Readers of this column are probably familiar with learning objectives. We as a profession love learning objectives. The question on our minds, with love in our hearts, but pragmatism on our minds is: are our learners in love with our objectives? We would like to focus on several tips for creating worthy learning objectives.
Check for Focus & Structure
In CPD, learning objectives are provided to participants so that they know what they will learn in an educational activity. While it is tempting to list a series of topics that a speaker should cover, worthy learning objectives must be learner-focused, and not speaker-focused. With this focus in mind, learning objectives also need several elements to make a strong and worthy learning objective. The SACME CE Educational Toolkit (see page 33 of Toolkit at http://www.accme.org/ceeducatorstoolkit) suggests the approach of TACT:
- (T) Target – who is the learning for?
- (A) Action – what change is required?
- (C) Context – where is the change happening?
- (T) Time – when will the change be visible?
Check for Clarity & Alignment
We may have lofty goals for an educational event, such as a widespread systemic change in the healthcare system, and society. When it comes to learning objectives, it is important to remember that ambiguous and poorly written learning objectives are difficult to measure. Using a resource such as Bloom’s Taxonomy can help determine if the learning objectives are being assessed at the right level.
If your CPD program is offering a series of sessions, look at how the learning objectives within the series are aligned. Ensure that they build on each other in a meaningful way. Explore how learning objectives build toward meeting your CPD program goals, and how they fit with accreditation standards and professional competencies. When learning objectives are aligned, it provides transparency and clarity on what is being taught, and why it is important.
Alignment also comes into consideration when looking at the choice of instructional strategies used to meet the learning objectives. Consider how tightly the instructional strategies were chosen and are designed to meet and create the learning objectives. This is usually the site of frequent tweaks and refinements.
Take some time to reflect on how the learning objectives are working for your CPD program.
- Are there ambiguous learning objectives?
- Are there learning objectives that are double-barreled (i.e., really two separate and distinct learning objectives)?
- Difficult for learners to attain?
- Do the instructional strategies support and align with the learning objectives?
- Learning objectives must be learner-focused, and not speaker-focused.
- Learning objectives benefit from a clear structure.
- Learning objectives can be used by learners to guide their self-assessment.
- Learning objectives can align with other learning objectives, as well as CPD Program goals, accreditation standards, and professional competencies. When learning objectives are aligned, it provides transparency and clarity on what is being taught, and why it is important.
- Reflect on the learning objectives, learning, and teaching, and critically analyze what’s working and what isn’t working.
Practice Writing Some Real-time Learning Objectives
We have discussed some very specific writing guidelines and what experts in CPD believe to be the essential characteristics planners should incorporate into their activity learning objectives to improve learner outcomes. Now let’s practice! Below are some real-time learning objectives for actual CME activities at one of our SACME member institutions. The objectives were submitted as part of the activity planning document for accreditation review. We have provided some suggested revisions. As a skill-building exercise for you and your activity directors, we recommend you assess each of the objectives and rewrite them in accordance with TACT elements and describe the TACT element you have included to improve the objective.
EXAMPLE 1: 7th Annual Breast Health Symposium (Virtual format)
Course Practice Gap: Breast cancer is the most common non cutaneous cancer in women. It is daunting for health professionals to keep abreast of all the information and literature that is continuously being brought to the forefront on breast disease. The goals of the course are to enhance the knowledge base of the target audience (physicians, residents, advanced practice nurses and other clinical members of the interprofessional team) to improve personalized breast health treatment and care outcomes of patients.
Recently approved targeted drugs and imaging and surgical techniques have shown significant improvement in outcomes of certain breast cancer phenotypes. Knowledge of evidence and guidelines for both escalating and de-escalating therapy is essential for comprehensive, multidisciplinary management.
The course curriculum is structured to address patient care as the primary competency with an intended outcome of improved adherence to practice guidelines. It is approved for MOC credit in medical knowledge and practice assessment.
Current Learning Objectives
- Incorporate information from recent trials for high-risk breast cancer in practice
- Appropriately deescalate therapy in low-risk disease
- Effectively use national guidelines to deliver comprehensive breast health services
Revised Learning Objectives Using TACT
At the end of this course, the learning should be able to:
- Incorporate into practice the most recently approved targeted drugs, imaging, and surgical techniques for the treatment of high-risk breast cancer
- Apply the national clinical guidelines, for both escalating and deescalating therapy, immediately into practice
- Demonstrate practice improvement in care outcomes as a result of strict adherence to the guidelines within a specified treatment period
- Manage patients with a need for comprehensive breast health services more effectively by using an interprofessional team approach
EXAMPLE 2: Perioperative Management of Older Adults
Course Practice Gap: Many health systems and individual providers lack systemic assessments to screen and diagnose cognitive and functional impairments in older adults prior to surgery. Lack of diagnosis and recognition of these impairments can negatively impact a patient’s recovery and prognosis. Additionally, many older adults are at risk for post-operative complications including delirium, pressure ulcers, and pain.
This CME activity will improve the competence of health care providers in using tools and assessments for functional and cognitive impairments to improve patient care outcomes. It will provide training and guidelines on how to optimally screen patients and address patient and caregiver needs in the peri and post-operative period. Also, it will describe how an interdisciplinary approach involving rehabilitation professionals, nursing, physicians and case managers will improve patient care for geriatric patients. Best practices to address and support patient and caregiver needs in the peri and post-operative period will be demonstrated.
Current Learning Objectives:
- To describe the value of assessing cognitive and functional status as part of pre-operative evaluation for an older adult.
- To demonstrate the role of the interdisciplinary team including rehab and nursing in the peri-operative management of older adults.
- To describe the importance of proper pain management.
- To demonstrate the significance of patient/caregiver education in the peri-operative period for older adults.
Revised Learning Objectives Using Tact:
At the end of this course, learners should be able to:
- Conduct a comprehensive pre-operative evaluation to asses the cognitive and functional status, pain, other symptoms, and risk for complications of the geriatric patient.
- Manage pain, symptoms, and other complications during the pre and post-operative period of the patient.
- Develop a comprehensive care plan for the interdisciplinary clinical team, including the patient’s caregiver, for the peri and post-operative management of the geriatric patient.
- Educate both patients and caregivers about the important role of peri-operative care.
EXAMPLE 3: MRI to Improve the Treatment of Prostate Cancer
Course Practice Gap: Urologists lack knowledge of the PIRADS scoring system on MRI and how to make decisions on prostate biopsy. (PI-RADS is a rating scale for the likelihood that clinically significant prostate cancer (PCa) is present.) Urologists need to know when fusion biopsy should be added to random, cognitive biopsy in addition to understanding the role of MRI guided prostate biopsy and the detection of clinically significant cancer. Learners will become familiar and educated on the latest and novel techniques for cancer detection and will be able to stratify patients who are candidates for fusion prostate biopsy.
The physician competencies addressed in this course are to improve including patient care, medical knowledge and practice-based learning and improvement.
Current Learning Objectives
- Distinguish the prostate cancer screening methods.
- Distinguish the role of MRI to diagnose prostate cancer.
- Distinguish the role of MRI to treat prostate cancer.
Revised Learning Objectives Using Tact
At the end of this program, the learner should be able to:
- Apply the PIRADS cancer scoring system to select the best screening method for the patient, based on the likelihood of clinically significant prostate cancer.
- Select from among novel techniques for cancer detection including fusion biopsy, random cognitive biopsy, and guided prostate MRI biopsy when PIRADS scoring indicates the likelihood of significant prostate cancer.
- Treat patients using MRI as the standard of care for early-stage prostate cancer using fusion guided technology.
SACME CE Educational Toolkit http://www.accme.org/ceeducatorstoolkit
Accreditation Council for Continuing Medical Education. 2022. CE Educator’s Toolkit: Evidence-based design and implementation strategies for effective continuing education. http://www.accme.org/ceeducatorstoolkit
Helen Mawdsley, EdD is Director of Research, Office of Continuing Competency and Assessment , Assistant Professor, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Canada.
Eleftherios K. Soleas, PhD is Director of Continuing Professional Development & Educational Scholarship, Faculty of Health Sciences, Queen’s University and Adjunct Professor, Faculty of Education, Queen’s University, Kingston, Ontario.