CME meets ADDIE, Part 2

In Part 1, I described how ACCME's updated criteria seem to be aligned with ADDIE, an instructional design model with origins in military training. While there are innumerable differences between medicine and the military, they do have one thing in common. People can be killed or injured when training isn't done properly. So there is ample justification for a employing a reliable and well-tested instructional methodology.

ACCME's updated criteria establish higher standards for educational needs, objectives, and evaluation that are consistent with the ADDIE model. Communicating and implementing these higher standards will expand the role of CME managers as instructional design consultants. This will be challenging. Most instructional designers would probably agree that working with subject matter experts (SMEs) is the hardest part of their jobs. SMEs are busy, and don't appreciate intrusions into the way they do things. (Sound familiar?) Furthermore, many CME managers lack instructional design experience that would enhance the depth and credibility of their advice and feedback.

Yet, many attributes of CME managers will help them in their enhanced role as instructional design consultants. While the updated criteria require higher standards for instruction and evaluation (i.e., competence, performance, patient outcomes), they are still a refinement of the educational planning and evaluation elements of the previous ACCME essentials. CME managers are also experienced in providing consulting services for our clients. And, while it would be nice to have a background designing instructional materials, it is not a requirement to be effective in this role. After all, you don't need to be a lawyer to establish and implement a disclosure policy.

The role of CME programs is also evolving. The ADDIE method presupposes that a significant part of the responsibility for learning rests with those that designed the instruction. This brings CME a step closer to the educational programs of medical schools and residency programs, who take very seriously their responsibility for their students' learning. It is also a logical evolution for CME given that the amount of learning required for doctors to keep current is continuously increasing.

The ADDIE method has been criticized for resulting in instructional materials that are dull and uncreative. I think this criticism misses the point. The ADDIE method is about systematically defining what needs to be learned, how content should be sequenced, and whether it was learned. Using this method will not ensure that your instruction is attractive, creative or engaging, but neither will it prevent you from doing so if you have the skills.

The ADDIE method is not, however, without limitations. It was designed for developing instruction for which you can analyze the audience, needs, content, and evaluation criteria in advance. Therefore, this method can only be applied in a general way to educational activities in which you don't know who is going to learn what and when, such as self-directed independent study and informal learning from peer interactions.

Perhaps the most common criticism of the ADDIE method is cost. When I managed e-learning development projects, some clients would say that they want to thoroughly analyze needs, develop objectives, and evaluate the results, but only if it doesn't cost more. I had to respond that this couldn't be done. In some cases we could cut cost by skipping the evaluation phase or conducting a needs analysis based on relatively few sources. However, cutting corners within the ADDIE process shifts responsibility for learning from the instructional provider to learners.

Due to the cost of employing the ADDIE method, it is not surprising that businesses and professional organizations are not using it for developing much of their instructional materials. Multimedia technologies for capturing content and Internet technologies for publishing often make much cheaper to send presentations from subject matter experts directly to learners. For businesses with short product cycles, the incentive skip an instructional design process is even more stark. It doesn't make sense to spend four months developing instructional materials to support a product that will be obsolete in four months.

Overall, the ADDIE method is a system that uses every opportunity to improve instructional efficacy as educational activities are designed, developed, delivered, and evaluated. It will take time, and thus cost money. However, if we don't take responsibility for learning, CME won't be considered a co-equal partner with other medical education enterprises.