Internal Medicine End of Rotation ™ Exam Blueprint & Topic List

The Internal Medicine End of Rotation™ (EOR) exam is one of the PA Education Association’s objective, standardized evaluations and is intended to serve as one measure of the medical knowledge PA students gain during their supervised clinical practice experience. This article outlines the updated PAEA Internal Medicine EOR Exam Blueprint, including its content and task areas, and presents the Exam Topic List. The specifications presented here reflect the updated Internal Medicine Blueprint and Topic List published by PAEA as of July 2026. Updated Internal Medicine exam versions based on these specifications were published July 2026; legacy Internal Medicine examinations remain available through July 2027, so students should confirm which version their program is administering. Questions on an examination represent only a sample of the content that may be assessed and may not reflect every topic identified in the Topic List. Exam candidates and clinical coordinators are encouraged to review the original Blueprint, Topic List, and Core Tasks and Objectives through PAEA’s End of Rotation™ Blueprints and Topic Lists resource page at https://paeaonline.org/assessment/end-of-rotation/blueprints-and-topic-lists. ^[1]

AMBOSS is an independent entity with no affiliation to or endorsement by the PA Education Association (PAEA) or the PAEA End of Rotation™ examinations. The PAEA-derived portions of this article are based on the PAEA Internal Medicine End of Rotation™ Exam Blueprint, Topic List, and Core Tasks and Objectives, which are created and owned by PAEA®. The internal medicine-specific "Knowledge of" and "Skill in" descriptions, general study guidance, and organization of certain Professional Practice concepts were developed by AMBOSS and are not taken verbatim from the PAEA Core Tasks and Learning Objectives or from another source. AMBOSS does not claim ownership of material originating from PAEA. This article is provided at no cost to the public as an informational resource for PA students, educators, clinicians, and other healthcare professionals. It is not an official PAEA publication and does not contain actual PAEA examination questions. Use or reproduction of PAEA materials is subject to PAEA’s applicable terms and any required permissions. ^[2]

Content Categories

Task Categories

Each End of Rotation™ exam contains 120 multiple-choice questions, including 100 scored questions and 20 unscored pretest questions. The Blueprint percentages apply to the 100 scored questions. The updated Internal Medicine Blueprint is organized by both content area and task area, and Professional Practice is one of its eight task areas.

General study approach

• Use the Blueprint percentages to set relative study priorities rather than to exclude lower-percentage categories.
  • Cardiovascular, pulmonary, and gastrointestinal disease together account for 47% of the scored questions, and the six largest content categories account for 77%; however, every listed category remains testable.
  • Diagnosis and Clinical Therapeutics together account for 40% of the scored questions, and adding History & Physical and Diagnostic Studies brings these four task areas to 69%, emphasizing integrated clinical assessment, diagnostic reasoning, test interpretation, and evidence-based treatment.
• Internal Medicine End of Rotation™ questions focus on adult and geriatric patients and may be set in ambulatory, inpatient, and long-term-care settings. Preparation should therefore include acute illness, chronic disease, multimorbidity, polypharmacy, functional and cognitive impairment, and transitions between outpatient, hospital, and long-term care.
• End of Rotation™ questions use a one-best-answer clinical-vignette format intended to assess higher-order thinking. Study each condition through its risk factors and presentation, key distinguishing findings, appropriate diagnostic evaluation, evidence-based treatment, monitoring, complications, preventive needs, indications for consultation or hospitalization, and longitudinal follow-up.

Content Categories

Arrhythmias/Conduction disorders

• Atrial
• Heart blocks
• Junctional
• Premature beats
• Ventricular

Cardiomyopathy

• Dilated
• Hypertrophic
• Restrictive

Coronary artery disease

• Acute coronary syndrome
• Stable angina
• Vasospastic angina (Prinzmetal angina)

Heart failure

Hypertensive disorders

• Primary hypertension
• Secondary hypertension
• Severe asymptomatic hypertension (Hypertensive urgency)

Hypotension

• Orthostatic hypotension
• Vasovagal hypotension

Lipid disorders

Shock

• Cardiogenic
• Hypovolemic
• Obstructive

Traumatic, infectious, and inflammatory heart conditions

• Acute rheumatic carditis
• Infective endocarditis
• Myocarditis
• Pericardial effusion
• Pericarditis

Valvular disorders

• Aortic
• Mitral
• Pulmonary
• Rheumatic heart disease
• Tricuspid

Vascular disorders

• Aortic aneurysm/dissection
• Arterial embolism/thrombosis
• Arteriovenous malformation
• Atherosclerosis
• Deep vein thrombosis
• Peripheral artery disease
• Phlebitis/Thrombophlebitis
• Varicose veins
• Vasculitides
• Venous insufficiency

Acute respiratory distress syndrome

Acute respiratory failure

Asthma

Bronchiectasis

Chronic obstructive pulmonary disease

Idiopathic pulmonary fibrosis

Infectious disorders

• Acute bronchitis
• Acute epiglottitis
• Empyema
• Influenza
• Pneumonias
  • Bacterial
  • Fungal
  • Human immunodeficiency virus-related
  • Viral

Tuberculosis

Interstitial lung disease

Neoplasms

• Benign
• Malignant

Pleural effusion

Pneumothorax

Pulmonary circulation

• Cor pulmonale
• Pulmonary edema
• Pulmonary embolism
• Pulmonary hypertension

Pulmonary nodule

Sarcoidosis

Sleep apnea

Biliary tract disorders

• Cholangitis
• Cholecystitis
• Cholelithiasis

Esophageal disorders

• Boerhaave syndrome
• Esophageal strictures
• Esophageal varices
• Esophagitis
• Gastroesophageal reflux disease
• Mallory-Weiss tear
• Motility disorders
• Zenker diverticulum

Foodborne illness

Gastric disorders

• Gastritis
• Peptic ulcer disease

Gastrointestinal bleeding

Hepatic disorders

• Cirrhosis
• Hepatitis
• MASH (metabolic dysfunction-associated steatohepatitis)/MASLD (metabolic dysfunction-associated steatotic liver disease)
• Portal hypertension

Intestinal/Colorectal disorders

• Abscess/Fistula
• Acute infectious gastroenteritis (viral, bacterial)
• Appendicitis
• Celiac disease
• Diverticular disease
• Hemorrhoidal disorders
• Hernias
• Inflammatory bowel disease
• Irritable bowel syndrome
• Ischemic bowel disease
• Toxic megacolon

Neoplasms

• Benign
• Malignant

Nutrition

• Food allergies and food sensitivities
• Hypervitaminosis/Hypovitaminosis

Pancreatitis

Adrenal disorders

• Adrenal insufficiency (acute/chronic)
• Hyperaldosteronism
• Hypercortisolism
• Pheochromocytoma

Diabetes mellitus

Diabetic ketoacidosis

Disorders of calcium and phosphorus

Hyperosmolar hyperglycemic syndrome

Lipid disorders

Myxedema coma

Neoplasms

• Benign
• Malignant

Paget’s disease of bone

Pituitary disorders

• Acromegaly
• Cushing disease
• Diabetes insipidus
• Growth hormone deficiency
• Pituitary adenoma
• Syndrome of inappropriate antidiuretic hormone secretion

Thyroid/Parathyroid disorders

• Hyper/Hypoparathyroidism
• Hyper/Hypothyroidism
• Thyroid storm
• Thyroiditis

Congenital/Genetic disorders

• Huntington disease

Degenerative/Neuromuscular disease

• Dementia/Delirium
• Multiple sclerosis
• Myasthenia gravis
• Parkinson disease
• Tremor/Tic disorder

Headache

• Complex
• Primary

Increased intracranial pressure

Infectious disorders

• Abscess
• Encephalitis
• Meningitis

Neoplasms

• Benign
• Malignant

Peripheral nerve disease

• Guillain-Barré syndrome
• Neuralgia/Neuritis
• Neuropathy

Seizure disorders

Stroke

• Hemorrhagic
• Ischemic
• Transient ischemic attack

Trauma

• Intracranial hemorrhage
• Mild traumatic brain injury
• Spinal cord injury

Acid-base disturbances

Electrolyte disturbances

Infectious disorders

• Cystitis
• Prostatitis
• Pyelonephritis

Neoplasms

• Benign
• Malignant

Obstructive disorders

• Uro/Nephrolithiasis

Renal artery stenosis

Renal disease

• Acute kidney injury
• Chronic kidney disease
• Cystic kidney disease
• Hydronephrosis
• Nephritic syndrome
• Nephropathy
• Nephrotic syndrome

Avascular necrosis

Infectious disorders

• Osteomyelitis
• Septic arthritis

Inflammatory conditions

• Bursitis
• Costochondritis
• Myositis
• Tendonitis
• Tenosynovitis

Neoplasms

• Benign
• Malignant

Osteoarthritis

Osteoporosis

Rheumatologic disorders

• Connective tissue diseases
• Gout/Pseudogout
• Polyarteritis nodosa
• Polymyalgia rheumatica
• Polymyositis
• Psoriatic arthritis
• Reactive arthritis
• Rheumatoid arthritis
• Sjögren syndrome
• Systemic lupus erythematosus
• Systemic sclerosis (scleroderma)

Spine disorders

• Ankylosing spondylitis
• Spinal stenosis
• Spondylolisthesis
• Spondylolysis

Traumatic conditions

• Falls
• Fractures/Dislocations
• Hematomas

Anemias

• Hemolytic
• Macrocytic
• Microcytic
• Normocytic

Coagulation disorders

• Disseminated intravascular coagulation
• Immune thrombocytopenic purpura
• Thrombotic thrombocytopenic purpura
• von Willebrand disease

Fever of unknown origin

Glucose-6-phosphate dehydrogenase (G6PD) deficiency

Hemorrhagic shock

Leukemias

Lymphomas

Multiple myeloma

Polycythemia

Sickle cell disease

Thalassemias

Bacteremia

Bacterial infections

Fever

• Fever of unknown origin
• Neutropenic fever

Fungal infections

• Cryptococcus
• Histoplasmosis

Opportunistic infections

Parasitic infections

• Toxoplasmosis

Post-COVID conditions

Sepsis

Septic shock

Sexually transmitted infections

Vector-borne infections

Viral infections

• Coronavirus disease 2019 (COVID-19)
• Human immunodeficiency virus/Acquired immunodeficiency syndrome
• Influenza

Advance care planning

Anxiety disorders

• Generalized anxiety disorder
• Panic disorder
• Phobic disorders

Bipolar and related disorders

Child/Elder neglect or violence

Delirium

Depressive disorders

Eating disorders

Pain management

Psychosis

Sleep-wake disorders

Substance-related disorders

Trauma/Stress-related disorders

• Adjustment disorder
• Bereavement
• Posttraumatic stress disorder

Task Categories

*AMBOSS editorial study guidance: The internal medicine-specific "Knowledge of" and "Skill in" descriptions were developed by AMBOSS and are not taken verbatim from the PAEA Core Tasks and Learning Objectives or from another source.

• Knowledge of:
  • Components and techniques of comprehensive, focused, and problem-based histories and physical examinations for adult and geriatric patients
  • Pertinent medical, surgical, family, medication, allergy, substance-use, occupational, social, and functional histories
  • History of chronic disease trajectory, prior hospitalizations, procedures, complications, treatment response, adherence, and specialty care
  • Risk factors and historical features associated with common cardiovascular, pulmonary, gastrointestinal, endocrine, neurologic, renal, rheumatologic, hematologic, infectious, and behavioral health conditions
  • Medication reconciliation, including prescription medications, over-the-counter products, supplements, anticoagulants, adherence, adverse effects, and polypharmacy
  • Functional status, cognition, fall history, frailty, nutrition, sensory impairment, caregiver support, and activities of daily living in older adults
  • Signs and symptoms of acute decompensation of chronic disease and common medical emergencies
  • Effects of housing, transportation, finances, health literacy, social support, and other social determinants on chronic disease management
• Skill in:
  • Conducting comprehensive and focused interviews and physical examinations with compassion, cultural humility, and attention to patient priorities
  • Obtaining pertinent information from patients, caregivers, prior records, consultants, pharmacies, and other available sources
  • Performing targeted cardiovascular, pulmonary, abdominal, neurologic, vascular, musculoskeletal, skin, and other system-specific examinations
  • Assessing volume status, perfusion, respiratory effort, hemodynamic stability, pain, functional status, cognition, and general clinical appearance
  • Recognizing abnormal findings associated with heart failure, respiratory compromise, shock, infection, neurologic dysfunction, renal failure, and other acute conditions
  • Reconciling medications and identifying potential adverse effects, interactions, duplication, nonadherence, or inappropriate therapy
  • Assessing gait, balance, fall risk, frailty, cognition, function, and caregiver support when clinically relevant
  • Recognizing findings that require urgent stabilization, emergency evaluation, specialty consultation, or hospital-level care

• Knowledge of:
  • Patient-centered education related to laboratory and diagnostic studies
  • Indications, limitations, risks, contraindications, techniques, and potential complications of commonly used diagnostic studies in adult medicine
  • Selection of initial and subsequent testing based on clinical presentation, comorbidities, cost, probable yield, invasiveness, contraindications, and potential effect on management
  • Interpretation of complete blood counts, metabolic studies, renal and hepatic testing, endocrine studies, cardiac biomarkers, coagulation studies, urinalysis, microbiologic studies, and other routine laboratory tests
  • Indications for electrocardiography, radiography, ultrasonography, computed tomography, magnetic resonance imaging, echocardiography, vascular studies, pulmonary function testing, blood gas analysis, endoscopy, and other commonly used diagnostic modalities
  • Effects of age, renal or hepatic impairment, medications, volume status, chronic disease, and multimorbidity on laboratory and diagnostic findings
  • Use of serial laboratory, imaging, physiologic, and clinical trends to evaluate disease progression and response to treatment
• Skill in:
  • Selecting appropriate initial, subsequent, screening, and confirmatory laboratory and diagnostic studies
  • Reviewing and interpreting routine laboratory studies, electrocardiograms, imaging, pulmonary testing, microbiologic studies, and other diagnostic data in clinical context
  • Comparing current findings with prior results and identifying clinically significant trends
  • Recognizing findings that require immediate treatment, emergency evaluation, specialty consultation, hospitalization, or additional diagnostic testing
  • Integrating diagnostic results with history, physical examination findings, comorbidities, and the clinical course
  • Determining when additional testing is required and when testing is unlikely to change management
  • Accounting for renal function, contrast risk, anticoagulation, implanted devices, procedural risk, and other patient-specific considerations when selecting tests
  • Communicating indications, risks, preparation requirements, uncertainty, results, and follow-up plans clearly to patients and caregivers

• Knowledge of:
  • Significance of the history, physical examination, laboratory studies, imaging, and clinical course as they relate to the differential diagnosis
  • Epidemiology, risk factors, pathophysiology, diagnostic criteria, typical presentations, atypical presentations, and complications of common adult medical conditions
  • Age-related and geriatric differences in disease presentation, including nonspecific or subtle manifestations of serious illness
  • Distinguishing features of common cardiovascular, pulmonary, gastrointestinal, endocrine, neurologic, renal, rheumatologic, hematologic, infectious, and psychiatric conditions
  • Medical, medication-related, toxicologic, metabolic, infectious, and neurologic conditions that may mimic one another
  • Effects of multimorbidity, polypharmacy, frailty, organ dysfunction, and social determinants on clinical presentation
  • Red-flag findings associated with acute organ dysfunction, sepsis, shock, respiratory failure, acute coronary syndromes, stroke, gastrointestinal bleeding, metabolic emergencies, and other time-sensitive conditions
• Skill in:
  • Formulating and prioritizing an appropriate differential diagnosis based on the available clinical information
  • Selecting the most likely diagnosis while maintaining consideration of serious alternative diagnoses
  • Distinguishing acute disease from chronic disease and stable chronic illness from acute decompensation
  • Recognizing atypical and nonspecific presentations of disease in older adults and medically complex patients
  • Identifying concurrent diagnoses, complications, end-organ effects, and clinically important comorbidities
  • Recognizing medical emergencies and determining when immediate stabilization must precede further diagnostic evaluation
  • Revising the differential diagnosis when treatment fails, symptoms evolve, or new laboratory, imaging, or examination findings emerge
  • Managing diagnostic uncertainty through reassessment, additional testing when appropriate, consultation, safety-net instructions, and longitudinal follow-up

• Knowledge of:
  • Age-, sex-, and risk-based preventive care recommendations for adult and geriatric patients
  • Recommended immunizations for adults, older adults, travelers, and patients with chronic disease or immunocompromising conditions
  • Screening recommendations for cardiovascular risk factors, diabetes, osteoporosis, common cancers, substance use, depression, cognitive impairment, and other preventable or detectable conditions
  • Lifestyle interventions involving nutrition, physical activity, sleep, tobacco cessation, alcohol use, weight management, and injury prevention
  • Fall prevention, osteoporosis prevention, functional assessment, cognitive assessment, sensory screening, and other geriatric health-maintenance considerations
  • Effects of aging, multimorbidity, polypharmacy, family roles, caregiver needs, environmental exposures, and social determinants on health
  • Principles of medication review, deprescribing, and prevention of treatment-related harm in medically complex patients
  • Role of advance care planning and goals-of-care discussions in longitudinal adult and geriatric care
• Skill in:
  • Identifying preventive services and screening studies that are due based on age, history, comorbidities, medications, family history, and individual risk
  • Providing evidence-based counseling regarding immunization, nutrition, physical activity, tobacco, alcohol, fall prevention, and other modifiable health risks
  • Assessing fall risk, functional status, cognition, frailty, and medication burden in older adults
  • Using shared decision-making when benefits and harms of screening or preventive interventions depend on age, comorbidity, life expectancy, or patient preferences
  • Identifying potentially inappropriate or unnecessary medications and opportunities to reduce treatment burden
  • Recognizing barriers to preventive and chronic care related to cost, transportation, housing, food access, health literacy, disability, or caregiver support
  • Coordinating follow-up and additional evaluation for abnormal screening results
  • Incorporating patient goals, prognosis, and preferences into preventive and longitudinal care planning

• Knowledge of:
  • Indications, contraindications, risks, benefits, complications, and monitoring requirements of common nonpharmacologic interventions and procedures used in adult medicine
  • Principles of oxygen therapy, ventilatory support, fluid management, blood-product administration, and stabilization of acutely ill patients
  • Indications for vascular access, drainage procedures, urinary catheterization, thoracentesis, paracentesis, and other commonly encountered medical procedures
  • Nonpharmacologic management of cardiovascular, pulmonary, metabolic, gastrointestinal, renal, musculoskeletal, neurologic, and chronic pain conditions
  • Roles of nutrition therapy, physical therapy, occupational therapy, rehabilitation, respiratory therapy, behavioral health, and other supportive services
  • Criteria for emergency evaluation, specialty consultation, hospital admission, higher levels of care, procedural intervention, dialysis evaluation, or transfer
  • Principles of discharge planning, posthospital follow-up, rehabilitation, and prevention of readmission
• Skill in:
  • Prioritizing clinical interventions based on severity, physiologic stability, working diagnosis, comorbidities, and risk of deterioration
  • Initiating appropriate stabilization for respiratory compromise, shock, severe infection, metabolic emergencies, acute neurologic disease, and other urgent conditions
  • Selecting appropriate fluid, oxygen, respiratory-support, procedural, rehabilitative, and other nonpharmacologic interventions
  • Determining when outpatient management is appropriate and when consultation, hospitalization, procedural management, or transfer is required
  • Obtaining informed consent and explaining the benefits, risks, alternatives, and expected course of proposed interventions
  • Evaluating response to intervention through repeat examination, vital signs, laboratory results, imaging, functional status, and other clinically relevant findings
  • Coordinating specialty, rehabilitation, home-health, long-term-care, palliative-care, and other appropriate services
  • Providing clear discharge instructions, warning signs, return precautions, and follow-up plans

• Knowledge of:
  • Indications for use
  • Contraindications and precautions
  • Mechanisms of action
  • Dosing and routes of administration
  • Pharmacokinetics and pharmacodynamics
  • First-line and alternative pharmacologic treatments for common cardiovascular, pulmonary, gastrointestinal, endocrine, neurologic, renal, rheumatologic, hematologic, infectious, and behavioral health conditions
  • Principles of antimicrobial selection, empiric therapy, targeted therapy, treatment duration, and antimicrobial stewardship
  • Anticoagulant, antiplatelet, antihypertensive, lipid-lowering, glycemic, inhaled, diuretic, analgesic, anti-inflammatory, and other commonly used adult pharmacotherapies
  • Medication selection and dose adjustment in renal impairment, hepatic impairment, advanced age, frailty, and multimorbidity
  • Polypharmacy, drug-drug interactions, drug-disease interactions, prescribing cascades, adverse effects, withdrawal syndromes, and medication toxicity
  • Indications for medication initiation, titration, substitution, tapering, discontinuation, and deprescribing
  • Monitoring requirements for medications with renal, hepatic, hematologic, metabolic, cardiovascular, or other important toxicities
• Skill in:
  • Developing individualized pharmacologic treatment plans that incorporate diagnosis, disease severity, comorbidities, organ function, prior response, patient preferences, cost, and access
  • Selecting appropriate first-line medications and modifying regimens based on response, adverse effects, contraindications, and changing clinical status
  • Adjusting medication doses for renal or hepatic impairment and other patient-specific factors
  • Reconciling medications and identifying duplication, interactions, nonadherence, potentially inappropriate therapy, and prescribing cascades
  • Selecting appropriate empiric and targeted antimicrobial therapy and reassessing the need for continued treatment
  • Monitoring therapeutic response through symptoms, examination findings, laboratory studies, home measurements, imaging, and other disease-specific parameters
  • Recognizing and managing adverse effects, drug interactions, medication toxicity, and treatment failure
  • Deprescribing medications when risks or treatment burden outweigh expected benefit
  • Counseling patients and caregivers regarding medication purpose, administration, expected benefits, adverse effects, precautions, monitoring, and adherence

• Knowledge of:
  • Associations among adult medical conditions and complications identified through the application of scientific concepts
  • Cardiovascular physiology, hemodynamics, vascular biology, and mechanisms of atherosclerotic and structural heart disease
  • Pulmonary mechanics, ventilation, perfusion, gas exchange, and mechanisms of respiratory failure
  • Renal physiology, fluid balance, electrolyte regulation, and acid-base homeostasis
  • Endocrine feedback systems, glucose metabolism, calcium and phosphorus regulation, and mechanisms of metabolic disease
  • Gastrointestinal, hepatic, and pancreatic physiology and mechanisms of inflammatory, obstructive, vascular, and metabolic disease
  • Neurologic anatomy and physiology relevant to cognition, movement, sensation, seizures, stroke, and peripheral nerve disease
  • Hematopoiesis, coagulation, thrombosis, immunity, inflammation, autoimmunity, and mechanisms of infectious disease
  • Physiologic effects of aging, frailty, reduced organ reserve, and multimorbidity
  • Pharmacologic principles relevant to adult and geriatric medication selection, dosing, interactions, and toxicity
  • Public-health principles relevant to chronic disease, infection, cardiovascular risk, aging, disability, and health disparities
• Skill in:
  • Applying anatomy, physiology, and pathophysiology to adult medical diagnosis and management
  • Relating underlying disease mechanisms to symptoms, examination findings, laboratory abnormalities, imaging, complications, and treatment response
  • Applying cardiovascular and pulmonary physiology to interpretation of hemodynamic and respiratory abnormalities
  • Applying renal, electrolyte, and acid-base physiology to diagnostic reasoning and treatment
  • Applying endocrine and metabolic physiology to common hormonal and glucose disorders
  • Applying immunologic, microbiologic, hematologic, and inflammatory principles to infectious, rheumatologic, and hematologic disease
  • Applying age-related physiologic changes to medication selection, fluid management, diagnostic interpretation, and risk assessment
  • Incorporating evidence-based medicine and current internal medicine guidance into clinical decision-making

Legal/medical ethics

• Knowledge of:
  • Informed consent and refusal for diagnostic studies, medications, procedures, hospitalization, and other medical interventions
  • Assessment of decision-making capacity and identification of an appropriate surrogate decision-maker
  • Advance directives, code status, including do-not-resuscitate and do-not-intubate orders, medical power of attorney, organ donation, and goals-of-care decisions
  • Ethical considerations involving serious illness, treatment refusal, medical futility, life-sustaining treatment, palliative care, and end-of-life care
  • Confidentiality, privacy, patient autonomy, and appropriate involvement of families and caregivers
  • Legal and ethical responsibilities related to suspected abuse, neglect, exploitation, impaired driving, and applicable mandated-reporting requirements
  • Patient rights, cultural and religious beliefs, health disparities, and legal or policy issues affecting access to medical care
• Skill in:
  • Assessing and documenting decision-making capacity when cognition, delirium, psychiatric illness, substance use, or severe medical illness may affect health care decisions
  • Supporting informed, voluntary, and patient-centered treatment decisions through shared decision-making
  • Discussing prognosis, treatment limitations, goals of care, advance care planning, and end-of-life preferences sensitively
  • Communicating appropriately with legally authorized representatives when a patient lacks decision-making capacity
  • Maintaining confidentiality while recognizing applicable situations requiring disclosure or mandated reporting
  • Recognizing and escalating complex ethical or legal concerns to the supervising physician, ethics service, risk management, legal counsel, or other appropriate resource

Medical informatics

• Knowledge of:
  • Accurate and complete documentation of history, examination, clinical reasoning, diagnosis, treatment, procedures, complications, and follow-up
  • Documentation requirements related to medication reconciliation, advance care planning, informed consent, transitions of care, and chronic disease management
  • Electronic health records, clinical decision-support systems, prescription-monitoring programs, patient portals, telemedicine, and evidence-based medical resources
  • Risks associated with copied documentation, incomplete medication reconciliation, alert fatigue, privacy breaches, and failure to follow abnormal results
• Skill in:
  • Documenting clinical reasoning, uncertainty, treatment decisions, patient preferences, and follow-up accurately and promptly
  • Using health information systems to review prior records, trends, medication histories, procedures, hospitalizations, and specialty recommendations
  • Tracking diagnostic studies, referrals, abnormal results, and pending tests until appropriate action is completed
  • Protecting patient information when using electronic records, portals, telemedicine, mobile devices, and other communication systems

Patient care and communication (individual patients)

• Knowledge of:
  • Affordable, effective, and patient-specific medical care for adults and older adults
  • Communication and care preferences of diverse patients, families, and caregivers
  • Effects of health literacy, language, disability, culture, cognition, finances, housing, transportation, food access, and social support on health decisions and outcomes
  • Communication strategies for chronic disease, multimorbidity, diagnostic uncertainty, serious illness, poor prognosis, and end-of-life care
  • Effects of functional decline, caregiver burden, social isolation, and loss of independence on patient well-being
• Skill in:
  • Establishing therapeutic relationships with empathy, professionalism, cultural humility, and respect
  • Using qualified interpreters and accessible communication methods when appropriate
  • Explaining diagnoses, diagnostic uncertainty, treatment options, medications, risks, benefits, and follow-up plans in understandable language
  • Confirming comprehension through teach-back and adapting education to health literacy, cognitive, sensory, and functional needs
  • Engaging patients, families, and caregivers in shared decision-making while respecting patient autonomy and confidentiality
  • Communicating difficult information and discussing prognosis, functional decline, treatment limitations, and goals of care sensitively
  • Identifying barriers to adherence and coordinating realistic resources and follow-up plans

PA role in professional practice

• Knowledge of:
  • Professional and clinical limitations, scope of practice, credentialing, privileging, supervision, and collaboration requirements
  • Responsibilities of the PA in ambulatory care, inpatient medicine, long-term care, chronic disease management, procedures, and transitions of care
  • Roles and responsibilities of physicians, nurses, pharmacists, therapists, social workers, specialists, palliative-care clinicians, and other members of the health care team
  • Professional boundaries, conflicts of interest, clinician impairment, ethical conduct, and effects of implicit bias on assessment and treatment
• Skill in:
  • Recognizing personal limitations and seeking supervision, consultation, referral, or transfer of care appropriately
  • Communicating effectively during consultations, referrals, handoffs, multidisciplinary rounds, and transitions of care
  • Coordinating care across outpatient clinics, hospitals, rehabilitation facilities, long-term-care settings, specialty practices, and home-based services
  • Maintaining professional behavior, accountability, reliability, and appropriate boundaries in complex and high-stress clinical environments

Professional development

• Knowledge of:
  • Continuing medical education resources relevant to adult and geriatric medicine
  • Evidence-based guidelines, quality standards, performance measures, and evolving diagnostic and therapeutic practices
  • Principles of lifelong learning, self-assessment, feedback, clinician well-being, and maintenance of professional competence
• Skill in:
  • Critically evaluating medical literature and applying evidence-based recommendations appropriately
  • Identifying and interpreting information from reliable internal medicine and specialty resources
  • Recognizing personal knowledge or skill gaps and pursuing appropriate education, supervision, feedback, or additional training
  • Using clinical outcomes, morbidity review, quality-improvement activities, and patient-safety events to improve future performance

Public health (population/society)

• Knowledge of:
  • Principles of disease prevention, health promotion, health equity, population health, communicable-disease control, and outbreak recognition
  • Population-level burden and prevention of cardiovascular disease, diabetes, chronic pulmonary disease, kidney disease, infectious disease, substance use, and other common adult conditions
  • Environmental and occupational exposures, travel-related risks, antimicrobial resistance, and community health needs
  • Health disparities and barriers affecting access to preventive, chronic, specialty, rehabilitation, long-term, and palliative care
  • Community resources addressing food insecurity, housing instability, transportation, substance use, behavioral health, disability, caregiving, and access to care
• Skill in:
  • Recognizing reportable diseases and following applicable public-health and mandated-reporting requirements
  • Identifying emerging infections, exposure clusters, and other population-level health concerns
  • Counseling patients regarding prevention, risk reduction, immunization, smoking cessation, physical activity, nutrition, and other healthy behaviors
  • Connecting patients and caregivers with preventive, behavioral, social, rehabilitation, long-term-care, and community-based services
  • Recognizing health disparities and incorporating population-level risks and barriers into individual care plans

Risk management

• Knowledge of:
  • Accountability, standards of care, and appropriate resource utilization in internal medicine practice
  • Common causes of diagnostic error, medication error, communication failure, delayed treatment, missed abnormal results, and unsafe transitions of care
  • Patient-safety measures, including patient identification, allergy verification, medication reconciliation, infection prevention, fall prevention, procedural time-outs, and the Universal Protocol when applicable
  • Risks associated with polypharmacy, anticoagulation, renal or hepatic impairment, delirium, falls, pressure injuries, and functional decline
  • Quality-improvement principles and requirements for reporting adverse events, near misses, equipment failures, occupational exposures, and other safety concerns
• Skill in:
  • Using medication reconciliation, allergy review, interaction screening, renal and hepatic dose review, and appropriate monitoring to reduce treatment-related harm
  • Recognizing and responding to clinical deterioration, diagnostic uncertainty, and unexpected changes in patient status
  • Providing explicit return precautions and safety-net instructions when managing uncertain or evolving conditions
  • Tracking diagnostic studies, consultations, referrals, abnormal results, and pending studies to prevent loss to follow-up
  • Providing safe handoffs that communicate active problems, baseline function, medications, completed and pending studies, treatment response, goals of care, and contingency plans
  • Recognizing, documenting, reporting, and responding appropriately to adverse events and near misses
  • Escalating concerns when patient safety, clinician impairment, staffing, equipment function, or standards of care are compromised

AMBOSS is an independent entity with no affiliation to or endorsement by the PA Education Association (PAEA) or the PAEA End of Rotation™ examinations. The PAEA-derived portions of this article are based on the publicly available PAEA Internal Medicine End of Rotation™ Exam Blueprint, Topic List, and Core Tasks and Objectives, which are solely created and owned by PAEA®. The internal medicine-specific "Knowledge of" and "Skill in" descriptions, general study guidance, and organization of certain Professional Practice concepts were developed by AMBOSS and are not taken verbatim from the PAEA Core Tasks and Learning Objectives or from another source. AMBOSS does not claim ownership of material originating from PAEA. This article is provided at no cost to the public as an informational resource for PA students, educators, clinicians, and other healthcare professionals. It is not an official PAEA publication and does not contain actual PAEA examination questions. Questions on an examination represent only a sample of the content that may be assessed, and the Topic List is not a comprehensive list of all possible examination topics. Use or reproduction of PAEA materials is subject to PAEA’s applicable terms and any required permissions. ^[2]