- The AOA written exam is 200 single-answer MCQs in 4.5 hours, passing score 500 on a 200-800 scale.
- Medical management is worth 40-46% of the exam - more than the next two domains combined.
- Application/examination fee is $1,200, and remote testing runs through MonitorEDU proctoring on the Paradigm platform.
- Eligibility requires active primary AOBIM certification, an active state license, and a one-year AOA-approved fellowship completed after July 1, 2009.
Quick Facts Snapshot
This cheat sheet is built specifically for candidates pursuing Certification in Hospice and Palliative Medicine (HPM) through the American Osteopathic Board of Internal Medicine (AOBIM) route, with the written exam administered by the American Osteopathic Conjoint Examination Committee on Hospice and Palliative Medicine under the AOA. If you're prepping for the osteopathic subspecialty exam rather than a different credential, keep this page bookmarked as your one-stop reference.
| Item | Detail |
|---|---|
| Certifying body | AOA / AOBIM (Conjoint Committee on HPM) |
| Application/exam fee | $1,200 |
| Question format | 200 single-answer multiple-choice questions |
| Time limit | 4.5 hours |
| Passing score | 500 on a 200-800 scale |
| Remote proctoring | MonitorEDU on the Paradigm platform |
| Content areas | 8 domains, largest is Medical management (40-46%) |
For a deeper dive into any of these figures, see the full HPM Certification Cost 2026: Complete Pricing Breakdown and HPM Passing Score 2026: Exactly What You Need to Pass articles. This page is meant for quick recall the week before your test, not a first introduction - if you're new to the credential, start with What Is HPM Certification?
Eligibility at a Glance
Before you even think about domain weighting, confirm you meet the published eligibility criteria. The Conjoint Committee requires:
- Active primary AOA board certification in good standing (through AOBIM)
- An active U.S. state medical license
- Completion of a one-year AOA-approved hospice and palliative medicine fellowship, completed after July 1, 2009
- Verification submitted by your fellowship program director
For the full breakdown of documentation timelines and what to do if your fellowship dates are borderline, see HPM Requirements 2026: Eligibility, Prerequisites & How to Qualify.
Exam Format and Delivery
The written examination is delivered as 200 single-answer multiple-choice items with a 4.5-hour time limit. That works out to roughly 1.35 minutes per question if you spread time evenly - but most candidates find the medical management vignettes take longer than the shorter domains like grief and bereavement or communication and teamwork.
Remote administration uses MonitorEDU for proctoring on the Paradigm testing platform. If you're planning to test from home rather than a physical testing center, build in time before your appointment to confirm your equipment and workspace meet the proctoring requirements - technical delays eat into your available prep time on exam day.
Key Takeaway
Budget your 4.5 hours by domain weight, not by question order - spend proportionally more time per question on medical management items since they carry the heaviest scoring weight.
For registration windows and deadlines tied to this format, check HPM Exam Dates 2026: Testing Windows, Deadlines & Scheduling.
The Eight Content Domains
The current official written-exam webpage lists eight content areas, each with a defined percentage range. Memorize these ranges - they tell you exactly where to invest study hours.
Domain 1: Approach to Care (7-12%)
Covers the overall philosophy and structure of hospice and palliative care delivery, including interdisciplinary team models and care settings.
- Understand levels of hospice care and eligibility criteria
Domain 2: Psycho-Social and Spiritual Considerations (8-12%)
Tests your ability to assess and address non-physical dimensions of suffering.
- Screening tools for psychosocial and spiritual distress
Domain 3: Impending Death (6-10%)
Focuses on recognizing and managing the active dying phase.
- Signs of imminent death and family communication around them
Domain 4: Grief and Bereavement (4-8%)
The smallest domain but still testable - expect a handful of scored items.
- Normal vs. complicated grief patterns
Domain 5: Medical Management (40-46%)
By far the largest domain - nearly half the exam. See the dedicated section below.
- Symptom control across multiple organ systems and disease trajectories
Domain 6: Communication and Teamwork (4-9%)
Assesses goals-of-care conversations and interdisciplinary collaboration.
- Structured communication frameworks for serious illness conversations
Domain 7: Ethical and Legal Decision Making (6-10%)
Covers surrogate decision-making, advance directives, and end-of-life legal frameworks.
- Capacity assessment and informed consent in the palliative setting
Domain 8: Prognostication and Natural History of Serious History (6-10%)
Retains the board's published wording. Focuses on disease trajectories and prognostic tools across serious illnesses.
- Prognostic indices for non-cancer diagnoses
For a much deeper treatment of each domain, including topic-level breakdowns, read HPM Exam Domains 2026: Complete Guide to All 8 Content Areas.
Why Medical Management Dominates
Medical management sits at 40-46% - a range that alone exceeds the combined weight of Domains 3, 4, and 6. Any serious HPM study plan has to treat this domain as the backbone of preparation, not just one topic among eight.
Candidates who treat all eight domains as equally weighted routinely underperform relative to their effort, simply because they didn't allocate proportional time. This is one of the most common errors discussed in How Hard Is the HPM Exam? Complete Difficulty Guide 2026.
Scoring and Passing
The exam uses a 200-800 scale, with 500 as the passing threshold. This is not a raw percent-correct score - it's a scaled score, meaning the number of correct answers needed to reach 500 can vary slightly depending on the specific form of the exam you're administered.
Key Takeaway
Don't try to reverse-engineer "how many questions you can miss" from the 200-800 scale - focus instead on mastering each domain proportionally to its weight.
For a full explanation of how the scaled score works and what it means practically for your prep, see HPM Passing Score 2026: Exactly What You Need to Pass. If you want to understand how outcomes have trended, review HPM Pass Rate 2026: What the Data Shows.
Maintaining Certification
Once you pass, ongoing certification requirements shift from a single high-stakes exam to continuous participation. Key points to remember:
- Active licensure must be maintained at all times
- Primary-board CME and practice-performance requirements apply through AOBIM
- HPM longitudinal assessment has replaced the former high-stakes recertification examination
- For the 2025-2027 CME cycle, AOBIM time-limited diplomates need 60 credits over three years, including 15 Category 1 and/or Category 1-A credits
- HPM itself adds no separate CME or practice-performance requirement beyond what the primary board already requires
- The HPM longitudinal assessment is distinct from the initial written exam and moved to the AOA Learning Portal in January 2026
Last-Mile Review Plan
In the final weeks before your test date, structure review sessions around domain weight rather than working straight through a textbook cover to cover. A simple approach:
Medical Management Deep Dive
- Work through pain and symptom management scenarios daily
- Drill pharmacologic dosing and side-effect profiles relevant to serious illness
Mid-Weight Domains
- Cover Approach to Care, Psycho-Social/Spiritual, Ethical/Legal, and Prognostication
- Use timed practice blocks matching the 4.5-hour exam pacing
Smaller Domains and Full Review
- Finish Impending Death, Grief and Bereavement, and Communication/Teamwork
- Run at least one full-length timed practice session
For a complete week-by-week methodology, including how to layer active recall onto this schedule, see HPM Study Guide 2026: How to Pass on Your First Attempt. You can build and time your own domain-weighted practice sets using the tools on the main practice test site.
Where This Credential Fits
Understanding the exam mechanics is only half the picture. Physicians pursuing this credential typically work in hospice organizations, palliative care consult services, and inpatient units where board certification signals subspecialty competence to employers and referral networks. If you're still weighing whether to pursue it, Is the HPM Certification Worth It? Complete ROI Analysis 2026 and HPM Salary Guide 2026: Complete Earnings Analysis cover the career and compensation angle, while HPM Jobs surveys the hiring landscape. For background on training pathways leading into eligibility, see HPM Training.
You can also use our practice test platform to simulate the 200-question format under real time pressure before your scheduled exam date.
FAQ
The written examination contains 200 single-answer multiple-choice questions, administered with a 4.5-hour time limit.
A scaled score of 500 on the 200-800 scale is required to pass.
Medical management, at 40-46% of the exam, is by far the largest domain and should receive the largest share of your study time.
The published application/examination fee is $1,200 for the written exam administered under the AOA's Conjoint Committee on HPM.
No. Continuing certification now uses the HPM longitudinal assessment, which replaced the former high-stakes recertification exam and moved to the AOA Learning Portal in January 2026, rather than repeating the original 200-question exam.