What are high-yield topics to know for the American Board of Internal Medicine (ABIM) in hospice/palliative care and geriatrics specialties?

High-Yield Topics for ABIM in Hospice/Palliative Care and Geriatrics Specialties

The most important high-yield topics for ABIM certification in hospice/palliative care and geriatrics focus on symptom management, advance care planning, and geriatric syndromes that directly impact patient mortality, morbidity, and quality of life.

Palliative Care High-Yield Topics

Pain and Symptom Management

• Pain management: Opioid titration, equianalgesic dosing, adjuvant medications, and management of opioid side effects 1
• Dyspnea management: Evidence-based approaches including:
  • Opioids (morphine 2.5-10 mg PO q4h or 1-3 mg IV q1h)
  • Benzodiazepines (lorazepam 0.5-1 mg PO q1h) for refractory cases
  • Anticholinergics for secretion management (glycopyrrolate 0.2-0.4 mg IV/SQ q4h, scopolamine patches) 1
• Terminal secretion management: Glycopyrrolate, scopolamine, atropine drops 1
• Thirst management: Oral interventions and moisturizing agents 1

Advance Care Planning and Communication

• Goals of care discussions: Timing, documentation, and implementation 1
• Advance directives: Living wills, healthcare proxies, MOLST/POLST forms 1
• Prognostication: Recognizing end-of-life trajectories in cancer vs. non-cancer conditions 1
• Communication skills: Breaking bad news, discussing prognosis, addressing family conflict 1

Palliative Care Integration

• Early palliative care integration: Criteria for specialty palliative care referral 1
• Hospice eligibility criteria: Disease-specific guidelines for hospice referral 1
• Care transitions: Hospital to home, home to hospice 1
• Interdisciplinary team approach: Roles of different team members (physicians, nurses, social workers, chaplains) 1

End-of-Life Care

• Care of the imminently dying patient: Symptom management in final days/hours 1
• Palliative sedation: Indications, medications, ethical considerations 1
• Withdrawal of life-sustaining treatments: Process and symptom management 1
• Family support during dying process: Addressing anticipatory grief 1

Geriatrics High-Yield Topics

Geriatric Assessment

• Comprehensive geriatric assessment: Functional status (ADLs/IADLs), cognitive assessment, fall risk 2
• Frailty assessment: Identification and management strategies 2
• Geriatric 5Ms framework: Mind, Mobility, Medications, what Matters most, and Multicomplexity 2

Geriatric Syndromes

• Delirium: Prevention, diagnosis, and management strategies 1
  • Non-pharmacological interventions as first-line treatment
  • Appropriate use of antipsychotics when necessary
• Dementia: Assessment, management of behavioral symptoms, caregiver support 3
• Falls: Risk assessment, prevention strategies, post-fall management 2
• Polypharmacy: Medication reconciliation, deprescribing principles, Beers criteria 2

Special Considerations in Older Adults

• Multimorbidity management: Prioritizing conditions based on patient goals 2
• Medication management: Addressing regimen complexity, drug interactions, and appropriate prescribing 2
• Functional rehabilitation: Role of PT/OT in maintaining independence 4
• Transitions of care: Hospital to home, home to long-term care 5

Geriatric Palliative Care Integration

• Dementia and end-of-life care: Pain assessment in non-verbal patients, advance care planning 3
• Palliative care in heart failure, COPD, and other non-cancer conditions 6
• Home-based palliative care models for homebound elderly 5
• Goals of care in patients with limited life expectancy: Deprescribing, symptom focus 1

Common Pitfalls to Avoid

1. Failing to recognize hypoactive delirium, which is often missed or misattributed to dementia 1

2. Undertreatment of pain in patients with dementia due to assessment challenges - use behavioral pain scales when needed 3

3. Applying single-disease guidelines without modification in older adults with multiple conditions, leading to polypharmacy and treatment burden 2

4. Delaying palliative care referrals until the very end of life, missing opportunities for improved quality of life and symptom management 1

5. Inadequate assessment of caregiver needs and burden, which can lead to caregiver burnout and poor patient outcomes 3

6. Focusing solely on disease control rather than patient goals, particularly in patients with limited life expectancy 2

7. Overlooking the importance of non-pharmacological approaches to symptom management (positioning for dyspnea, fans for air hunger) 1

8. Failing to address spiritual and existential concerns as part of comprehensive end-of-life care 1