Content Blueprint

The HMDCB certification examination is an assessment of the knowledge, skills, and competence required of a hospice medical director. The HMDCB Content Blueprint (shown below) is based on the 2013 Practice (Job) Analysis Study, and provides detailed information about the five content areas to expect on a typical examination. 

The HMDCB initial examination consists of 165 questions, 150 of which are scored multiple-choice questions, and the remaining 15 are unscored pretest items. The Continuing Certification Program examination is 100 questions. The percentage of questions from each of the five competency areas appears in the content headings below. Each question will be categorized according to the level of complexity, or the cognitive level that a hospice medical director would use when performing the task. Approximately 12% require recall of information, 60% require application of knowledge, and 28% require analysis of a situation.

The five competency areas are listed below. To review the detailed outline for each area, click on a competency area or simply scroll down on this page.

1. Patient and Family Care

2. Medical Knowledge

3. Medical Leadership and Communication

4. Professionalism

5. Systems-Based Practice

Patient and Family Care (17%)

  1. Oversee and manage:
    1. family meetings
    2. goals of care
    3. do not resuscitate (DNR) orders/orders for life-sustaining treatment
    4. conflict resolution
    5. withdrawal of life-sustaining therapies
    6. palliative sedation
    7. medication review
  2. Assess patient and family with regards to cultural and personal diversities
  3. Educate the patient and family (e.g., disease trajectory, prognosis, symptom management, impending death, and complication anticipation)
  4. Assess and document the patient’s decision-making capacity
  5. Serve as a patient advocate
  6. Facilitate legal surrogate’s role in decision making
  7. Support the family through the moment of death
  8. Ensure provision of primary care to Hospice patients (e.g., when primary physician is not available)
  9. Recognize social problems experienced by hospice patients and their families and collaborate with the interdisciplinary group to assess and manage them
  10. Assess and resolve issues with family dynamics (e.g., coping styles, psychological defenses, and developmental stages)


Medical Knowledge (26%)

  1. Assess and differentiate types of pain including total pain
  2. Assess and manage:
    1. acute and chronic pain
    2. medications for pain
    3. non-opioid medications for pain
    4. non-pain symptoms*
    5. non-pharmacologic measures for pain and non-pain symptoms (complementary and alternative therapies)
    6. disorders* (e.g., delirium, dementia, depression, and anxiety
  3. Demonstrate knowledge of:
    1. the physical, emotional, spiritual, and psychosocial dimensions of care
    2. settings where hospice and palliative care are provided
    3. patient assessment and management across hospice care settings
    4. addiction, pseudo-addiction, opioid toxicity, and dependence and tolerance
    5. brain death, persistent vegetative state, and minimally conscious state
    6. normal and complex grief
    7. pediatric life-threatening conditions
    8. signs and symptoms of impending death
    9. various routes of medication delivery
    10. palliative sedation
  4. Manage medical conditions commonly encountered in hospice care
  5. Assess and manage of risk associated with drug abuse, addiction and diversion
  6. Identify indications for interventional symptom management, including radiation therapy*
  7. Formulate and certify prognosis for hospice patients by:
    1. Reviewing available clinical data* (e.g., comorbid and secondary conditions, medical findings, disease progression, medications and treatment orders)
    2. Understanding the patient's and family's expectations and goals for care
  8. Demonstrate knowledge of, and recognize limitations of, evidence-based medicine in hospice care

Medical Leadership and Communication (21%)

  1. Demonstrate interpersonal communication skills*
  2. Model empathic communication (e.g., expression of compassion)
  3. Communicate with referring and consultant clinicians about the care plan
  4. Facilitate conflict resolution and 'service recovery'*
  5. Explain physician culture and behaviors to hospice staff
  6. Educate Hospice staff about communication with physicians
  7. Provide ongoing education for Hospice staff
  8. Provide education of the community at large
  9. Provide emotional support to staff around difficult decisions and care scenarios
  10. Communicate the mission of hospice to hospital administrators, clinicians, and community at large
  11. Facilitate the interdisciplinary group process
  12. Demonstrate the ability to reflect on his/her personal leadership style and use different styles to suit the situation and goals
  13. Demonstrate skill as a supervisor and mentor
  14. Supervise team providers (e.g., physician and nurse practitioner) related to:
    1. certification and recertification*
    2. development of a plan of care
    3. symptom management
    4. clinical assessments and face-to-face encounters
    5. pharmacy and formulary management
    6. performance improvement
    7. fatigue and burnout
    8. documentation of care
    9. billing and coding
  15. Provide oversight of skills management for Hospice staff


Professionalism (10%)

  1. Recognize and manage fatigue and burnout
  2. Practice active self-care
  3. Demonstrate boundaries with colleagues, patients, and families and help interdisciplinary group members do the same
  4. Recognize and accept responsibility for errors when appropriate
  5. Disclose medical errors in accord with institutional policies and professional ethics
  6. Make recommendations to attending and consulting physicians(s) and coordinate medical care
  7. Collaborate with other health professionals to coordinate the plan of care
  8. Demonstrate commitment to continuing professional development and life long learning
  9. Seek feedback and engage in the self-assessment process


Systems-Based Practice (25%)

  1. Apply knowledge of ethics and law related to:
    1. informed consent
    2. confidentiality
    3. decision-making capacity for patient and surrogate
    4. limits of surrogate decision-making
    5. truth-telling
    6. withholding/withdrawing life-sustaining therapies*
    7. medical futility
    8. use of artificial hydration and nutrition*
    9. physician-aided dying (assisted suicide)
    10. euthanasia
    11. principle of double effect
    12. organ donation
    13. nurse-physician collaboration
    14. indications for referring to an ethics consultant
    15. conflicts of interest
  2. Demonstrate knowledge of hospice regulation and reimbursement
  3. Utilize local coverage determinations and understand limitations*
  4. Participate in the process of:
    1. additional development requests (ADR)
    2. redetermination or reconsideration
    3. testifying to the Administrative Law Judge
    4. differentiate and respond to technical and medical denials
  5. Participate in the following aspects of the survey process:
    1. the role of clinical documentation
    2. focused or targeted medical review
    3. of a Corrective Action Plan
  6. Ensure patient access to allied health professionals (e.g., speech therapist, nutritionist)
  7. Comply with legal and regulatory issues surrounding opioid prescribing
  8. Comply with Medicare/Medicaid Hospice Benefit* (e.g., Conditions of Participation, requirements for certification, related/unrelated to terminal diagnosis, and levels of hospice care)
  9. Perform pre-hospice consultation
  10. Ensure compliance with accreditation policies (e.g., The Joint Commission, CHAP)
  11. Understand these elements of quality improvement (QI) in the hospice setting:
    1. differentiate quality assurance and performance improvement*
    2. role of clinical indicators
    3. approach to data collection for quality review
    4. role of focused QI studies
  12. Assist in the design of clinically relevant quality-of-care outcome measures
  13. Use data to demonstrate clinical, utilization, and financial outcomes of hospice care
  14. Demonstrate awareness of and adherence to patient safety standards
  15. Observe hospice policy (e.g., related to infection control, employee safety, emergency preparedness, harassment)
  16. Promote the role of the medical director as a member of the leadership team
  17. Develop strategies to manage barriers to utilization of medications (including controlled drugs) in different clinical care settings

*indicates content that should be represented on every exam.
Note: The total percentage does not equal 100 due to rounding.

"It is a very comprehensive exam that is designed to evaluate the knowledge and clinical judgment skills in key areas of hospice. I am glad I took this test."

Palliative Medicine Lead
Kaiser Permanente, Modesto, CA