CMD Professional Standards & Competencies 3 — Questions and Answers
Question 1: A facility's annual survey reveals a deficiency in antibiotic stewardship practices. As Medical Director, your FIRST priority should be to:
- Suspend all antibiotic prescribing until a new policy is approved
- Conduct a root cause analysis and develop a corrective action plan (Correct answer)
- Require all physicians to attend an external antibiotic training course immediately
- Delegate resolution entirely to the Director of Nursing
Correct answer: Conduct a root cause analysis and develop a corrective action plan
Root cause analysis identifies the underlying system failures driving deficiencies, which is necessary before implementing meaningful corrective interventions.
Question 2: The Medical Director role in managing a facility's infection control program PRIMARILY involves:
- Personally culturing wound specimens for each resident
- Providing medical oversight and clinical guidance to the infection preventionist (Correct answer)
- Reporting all infections directly to the CDC without staff involvement
- Approving every antibiotic prescription before dispensing
Correct answer: Providing medical oversight and clinical guidance to the infection preventionist
The Medical Director provides clinical leadership and oversight to the infection control program, partnering with the infection preventionist rather than performing hands-on technical tasks.
Question 3: Under what circumstance is it MOST appropriate for a Medical Director to override an attending physician's clinical decision in a long-term care setting?
- When the decision differs from the Medical Director's personal preference
- When the decision poses a clear and immediate risk to resident safety (Correct answer)
- When the attending physician has fewer years of experience
- When a family member requests a different treatment approach
Correct answer: When the decision poses a clear and immediate risk to resident safety
Overriding a physician's clinical judgment is justified only when there is a demonstrable, immediate patient safety risk—not differences in style or preference.
Question 4: Which principle from the AMDA Code of Ethics MOST directly applies when a Medical Director must balance cost-containment directives from facility ownership with individual resident care needs?
- Nonmaleficence and beneficence (Correct answer)
- Autonomy only
- Justice and resource allocation
- Veracity and full disclosure
Correct answer: Nonmaleficence and beneficence
Nonmaleficence (do no harm) and beneficence (act in the patient's best interest) are the primary ethical principles that must guide clinical decisions, even under financial pressure.
Question 5: A Medical Director is asked to sign off on a facility policy that allows nurses to independently adjust insulin doses without a physician order. The BEST response is to:
- Approve the policy if the facility administrator supports it
- Refuse to sign and report the administrator to CMS
- Review relevant state nurse practice act and facility protocols before deciding (Correct answer)
- Approve only if insulin adjustments stay within a narrow sliding scale order
Correct answer: Review relevant state nurse practice act and facility protocols before deciding
The Medical Director must ensure policies comply with applicable state nurse practice acts and regulatory standards before endorsing any scope-of-practice expansion.
Question 6: Which scenario MOST clearly demonstrates a conflict of interest that a Medical Director must disclose?
- Attending a free educational lunch sponsored by a pharmaceutical company
- Owning stock in a medical supply company from which the facility purchases durable medical equipment (Correct answer)
- Serving on a state medical society committee
- Having a personal friendship with a staff nurse
Correct answer: Owning stock in a medical supply company from which the facility purchases durable medical equipment
Financial interest in a vendor supplying the facility creates a direct conflict of interest that must be disclosed, as it can influence purchasing or prescribing decisions.
Question 7: In PALTC settings, the Medical Director's responsibility during a change-of-ownership (CHOW) transition PRIMARILY includes:
- Renegotiating their own employment contract on behalf of the facility
- Ensuring clinical care continuity and reviewing staff credentialing processes (Correct answer)
- Auditing the financial accounts of the prior ownership
- Immediately discharging residents whose care is deemed too costly
Correct answer: Ensuring clinical care continuity and reviewing staff credentialing processes
During ownership transitions, the Medical Director's primary obligation is to protect resident care continuity and ensure clinical staff credentialing remains compliant.
CMD Professional Standards & Competencies 3
A facility's annual survey reveals a deficiency in antibiotic stewardship practices.
As Medical Director, your FIRST priority should be to: