ABIM Palliative Care
ABIM Hospice and Palliative Medicine Certification Examination
More study resources
Cheat sheet
Keep the key ideas within reach.
ExploreKey terms
Get comfortable with the vocabulary.
ExploreStudy plan
Give each week a clear focus.
ExploreCommon mistakes
Understand the traps and how to avoid them.
ExploreCase studies
Put your knowledge to work in context.
ExploreExam-day guide
Prepare for the day ahead.
ExploreAbout this exam
Hospice and palliative medicine is the subspecialty that asks a physician to hold two ideas at once: meticulous symptom control, and a clear-eyed understanding of what a seriously ill person actually wants from the time that remains. The ABIM subspecialty certification exam assesses whether a physician can do both across the full range of settings, from an inpatient consult service to a home hospice visit. Candidates are typically physicians who have completed fellowship training in hospice and palliative medicine, or who qualify through an approved practice pathway, and who already hold a primary certificate in a specialty such as internal medicine, family medicine, pediatrics, psychiatry, neurology, or emergency medicine. This page is independent study material; it is not affiliated with or endorsed by ABIM.
The exam rewards breadth over depth in any single niche. Expect to move between opioid pharmacology, dyspnea management, delirium, goals-of-care communication, grief, pediatric and geriatric considerations, disease-specific trajectories, and the regulatory and team-based realities of hospice work, often within a handful of consecutive items. Preparation works best in three passes: map your gaps against the published content outline, rebuild the weak domains from primary sources such as society guidelines and major textbooks, then practice board-style questions under time pressure while writing down every rationale you got wrong. Communication and ethics items are frequently missed by strong clinicians because the best answer is usually the one that clarifies values before recommending an intervention.
Logistics change often. ABIM publishes the current item count, testing time, fee, passing standard, and retake rules on its own website; verify them there before you schedule.
What you'll study
About ABIM Palliative Care preparation
What does the exam actually test?
The content spans pain assessment and management, non-pain symptoms such as dyspnea, nausea, constipation, fatigue, and delirium, communication and advance care planning, psychosocial and ethical issues, disease-specific trajectories, end-of-life care and bereavement, special populations, and systems-based practice. Treat the official ABIM content outline as the authority on the current blueprint and its weighting.
How many questions are there, and how long do I have?
ABIM sets and periodically revises these figures, so no number is quoted here. Check the exam's page on abim.org for the current item count, appointment length, and break policy. Plan your pacing around the published count rather than numbers repeated in older forum posts, which are frequently out of date.
How difficult is it?
It is a subspecialty exam taken by physicians who already passed a primary board, so the baseline is high. The difficulty lies less in obscure facts than in discrimination: several options are defensible, and the credited answer is usually the one that best matches the patient's stated values and the safest pharmacology.
In what order should I study?
Start with pain and non-pain symptom management, since those domains carry the most items and underpin the rest. Then layer in communication, ethics, and disease trajectories, which reward clinical reasoning more than memorization. Save systems, regulatory, and quality material for a late, short pass, and finish with timed practice questions.
What do candidates most often get wrong?
Three patterns recur: reflexively choosing the most aggressive intervention over the one that fits the goals of care, misjudging opioid conversion and equianalgesic dosing, and overlooking non-pharmacologic or team-based answers. Another common error is neglecting the small domains, where a few easy questions are available to anyone who read the material.
Can I take it remotely?
ABIM has offered remote proctoring for some exams where the technology and security requirements are met. Availability varies by exam and by location, so confirm on the ABIM website whether remote delivery is offered for this exam at the time you register, and check the room and equipment requirements before choosing that option.
What happens if I fail?
ABIM publishes its retake policy, waiting periods, and any limits on attempts. Those rules change, so read the current policy on abim.org rather than relying on what a colleague experienced several years ago. Between attempts, use the score report to identify weak domains instead of rereading everything.
How long does the certification last?
ABIM has moved subspecialty certificates to a continuous certification model rather than a single fixed expiration date, which means ongoing assessment and attestation requirements rather than one terminal exam. The specific requirements have changed repeatedly, so verify your current obligations directly with ABIM.
Is this page an official study resource?
No. This is independent material written for study purposes and is not affiliated with, endorsed by, or derived from ABIM or any commercial question bank. Always treat the official content outline and primary clinical literature as the final authority when the two appear to disagree.