Linking Outcomes to Objectives

Levels of Outcomes

Moore's expanded framework identifies a set of objectives for CME activities ranging from participation (I sat in on a lecture) to improved health of patient communities1:

Outcome Level Description Source of objective data
Participation Number of physician who attend an event Attendance records
Satisfaction Degree to which an event meets participant expectations Evaluations
Declarative Knowledge Degree to which participants state what the activity intended them to learn Pre- and post-tests of knowledge
Procedural knowledge Degree to which participants state how to do what the activity intended them to learn Pre- and post-tests of knowledge
Competence Degree to which participants can show in an educational setting how to do what the activity intended them to be able to do Observation in an educational setting
Performance Degree to which participants do what the CME activity intended them to be able to do Observation of performance in patient care setting
Patient health Degree to which the health status of patients improves due to changes in the practice behavior of participants Health status measures, e.g. from charts or EHR
Community health Degree to which the health status of a community of patients improves due to changes in the practice behavior of participants Epidemiological data

We achieve levels 1 and 2 through standard processes of attendance taking and activity evaluation. Declarative and procedural knowledge can both be demonstrated through basic assessment techniques.

It would be great to ensure competence, but this isn't practical for most education environments. The good news is that if we follow the ACCME process of defining a need based on an identified measurable gap, we can measure both competence and performance with appropriate follow-up. The final levels of patient and community health then flow directly from repeated implementation of the same process to close known performance gaps.