Competencies Curriculum Domain IV: Medical Knowledge

This is Domain IV 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 IV, taking the Competencies Curriculum, learning objectives, faculty, and more. To purchase the full bundle, click here.

Domain IV Content:


Section 4.1 Identifying and Managing Changes in Condition

This section discusses identifying, evaluating, and addressing significant symptoms associated with change of condition, based on knowledge of diagnosis in individuals with multiple comorbidities and risk factors.

  • Collect information about the change in condition from diverse sources including but not limited to the patient, nurse, therapist, family members, chart notes.
  • Formulate a complete, accurate, timely problem statement regarding a reported change in condition.
  • Detail the current change in terms of timing, severity, frequency, duration, chronicling the story, (etc.)
  • Integrate information about the change in condition with the patient’s baseline function, conditions, and medications.
  • Construct a preliminary differential diagnosis based on the information collected that informs additional data collection decisions and plans for evaluation, treatment, and re-evaluation over time.

Section 4.2 Formulating a Pertinent and Adequate Differential Diagnosis

This sectin describes formulating a pertinent and adequate differential diagnosis for all medical signs and symptoms, recognizing atypical presentation of disease, for post-acute and long-term care (PALTC) patients/residents.

  • Construct a relevant differential diagnosis for medical signs and symptoms for PALTC patients.
  • Identify atypical presentations of common disease.
  • Identify and manage adverse outcomes (e.g., sepsis, pneumonia, wound-related sepsis, colitis, GI Bleeding, MI) in the post-acute population including those that can lead to rehosptalization.

Section 4.3 Identifying and Developing a Person-centered Medical Plan

This module reviews identifying and developing a person-centered medical plan for diseases and geriatric syndromes commonly found in PALTC patients.

  • Identify geriatric syndromes and describe an approach to their evaluation, diagnosis, and treatment.
  • Value a syndromal approach to assessing and managing symptoms including related documentation.
  • Formulate individualized treatment plans for geriatric syndromes including delirium, dementia, incontinence, falls, weight loss/malnutrition, pain, behavioral symptoms, frailty, and constipation.
  • Formulate an individualized approach to disease management based on appropriate goals for patients in PALTC. This will include major disease categories such as heart disease, HTN, DM, Parkinson’s disease, dementia, chronic kidney disease, COPD, pressure ulcers.

Section 4.4 Minimizing Risk and Optimizing Patient Safety

This module addresses identifying interventions to minimize risk factors and optimize patient/resident safety (e.g. prescribed antibiotics and antipsychotics prudently, assesses the risks and benefits of initiation or continuation of physical restraints, urinary catheters and venous access catheters).

  • Identify and address risk factors for unintended and undesired consequences of medical treatment.
  • Identify and modify current aspects of the plan of care that increase risk or fail to reduce risk for common geriatric syndromes, complications and comorbidities.
  • Describe risks and benefits for individual patients and for the community/facility regarding the prudent use of medical interventions and procedures (e.g. antibiotic use, catheters, restraints, medical testing).

Section 4.5 Managing Pain Safely and Effectively

This module reviews managing pain effectively and without causing undue treatment complications.

  • Recognize/identify categories and components of pain including physical, emotional, social, and spiritual.
  • Identify indications for specific approaches to pain management.
  • Identity potential resources to help manage pain.
  • Evaluate and reassess the effectiveness and adverse consequences (e.g., sedation, respiratory suppression, constipation) of pain treatment interventions in accordance with patient goals and preferences.
  • Describe ways to assess and manage pain in patients with cognitive impairment.
  • Routinely utilize desirable pain assessment techniques in the SNF/NF setting.

Section 4.6 Prescribing Medications Prudently and Effectively

This module reviews prescribing and adjusting medications prudently consistent with identified indications and known risks and warnings.

  • Routinely review medications for indication, duration, dosage, interactions, and presence of adverse consequences.
  • Minimize polypharmacy, potentially inappropriate medications, and those with potentially serious drug-drug and drug-disease interactions.
  • Identify and explain relatively and absolutely contraindicated drugs.
  • When there is a symptom or syndrome, demonstrate a routine practice of reviewing the potential for current medications to contribute to or cause any symptom or syndrome identified.
  • Prescribe based on an analysis of indications, response to previous and current treatment, factors that influence the effectiveness and risk of the medications, and the goals of care.
  • Document the rationale for the current medication regimen in a manner that supports safe and effective patient care and facilitates regulatory compliance.


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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

Physician CME

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 4.25 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 4.25 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 4.25 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