ABEM HPM study plan

Differentiate nociceptive, neuropathic, and nociplastic pain using history, exam, and validated tools across 20 written vignettes.

Select and justify an initial analgesic regimen (non-opioid, adjuvant, opioid) for acute cancer pain, chronic cancer pain, and non-cancer pain in 15 cases.

Calculate starting, rescue, and titration doses of short-acting opioids for opioid-naive and opioid-tolerant patients, including hepatic and renal dose adjustments.

Build a monitoring table for acetaminophen, NSAIDs, gabapentinoids, SNRIs, and corticosteroids that lists ceiling doses, organ toxicity, and required labs.

Explain the pharmacology that drives opioid selection: half-life, hepatic metabolism, active metabolites, and renal clearance.

Convert doses among morphine, hydromorphone, oxycodone, fentanyl, and methadone using equianalgesic ratios, then apply a 25-50% cross-tolerance reduction in 10 cases.

Construct a stepwise opioid rotation plan and a safety monitoring plan covering constipation, sedation, respiratory depression, opioid-induced nausea, and opioid-induced hyperalgesia.

Distinguish the indications, dosing, QT risk, and drug interactions of methadone and buprenorphine in 10 comparison items.

Describe interventional and non-pharmacologic options for refractory pain, including nerve blocks, palliative radiation, PCA, and physical modalities.

Outline a differential-driven approach to dyspnea that separates hypoxic from non-hypoxic drivers and selects opioids, fans, oxygen, and anxiolytics appropriately.

Construct mechanism-based antiemetic plans using the emetic pathways (chemotherapy, GI, vestibular, CNS, metabolic) in 15 vignettes.

Manage opioid-induced constipation and malignant bowel obstruction, selecting laxatives, octreotide, dexamethasone, and antisecretory agents with justification.

Evaluate anorexia-cachexia, fatigue, insomnia, and pruritus, then choose evidence-informed interventions and identify medications to deprescribe.

Apply the concept of proportional palliative sedation and comfort-focused prescribing when symptom burden is refractory.

Explain how renal and hepatic impairment change dosing of common palliative medications, including morphine metabolites and metoclopramide.

Assess delirium with the Confusion Assessment Method, list reversible contributors, and choose non-pharmacologic and antipsychotic strategies in 12 cases.

Recognize the last days to hours of life using functional decline, oral intake, and respiratory pattern changes, and discontinue non-beneficial medications and monitoring.

Write a comfort-focused order set covering pain crisis, dyspnea, terminal agitation, death rattle, fever, and seizure prophylaxis at end of life.

Counsel a family on what to expect in the final days, using plain language, in a written script of 300 words or fewer.

Formulate a goals-of-care recommendation that integrates prognosis, performance status, and patient values in 10 written cases.

Estimate prognosis using the surprise question, Palliative Performance Scale, ECOG, and validated survival tools, and state uncertainty explicitly.

Deliver a bad-news and family-meeting conversation using SPIKES and NURSE structures, with a self-recording of at least 10 minutes.

Document advance care planning elements correctly: code status, surrogate decision-maker, POLST or MOLST where applicable, and advance directive standards.

Explain how to coordinate care transitions among oncology, hospice, primary care, and the emergency department for a patient with serious illness.

Screen for and distinguish depression, anxiety, grief, and existential distress, separating each from delirium and from normal sadness, in 12 cases.

Assess spiritual needs with FICA or HOPE and adapt the plan to at least three distinct religious or cultural practices around dying.

Identify caregiver burden, anticipatory grief, and bereavement risk, and describe the criteria that separate prolonged grief from ordinary grief.

Recognize how clinician bias, health literacy gaps, and interpreter use change the communication approach, and apply teach-back in practice.

Describe how family dynamics, decisional conflict, and requests for therapies that cannot help are addressed without abandoning the patient.

Apply the elements of informed consent, decisional capacity, confidentiality, and surrogate decision-making standards in 15 ethics vignettes.

Distinguish withholding and withdrawing life-sustaining treatment, voluntary stopping of eating and drinking, palliative sedation, and physician aid in dying as defined by law and specialty statements.

State hospice eligibility by diagnosis with typical prognostic and functional criteria, and distinguish routine home care, continuous care, inpatient, and respite levels.

Explain Medicare Hospice benefit structure, per-diem payment, the hospice cap, the face-to-face requirement, and the components of the physician billing and documentation rules.

Design a quality improvement project for a hospice or palliative program using one validated measure, a data source, and a PDSA cycle.

Audit all prior deliverables and rebuild the three weakest topic summaries into one-page condensed reviews.

Complete at least 120 timed board-style practice questions distributed across all eight domains, and log every error by domain and reason.

Re-teach the five most-missed concepts aloud in under five minutes each as a self-test of true understanding.

Rehearse the high-yield dose conversions, equianalgesic ratios, and prognostic tools from memory until recall is errorless.

State a personal exam-day pacing plan and a review schedule for the final 72 hours.