ABIM Palliative Care study plan

Classify 15 written pain vignettes as nociceptive, neuropathic, or mixed, defending each label with the specific history and exam findings that drove it.

Build a personal equianalgesic reference for morphine, oxycodone, hydromorphone, fentanyl, and methadone, citing a primary source for every ratio and flagging where sources disagree.

Work through 10 opioid initiations and escalations, calculating total daily dose, breakthrough dose, and a safe reassessment interval for each.

Describe mechanism, monitoring, and reversal for opioid-induced sedation and respiratory depression across four high-risk profiles: renal impairment, untreated sleep apnea, concurrent benzodiazepine, and opioid-naive older adult.

Match 10 pain syndromes (bone metastasis, painful diabetic neuropathy, postherpetic neuralgia, mucositis, malignant bowel obstruction) to a mechanism-appropriate first-line agent plus one adjunct.

Perform five opioid rotations applying an incomplete cross-tolerance reduction, documenting the arithmetic, the expected effect, and the follow-up plan for each.

State when methadone, buprenorphine, ketamine, or a lidocaine infusion belongs in a pain plan, and name one required monitoring parameter for each.

Distinguish the neurochemical pathways underlying nausea and pair each pathway with a drug class and receptor-level rationale.

Draft a stepwise antiemetic plan for opioid-induced nausea, chemotherapy-induced nausea, and malignant bowel obstruction, noting where the three plans diverge.

Compare opioid, benzodiazepine, oxygen, and non-drug strategies for refractory dyspnea, articulating the evidence limits of each.

Write a bowel regimen protocol covering opioid initiation, laxative class selection, and stepwise rescue for suspected impaction.

Apply a validated delirium screening instrument to 8 vignettes and name the most likely precipitant in each.

Differentiate delirium, depression, and fatigue in 6 cases by time course, fluctuation, and associated features.

Evaluate the evidence for corticosteroids, progestins, and appetite stimulants in anorexia-cachexia, specifying which outcomes each does and does not improve.

Design a non-pharmacologic fatigue plan for a patient on active treatment, naming concrete activity, pacing, and sleep targets.

Map the illness trajectory of advanced cancer, heart failure, and COPD, and locate the palliative referral trigger within each trajectory.

List the guideline-anchored markers of advanced disease (performance status, functional class, staged lung disease, hospitalization frequency) that justify a goals conversation.

Analyze device and therapy decisions-defibrillator deactivation, inotropes, dialysis timing, long-term oxygen-and phrase each in goals-concordant language.

Prioritize a symptom regimen for each of the three trajectories and justify why the priorities differ.

Apply a hospice-eligibility framework to 8 vignettes and flag cases where the criteria are genuinely ambiguous.

Identify palliative needs across Parkinson disease, ALS, and advanced dementia, including dysphagia, aspiration risk, and fluctuating decision-making capacity.

Revise a medication list for a patient with severely reduced creatinine clearance, flagging opioids and adjuvants that accumulate or have active metabolites.

Plan symptom control for decompensated cirrhosis, covering ascites, encephalopathy, pruritus, and bleeding risk.

Describe palliative priorities in advanced HIV and end-stage infectious disease, including antimicrobial stewardship and deprescribing near end of life.

Differentiate palliative care eligibility from hospice eligibility in non-cancer populations using 6 vignettes.

Script the opening 60 seconds of a goals-of-care conversation for three distinct triggers: new metastatic diagnosis, ICU admission, and dialysis decision.

Practice ask-tell-ask, wish-and-worry, and NURSE statements until each can be delivered without notes in a role-play.

Complete a written advance care plan for a standardized patient covering health care proxy, code status, and treatment preferences.

Identify and correct five clinician behaviors that block patient emotion, including false reassurance, premature problem-solving, and deflection.

Document a goals conversation so that a covering clinician could act on the note without calling you.

Distinguish grief, depression, and demoralization across 6 vignettes and select a different intervention for each.

Assess spiritual and cultural needs with a structured framework and adapt one care plan to two differing belief systems.

Apply a structured capacity and surrogate decision-making framework plus core ethical principles to 5 family–team conflict vignettes.

Describe the physical signs of the last days of life and the corresponding care decisions, including route changes and discontinuation of non-beneficial interventions and monitoring.

Build a bereavement risk screening tool and a follow-up pathway for family caregivers.

Adjust drug selection and dosing for three geriatric profiles (frailty, polypharmacy, falls risk) using a potentially inappropriate medication list.

Describe pediatric palliative differences: weight-based dosing, family-centered decision-making, and school and sibling needs.

Identify the quality metrics and documentation elements that drive palliative care program reporting and payment.

Map each interdisciplinary team member's role and describe a concrete process for resolving team disagreement.

Complete a timed 60-item mixed practice exam and sort every missed item into a domain-level remediation list.