Competencies Curriculum Domain III: Systems

This is Domain III of V of AMDA - The Society for Post-Acute and Long-Term Care Medicine's Competencies Curriculum for Attending Physicians Practicing in Post-Acute and Long Term Care.

See below for information on content included in Domain III, taking the Competencies Curriculum, learning objectives, faculty, and more. To purchase the full bundle, click here.

Domain III Content:

Section 3.1 Providing Prudent and Minimally Disruptive Care

This section discusses providing care that uses resources prudently and minimizes unnecessary discomfort and disruption for patients/residents (e.g. limited nonessential vital signs and blood sugar checks).

  • Demonstrate clinical decision-making in the skilled nursing facility/nursing facility (SNF/NF) setting that takes into account medical necessity; relevance to patient care; consideration of staff time, knowledge and skills; patient comfort, goals of care and preferences; cost, and facility resources.

Section 3.2 Using Patient Databases in Clinical Practice

This section describes identified rationale for and uses of key patient/resident databases (e.g. the Minimum Data Set - MDS), in care planning, facility reimbursement, and monitoring quality.

  • Describe the basic components of the MDS.
  • List the MDS’ main uses for clinical decision making, care planning, facility reimbursement, and quality assessment and improvement in the SNF/NF setting.
  • Describe the specific data and screening tools present in the MDS and their applicability to patient care.

Section 3.3 Determining Appropriate Levels of Care

This section discusses determinations of appropriate levels of care for patients/residents including identification of those who could benefit from a different level of care.

  • Compare and contrast the capabilities (including scope of services) and limitations of the sites of care within the PALTC continuum.
  • Given a patient scenario, select the appropriate levels and sites of care considering the patient/resident’s medical needs, preferences, and values.

Section 3.4 Optimal Management of Care Transitions

This section reviews performing functions and tasks that support safe transitions of care.

  • Perform medication reconciliation on admission and discharge.
  • Describe and demonstrate the benefits of direct communication with relevant care providers at the previous or next site of care.
  • Develop or modify an existing plan of care by taking into account the patient baseline functional and clinical status, the hospital course, and the current clinical state.
  • Organize appropriate medical discharge documentation that communicates pertinent clinical information in a timely fashion with relevant care providers both on admission and discharge.
  • Describe the components of and rationale for an advanced care planning process.
  • Identify and present the information needed by patients, families, and other care sites to help make relevant decisions about patient/residents’ scope of care and life-sustaining treatments upon change of condition or transfer to another care setting, including completion of pre-hospital Do Not Resuscitate or POLST Paradigm forms where available.
  • Evaluate the current medical plan of care for the patient on admission and determine the need for modification with periodic reassessment at routine regulatory visits and upon changes of patient/resident condition.
  • Perform a patient history and physical examination in a timely fashion based on patient acuity and regulatory requirements, and adjust the plan of care as appropriate.
  • Prior to patient/resident discharge provide medical input to the interdisciplinary team (IDT) and the patient/family in order to help to ensure a safe discharge plan.

Section 3.5 Working Effectively with the Interdisciplinary Care Team

This section presents content on working effectively with other members of the IDT, including the medical director, in providing care based on understanding and valuing the general roles, responsibilities, and levels of knowledge and training for those of various disciplines.

  • Describe the scope of practice and role and responsibilities of the IDT members in the SNF/NF.

Section 3.6 Understanding and Explaining the Impact of Finances on Care Decisions

This module discusses informing patients/residents and their families of their healthcare options and potential impact on personal finances by incorporating knowledge of payment models relevant to the PALTC setting.

  • Explain payment models relevant to the PALTC setting including but not limited to Medicare, Medicaid, and Managed Care.
  • Explain to patients and families key considerations in balancing costs with scope of services in various PALTC settings.


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More information:

Taking the Competencies Curriculum

The Competencies Curriculum is divided into five domains. While participants are encouraged to take the entire curriculum, individuals may choose to take domains as they please, in any order. Participants have 60 days (from enrollment) to complete each Domain.

Credit Information

AMDA – The Society for Post-Acute and Long-Term Care Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing education for physicians. The Society designates this activity, Domain II: Medical Care Delivery Process for a maximum of 3 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

This self-study activity has been pre-approved by the American Board of Post-Acute and Long-Term Care Medicine (ABPLM) for a total of 3.0 clinical hours toward certification as a Certified Medical Director (CMD) in post-acute and long-term care medicine. The CMD program is administered by the ABPLM. Each physician should claim only those hours of credit actually spent on the activity.

Maintenance of Certification (MOC)
Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 3.0 MOC points and medical knowledge and patient safety credit MOC credit in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.


The following AMDA Education Committee members have financial relationships to report: Eric G. Tangalos, MD, CMD – Lilly, Pfizer: Consultant; Omnicare: P&T Committee Chair; all others have no relationships to disclose. The AMDA Competency Curriculum workgroup and faculty have no relationships to disclose. AMDA staff have no financial relationships to disclose.

System Requirements

To participate in the online curriculum, you must have the following system requirements:

  • Adobe Flash Plug-in
  • Internet Explorer 9+, Mozilla Firefox, Google Chrome, Safari
  • Broadband Internet connection
  • Also compatible with iOS and Android based tablets