The Hospice and Palliative Medicine Longitudinal Knowledge Assessment (LKA) is the alternative to the one-day examination requirement for the Hospice and Palliative Medicine Certificate of Added Qualification. We have partnered with the American Board of Internal Medicine (ABIM) to make this exam alternative option available through ABIM’s longitudinal assessment solution called LKA.

As a participating physician, you would complete up to 30 questions each quarter for five years. Clinical references can be used during the exam, and you have four minutes to complete each question. Immediate feedback is provided, and you choose the time and location that’s convenient for you. You’ll remain certified throughout your participation as long as you meet other ABFM requirements.

how it works

  • You will begin in the first quarter of the year when your exam requirement is due.
  • You will answer up to 30 timed (four minutes) questions each quarter for five years.
  • LKA also provides a bank of 30 additional minutes per year that can be drawn from in one-minute increments to add more time while answering questions.
  • If performance at the end of five years is sufficient to reach the minimum passing standard, a new five-year cycle begins in year six and certification continues.
  • Questions can be answered all at one time, or you may space out completing questions during the quarter.
  • You may skip up to 100 questions during the five-year assessment without impacting performance or enrollment.
  • Immediate feedback and critiques are provided for each question answered.
  • Quarterly performance summaries will be available at the end of the first year, so you can continually assess your performance and identify focus areas for future study.
  • Final results will be provided following the end of year five.
  • You may review all answered questions in the “Review” section of the LKA dashboard.

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Eligibility Requirements

Who is Eligible?

  • ABFM Diplomates are eligible to participate in LKA beginning in January of the tenth year after their last successful Hospice and Palliative Medicine examination. In 2024, certified physicians whose last successful Hospice and Palliative Medicine one-day examination was in 2014 are eligible to participate in the program. To opt in, this group must complete the online application process.
  • ABFM Diplomates whose Hospice and Palliative Medicine certification has lapsed are also allowed to enroll in LKA. However, Hospice and Palliative Medicine certification will not be restored until completion of the assessment with a passing score. 

Who is not eligible?

  • ABFM Diplomates pursuing initial Hospice and Palliative Medicine certification are not allowed to participate in LKA.
  • Physicians who are not certified in Family Medicine with ABFM are not allowed to enroll in LKA through ABFM.

APPLICATION information

Candidate Information Booklet
To assist you with the Hospice and Palliative Medicine Examination Application and results process, ABFM provides you with a Candidate Information Booklet that includes a comprehensive description of your requirements and policies.  We recommend that you read this thoroughly before beginning the application process.

Hospice and Palliative Medicine
Candidate Information Booklet:

    2023 [PDF, 434KB]

    2024 [PDF, 449KB]

Online application details
To participate in LKA, you will need to complete an application that will be reviewed and approved by ABFM, just as you have done previously for the one-day examination. There is no additional cost for LKA compared to the one-day examination option. The online application can be accessed inside your MyABFM Portfolio during the open application period. Click here to review important dates and deadlines for the online application.

ADA Accommodations
You may request additional time for answering questions via the online application.  If accommodations become necessary after the application process is completed, you may submit a written request to [email protected].

Ongoing requirements
You will need to submit annual CAQ process fees and continue completing Family Medicine Continuous Certification Process requirements in the three-year stages to remain enrolled in LKA. Note that continued certification is still contingent upon meeting the current and continuous three-year stage requirements for Family Medicine Certification.

Should you not submit annual CAQ process fees and/or not complete the requirements for Family Medicine Certification during the established time frames (Three-Year Stage), you will be removed from LKA and lose certification status. If you are removed from LKA, you may only regain CAQ certification by taking and passing the one-day examination.

Family Medicine Certification requirements are expected to alter over time and continued certification will be dependent upon adherence to the then current policies and procedures. It will be your obligation to become and remain familiar with the Family Medicine Certification program rules.

Application withdrawal
Withdrawal Prior to Beginning Participation. You may withdraw your LKA application and switch to the one-day examination on, or before, the final deadline to submit your online application. This can be done through your MyABFM Portfolio. Your fee will simply be transferred from one application to the other.

If your LKA application has reached an approved status before you choose to withdraw, you will need to contact ABFM for assistance in switching to the one-day examination application at [email protected] or 877-223-7437.

Withdrawal After Beginning Participation. If you withdraw or are removed from LKA after you begin participating, you would be required to take and pass the one-day Hospice and Palliative Medicine examination by no later than December 31 of the following calendar year to maintain Hospice and Palliative Medicine certification.

Once enrolled in LKA, you will have the ability to withdraw your participation inside ABIM's exam delivery platform.

For withdrawals/removals that occur prior to the end of the sixth quarter of participation, the previously paid exam fee may be carried forward and applied to the next one-day Hospice and Palliative Medicine examination attempt (up to three calendar years). For withdrawals/removals that occur after the end of the sixth quarter of LKA participation, the previously paid exam fee would be counted as used.


LKA is designed to assess Diplomates in a comparable way to the one-day examination. The longitudinal assessment will deliver up to 30 questions each quarter that can be answered online, anywhere, at any time. The assessment is delivered over five years. Successfully completing the assessment and achieving a passing score will satisfy your examination requirement and enable you to maintain your board certification.

Examination Content
LKA for Hospice and Palliative Medicine will assess the candidate’s knowledge and clinical judgement in aspects of hospice and palliative medicine required to demonstrate a high level of competence.
Complete details regarding exam content may be accessed on the ABIM website:

Answering Questions
The LKA platform delivers up to 30 questions each quarter over five years. You will have 4 minutes to answer each question. The question set can be answered all at one time during the quarter or can be spread over multiple sessions within the quarter. LKA also provides a bank of 30 additional minutes per year that can be drawn from in one-minute increments to add more time while answering questions.

Questions that are viewed and answered will be counted correct or incorrect.  Questions that are viewed but not answered will be counted as incorrect. Questions that are not viewed during a quarter will not be scored but will count as “skips.”

Skipping Questions
A skip is defined as a question that was available, but never opened in a given quarter. You may skip up to 100 questions during the five-year assessment without impacting performance or enrollment. If you exceed 100 skips, you would be removed from LKA the following quarter and be required to take and pass the one-day examination before the end of the following calendar year to continue certification.

Note: A question that is opened, but not answered is not considered a skip and would be counted incorrect.

The table below lists the beginning and ending date for each quarter that you will have to answer your questions.

Quarterly schedule


Hardware and Software Recommendations

LKA replaces the need to sit for a one-day examination. However, we strongly encourage you to approach this assessment with the same level of focus and determination that you would give to the traditional examination. While we realize that sometimes factors beyond your control have the potential to disturb your assessment, here are a few key checkpoints that will help to minimize problems:

  • Device: When answering questions, we suggest using a reliable laptop, desktop computer, or tablet that you are familiar with. While the questions will display on smart phones and other devices with internet browsing capability, your best option will be a laptop, desktop computer, or tablet.
  • Software: The question delivery platform will be viewable through an ABIM website, so you will be using an internet browsing program (Edge, Chrome, Firefox, Safari, etc.) to access the assessment. Be sure to have the most updated version of your web browser.
  • Internet Connection: Be sure that you have a secure, stable, and reliable connection to the internet before you begin a question. A wired connection at your home or office will provide the best connectivity. A wi-fi connected computer or tablet with strong signal is your second-best option. We advise against the use of cellular networks as they can be less reliable.
  • Environment: Create an environment conducive to taking an examination when answering questions. Remember that you will have a limited window of time to answer each question, so you want to eliminate as many potential distractions as possible. A few factors to consider: people, pets, electronic devices, telephones, time sensitive tasks, extreme weather conditions (power/internet outages), and your own health/safety. If you have printed or electronic resources you plan to use, make them accessible to yourself before you begin answering questions.
  • Support: If you encounter issues at any time while participating in this assessment, contact ABIM right away at 800-441-2246 or submit a message at ABIM office hours are Monday - Friday, 8:30am – 6:00pm (Eastern).


Immediate Feedback
Once an answer is submitted for a question, you will be prompted to provide confidence and relevance ratings. You will then be taken to a page which will indicate whether the answer you submitted is correct or incorrect as well as provide the rationale and supporting references for the question. You may also review all answered questions later in the “Review” section of the LKA dashboard.

Ongoing Feedback
ABIM will provide ongoing details about your cumulative performance on the Dashboard page. Note that a cumulative scaled score will, in most cases, not be provided until the beginning of your second year of participation. The “Review” section of LKA will provide further insight into your performance over time as well as some more granular opportunities to identify areas of strength and weakness.

Final Score
At the end of year five, a summative decision will be calculated based on your overall performance throughout the assessment. If performance at the end of five years meets or exceeds the minimum passing standard, certification will continue and a new five-year cycle of LKA will begin. If performance is below the minimum passing standard, you would remain certified through the end of year six and would need to take and pass the one-day examination during year six to continue certification.