Domain IV: Medical Knowledge


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). 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. 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. This section reviews performing functions and tasks that support safe transitions of care. 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. 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 PA/LTC setting.


Hours: 4.25


Certificates provided by accrediting body (1 Match)

American Medical Directors Association - The Society for Post-Acute and Long-Term Care Medicine

4.25 HOURS

Course Details

Course Code: REL-AHC-AMDA-DOM4
Hours: 4.25
Type: Online Course
Content Expiration Date: 5/31/2021
Learning Objectives:
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.
Construct a relevant differential diagnosis for medical signs and symptoms for PA/LTC patients.
Formulate a complete, accurate, timely problem statement regarding a reported change in condition.
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.
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 PA/LTC. This will include major disease categories such as heart disease, HTN, DM, Parkinson’s disease, dementia, chronic kidney disease, COPD, pressure ulcers.
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).
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.
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.


4.1  Identifying and Managing Changes in Condition

4.2  Formulating a Pertinent and Adequate Differential Diagnosis

4.3  Identifying and Developing a Person-Centered Medical Plan

4.4  Minimizing Risk and Optimizing Patient Safety

4.5  Managing Pain Safely and Effectively

4.6  Prescribing Medications Prudently and Effectively

Instructor: AMDA - The Society for Post-Acute and Long-Term Care Medicine

We are pleased to acknowledge the following contributors: Patricia L. Bach, PsyD, RN; Alva S. Baker, III, MD, CMDR; Daniel Bluestein, MD, MS, CMD; Bavid A. Brechtelsbauer, MD, CMD; Jeffrey B. Burl, MD, CMD; Amy Corcoran, MD CMD; Leonard Gelman, MD, CMD; Daniel Haimowitz, MD, FACP, CMD; Paul R. Katz, MD, CMD; Karyn Leible, MD, CMD; Meghan Lembeck, MD; James E. Lett, II, MD, CMDR; Steven A. Levenson, MD, CMD; Arif Nazir, MD, CMD; Dallas Nelson, MD, FACP, CMD; Debra Saliba, MD, MPH; Karl E. Steinberg, MD, CMD; Joshua Uy, MD; Matthew S Wayne, MD, CMD; Heidi K. White, MD, MEd, CMD

Disclosure: AMDA - The Society for Post-Acute and Long-Term Care Medicine has declared that no conflict of interest, Relevant Financial Relationship or Relevant Non-Financial Relationship exists.
Target Audience:
The target audience for this course is: Physicians; in the following settings: Post-Acute Care.
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Course Delivery Method and Format
Asynchronous/Online Distance Learning; please see certificate details for specifics on delivery format.
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