H
American Board of Internal Medicine
Clinical Competence in
End-of-Life Care*
| Components | Core Competencies |
| Medical Knowledge | Palliative care |
| • Assessment and treatment of psychological distress | |
| • Pharmacological and nonpharmacological treatment of pain and other symptoms | |
| Interviewing/ Counseling skills | Listening |
| Truth telling | |
| Giving bad news | |
| Discussing dying as a process | |
| Dealing with families of dying patients | |
| Team Approach | Understanding multidisciplinary natures of end-of-life care (physician, nursing staff, social services, palliative care or hospice team, pharmacist, chaplain, patient, patient's family, patient advocate) |
| Symptom Assessment and Management | Communication skills |
| Comfort | |
| Use of opioids, sedatives, or adjuvant analgesics, NSAIDs | |
| Control of dyspnea | |
| AHCPR and WHO guidelines | |
| Professionalism | Altruism |
| Accountability | |
| Confidentiality | |
| Transference and countertransference | |
| Nonabandonment | |
| Honoring patients' wishes | |
| Respect for colleagues | |
| Humanistic Qualities | Integrity |
| Compassion | |
| Sensitivity to patient needs for comfort and dignity | |
| Respect | |
| Courtesy | |
| Medical Ethics | Advance directives, DNR/DNI orders, |
| Conflicts of interest | |
| Futility | |
| Physician-assisted suicide | |
| Nutrition/hydration | |
| Surrogate decisionmaking | |
| Double effect |