflects the 2026 syllabus defined by ABIM.

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HPM Hospice and Palliative Medicine 1. Prognostication and Natural History of Serious and Complex Illness — 10% A. Knowledge of Serious and Complex Illness - Knowledge of disease trajectories - Pathophysiology - Differential diagnosis - Complications - Prognostication - Scope of palliative treatments for different serious and complex illnesses - Surgery - Radiation therapy - Other palliative treatments - Assessment of benefits and burdens of treatments - Seriously ill patient - Family - Pharmacology of essential palliative symptom management - Advance care planning for specific illnesses - Advance care planning concerning potential advanced therapies - Mechanical ventilation - Implantable defibrillator - Ventricular assist device - Other advanced therapies - Application across the age spectrum B. Disease Trajectories and Conditions - Cancer - Cardiovascular disease - Pulmonary disease - Multi-organ dysfunction syndrome - Acute neurologic disease - Neurodegenerative disease - Frailty syndrome - Multimorbidity / multiple comorbidities - Renal failure - Liver disease - Unintentional injury and trauma - Diseases of childhood - Perinatal conditions and infant death - Genetic/congenital conditions - Other pediatric conditions C. Prognostic Accuracy - Factors associated with prognostic accuracy - Clinical assessment of prognosis - Individual illness trajectories - Potential response to therapies - Consequences of failure to prognosticate - Prognostic uncertainty - Prognostic awareness - Communicating prognosis - Function - Timeframe - Quality of life - Challenges in communicating prognosis 2. Comprehensive Whole-Patient Assessment — 20% A. Pain and Non-Pain Symptom Assessment - Pain assessment - Non-pain symptom assessment - History - Measurement of symptoms - Function - Intensity - Diagnostic testing - Measurement in the context of communication challenges - Delirium - Cognitive impairment - Developmental capacity B. Concepts of Total Pain and Suffering - Physical - Psychological - Psychiatric - Spiritual - Social - Financial Psychological/Psychiatric Factors - Mood disorders - Anxiety - Impact of trauma - Personality traits Spiritual Factors - Meaning - Hope - Spiritual life - Religious beliefs - Religious practices Social Factors - Social support - Financial issues - Social determinants - Family and caregiver factors C. Pain Classification - Nociceptive pain - Somatic pain - Visceral pain - Neuropathic pain - Peripheral nerve injury - Spinal cord injury - Central pain - Phantom limb pain - Central sensitization - Neuroplasticity - Descending modulation of nociception - Incident pain - Ischemic pain - Physiologic manifestations of acute versus chronic pain D. Cultural and Individual Considerations - Patient culture - Family culture - Patient values - Family values - Implicit bias - Social determinants of health - Cultural considerations in pain and symptom relief E. Decision-Making Capacity - Assessment of decisional capacity - Cognitive capacity - Behavioral capacity - Emotional capacity - Developmental stages - Developmental capacity F. Caregiver Assessment - Caregiver supports - Caregiver stressors - Psychological supports - Psychiatric supports - Social supports - Financial supports - Family needs G. Comprehensive Support/Stress Assessment - Psychological supports and stressors - Psychiatric supports and stressors - Spiritual supports and stressors - Social supports and stressors - Financial supports and stressors 3. Managing Suffering and Distress — 40% A. Pain Management Analgesics Opioids - Opioid pharmacology - Opioid adverse effects - Opioid routes of administration - Equianalgesic dosing - Opioid selection - Opioid administration considerations - Opioid management in organ failure Nonopioids - Pharmacology - Adverse effects - Routes of administration Adjuvants - Pharmacology - Adverse effects - Routes of administration Nonpharmacologic Pain Management - Behavioral interventions - Integrative interventions - Interventional pain management - Surgical approaches Organ Failure and Pharmacology - Medication considerations in organ failure - Pharmacologic adjustment in serious illness - Medication safety B. Management of Non-Pain Symptoms - Anorexia - Cachexia - Weakness - Fatigue - Oral conditions - Dyspnea - Cough - Nausea - Vomiting - Dysphagia - Diarrhea - Constipation - Anxiety - Depression - Myoclonus - Dysuria - Edema - Ascites - Hiccups - Sleep issues - Pruritus - Incontinence - Wounds - Sexual dysfunction - Agitation - Hallucinations - Nonemergent delirium C. Pharmacologic Strategies - Medication selection - Medication pharmacology - Routes of administration - Adverse effects - Dose adjustment - Symptom-specific pharmacotherapy - Opioid therapy - Nonopioid therapy - Adjuvant therapy - Pharmacology in organ failure D. Nonpharmacologic Strategies - Behavioral interventions - Integrative medicine - Interventional approaches - Surgical approaches - Rehabilitative therapies - Nutrition E. Anticancer Therapeutics - Radiation therapy - Chemotherapy - Targeted therapy - Immunotherapy F. Psychosocial and Spiritual Distress - Basic psychosocial distress - Basic spiritual distress - Psychological support - Social support - Spiritual support - Integrative approaches 4. Palliative Care Emergencies and Refractory Symptoms — 5% A. Recognition of Palliative Emergencies - Acute airway obstruction - Acute hypoxia - Bowel obstruction - Emergent delirium - Device loss or malfunction - Fractures - Hemorrhage - Hypercalcemia - Increased intracranial pressure - Pneumonia - Pneumothorax - Seizures - Serotonin syndrome - Spinal cord compression - Superior vena cava syndrome B. Emergency Management - Identification - Anticipation - Triage - Assessment - Acute management - Symptom control - Communication with patient/family - Interdisciplinary management C. Refractory Symptoms - Recognition of refractory symptoms - Indications for proportional sedation - Medication selection - Sedation techniques - Proportional sedation - Monitoring and reassessment 5. Management of Medical Interventions — 6% A. Withholding and Withdrawal of Life-Sustaining Therapies - Counseling patient - Counseling family - Counseling healthcare providers - Prognostication before withdrawal - Psychosocial needs - Spiritual needs - Cultural needs - Shared decision-making - Goals of care - Interdisciplinary team involvement - Symptom management before withdrawal - Symptom management during withdrawal - Symptom management after withdrawal - Technical withdrawal process - Withholding/withdrawal of artificial nutrition and hydration - Provider and team reactions - Values and emotions - Ethical standards - Legal standards - Institutional culture - Institutional policies B. Respiratory Interventions - Mechanical ventilation - Withdrawal of respiratory life support - Symptom management around withdrawal C. Renal Interventions - Renal replacement therapy - Withdrawal/withholding considerations D. Cardiac Interventions - LVAD - Pacemakers - AICDs - Other advanced cardiac therapies - Device-related goals-of-care considerations E. Other Medical Interventions - Antibiotics - Anticoagulation - Intravenous fluids - Intravenous nutrition - Artificial nutrition and hydration - Life-sustaining therapies 6. Impending Death and the Death Event — 3% A. Care of the Imminently Dying Patient - Physical symptom management during dying - Psychosocial needs - Spiritual needs - Cultural needs - Family needs - Interdisciplinary collaboration - Communication around death - Empathic presence - Preparing family - Self-awareness - Self-care B. Manifestations of Impending Death Respiratory - Noisy respiratory secretions - Other respiratory manifestations Cardiovascular - Cardiovascular manifestations of dying Neurologic - Neurologic manifestations Renal - Renal manifestations Skin and Mucous Membranes - Skin changes - Mucous membrane changes Gastrointestinal - Gastrointestinal manifestations C. Death Event - Management of the death event - Religious considerations - Spiritual considerations - Psychosocial considerations - Cultural considerations - Socioeconomic considerations - Family considerations - Emotional responses to death and dying D. Post-Death Care - Death pronouncement - Death note - Death certificate - Communication with others - Autopsy - Organ donation 7. Communication Skills — 2% A. Fundamental Communication Skills - Building rapport - Listening versus hearing - Acknowledging emotion - Responding to emotion - Compassionate presence - Strategic silence - Recognition of communication cues - Guiding discussion - Recognizing one's own emotions - Recognizing preconceptions - Implicit bias - Addressing conflict - Patient-centered approach - Family-centered approach - Counseling techniques - Family conferences - Nontraditional families - Conflict-resolution skills B. Communication for Complex Decision-Making - Delivering medical information - Delivering serious news - Discussing prognosis - Eliciting patient values - Eliciting patient goals - Shared decision-making - Facilitating family meetings - Adaptive coping - Reframing hope - Promoting resilience - Legacy - Humor - Affiliation - Anticipation - Death notification 8. Grief, Loss, and Bereavement — 3% A. Types and Patterns of Grief - Anticipatory grief - Normal grief - Bereavement - Problematic grief - Complicated grief - Developmental differences in grief B. Assessment - Risk factors for grief - Risk factors by age - Risk factors by developmental stage - Grief assessment - Bereavement assessment - Loss history C. Support - Basic support for anticipatory grief - Basic bereavement support - Referral for grief support - Referral for therapeutic interventions - Needs of bereaved minor children 9. Interdisciplinary Teamwork, Quality, and Professionalism — 2% A. Interdisciplinary Teamwork - Roles and functions of team members - Understanding team-member roles - Respecting team-member functions - Effective teamwork - Team communication - Interdisciplinary team meetings - Team dynamics - Eliciting varied opinions - Eliciting unexpressed opinions - Team conflict resolution - Supporting team members - Giving feedback - Receiving feedback - Team education - Leadership skills B. Consultation - Institutional/system rules - Institutional culture - Ethics committee role - Religious institution affiliations - Medical staff requirements - Professional consultation etiquette - Negotiation with other providers - Goals of care - Primary-team relationships - Diplomacy in advocacy - Empathy toward colleagues - Respect toward colleagues C. Transitions of Care - Home - Inpatient - Outpatient - Extended care - Safe handoffs - Eligibility for different care settings - Capabilities of care settings - Payer sources - Expectations for next care setting - Alternative sites of care - Hospital - Nursing facility - Inpatient hospice - Home hospice - Long-term acute care facility - Home-based palliative care - Medication reconciliation - Formularies - Controlled-substance safety - Deprescribing D. Professionalism - Consultation - Co-management - Physician as team member - Staff support - Staff safety - Conflict resolution 10. Quality and Compliance — 2% A. Safety and Risk Mitigation - Safe prescribing - Polypharmacy - Medication reconciliation - Medication disposal - Legal issues - Regulatory issues - Risk Evaluation and Mitigation Strategies - Prescription Drug Monitoring Program - Substance use disorders - Diversion risk - Addiction treatment - Opioid risk assessment - Managing symptoms in patients at risk - Patient safety - Safety-risk screening - Error reporting - Handoff procedures - Learner supervision - Fatigue mitigation - Identification of safety events - Safety-event investigation - Situational awareness - Provider safety B. Hospice Regulations and Administration - Hospice regulations - Medicare hospice benefit - Non-Medicare hospice coverage - Hospice eligibility - Hospice levels of care - Evolving hospice business models - Role of hospice team physician - Hospice-specific documentation - Physician visits - Certification of terminal illness - Face-to-face visits - Interdisciplinary team input - Hospice business environment - Formularies - Contracts - Resources - Policies C. Quality Improvement - Quality improvement - Medication management - Documentation - Patient safety - Quality processes - Quality data 11. Ethical and Legal Aspects of Care — 7% A. Ethics of Serious Illness - Fundamentals of bioethics - Historical ethical context - Legal context - Ethical paradigms - Requests for hastened death - Proportional sedation for refractory symptoms - Death definition - Disorders of consciousness - Medically assisted nutrition and hydration - Withholding life-sustaining therapies - Withdrawing life-sustaining therapies - Decision-making capacity - Confidentiality - Assent - Consent - Dissent - Emancipated minors - Surrogate decision-making B. Physician-Patient Relationship - Nonabandonment - Truth-telling - Patient rights - Access to care - Rationing - Decision-making - Informed assent - Informed consent C. Pediatric Decision-Making - Pediatric decision-making - Assent - Consent - Developmental capacity - Surrogate decision-making - Best-interest standard D. Ethical Principles - Beneficence - Nonmaleficence - Principle of double effect - Best interest - Patient autonomy - Treatment refusal - Futility/nonbeneficial treatment E. Advance Care Planning and Treatment Decisions - Advance care planning - Surrogate decision-making - Treatment refusal - Withdrawal of interventions - Withholding of interventions - Medically assisted nutrition and hydration - Medical aid in dying F. Privacy and Confidentiality - Privacy - Confidentiality - Decision-making capacity - Disclosure considerations G. Altered States of Consciousness - Coma - Minimally conscious state - Vegetative state - Disorders of consciousness - Death by neurologic criteria 12. Self-Awareness - Personal accountability - Timeliness - Task completion - Documentation - Communication follow-up - Administrative responsibilities - Teaching responsibilities - Credentialing - Committee participation - Conflicts of interest - Personal interests - Professional interests - Corporate interests - Professional identity - Personal identity - Professional boundaries - Public-domain boundaries - Integration of clinical experience - Integration of personal-life experience - Cultural awareness - Spiritual awareness - Emotional awareness - Cognitive awareness - Implicit bias 13. Self-Care and Resilience - Distress - Excessive stress - Moral distress - Spiritual distress - Exhaustion - Compassion fatigue - Depersonalization - Burnout - Burnout risk factors - High volume - High acuity - Misaligned values - Misaligned incentives - Lack of transparency - Lack of recognition - Self-care strategies - Resilience strategies - Medical humanities - Healthy boundaries - Realistic expectations - Physical health - Recreation - Team engagement - Community engagement - Self-reflection - Personal/professional identity formation - Loss and bereavement - Insight into actions and consequences - Mindfulness - Compassion 14. Teaching - Giving feedback - Receiving feedback - Teaching basic palliative care - Teaching other healthcare providers - Learner needs assessment - Learning goals - Learning objectives - Adjusting teaching content - Adjusting teaching methods - Teaching according to setting - Teaching according to learner - Teaching opportunities - Coaching opportunities - Mentoring opportunities - Evidence-based HPM literature 15. Scholarship, Quality Improvement, and Research - Appraisal of HPM scholarship - Assimilation of evidence - Quality-improvement methods - Quality-improvement activities - Interpretation of quality data - Distinguishing quality improvement from research - Basic research approaches - HPM research - Research funding - Research ethics - Vulnerable populations 16. Career Preparation and HPM Practice - History of hospice and palliative medicine - Future trajectory of HPM - Current regulatory issues - Current political issues - Advocacy - Reimbursement - Interdisciplinary collaboration models - Leadership development - Career planning - Lifelong learning - Advocacy skills - Program development - Program Evaluation Committee participation - Quality metric identification - Billing fundamentals - Cost-effective care in HPM practice Pediatric HPM Content - Diseases of childhood - Perinatal conditions - Infant death - Genetic/congenital conditions - Other pediatric conditions - Pediatric developmental capacity - Pediatric decision-making - Assent - Consent - Emancipated minors - Surrogate decision-making - Best-interest decisions - Needs of bereaved minor children - Pediatric advance care planning - Pediatric serious illness - Pediatric symptom management