The Assessment of Competence

With the advent of ACCME's Updated Criteria, many CME managers will be assessing the competence of their learners. So what is meant by "competence" is important to understand. Competence includes both:
- an ability, knowledge, or skill, and
- the intention, plan, or disposition to use that ability, knowledge, or skill

Therefore, to assess competence, it might seem logical to take a two-step approach:
A) Did you obtain this ability, knowledge, or skill through this CME activity?
B) Do intend to use this new ability, knowledge, or skill in your practice?
For learners who answer "No" to Question B, we can include another assessment item to determine if there are barriers to implementation, thus addressing Criterion 18.

It might be counter-intuitive, but I think it is more efficient to start with Question B. If learners answer affirmatively, we can assume that they have obtained the required ability, skill, or knowledge. If they respond negatively, we can inquire whether the reason was our failure to adequately teach the topic, irrelevance to their practice, or if there is an obstacle to implementation.

A related issue is the conversion of competence-related learning objectives to assessment items. Here is a system based on three types of learning objectives.

1. Behavioral Objectives
Some learning objectives involve observable behaviors. These objectives have the form “students will be able to” operative, diagnose, use new techniques, etc. To convert behavioral learning objectives to evaluation items, replace “students will be able to” with “I plan to.” The format of the evaluation item then becomes, I plan to operate, diagnose, use new techniques, etc., with the learner providing a Yes or No response.

2. Cognitive Abilities
Learning objectives related to cognitive abilities follow the same format as behavioral learning objectives, “Students will be able to…” However, instead of overt behaviors, these objectives describe traits that might not be observable. For example, cognitive abilities might involve being able to summarize, compare, discuss, solve, evaluate, etc.

To convert a cognitive ability learning objective to an evaluation item, replace “students will be able to” with “I plan to use the ability to.” Therefore, evaluation items will have the format, “I plan to use the ability to summarize, discuss, solve, or evaluate…” Again, learners respond to this statement by agreeing or disagreeing.

3. Knowledge Transfer
Finally, some learning objectives involve knowledge transfer that is not associated with a particular ability. An example of this type of objective is, “Students will know that…” We can convert these objectives to evaluation items in the format “I plan to use knowledge about… in my practice.”

Since knowledge is only one component of competence, your objectives for a CME activity should not be restricted to knowledge transfer.