Medical Education
Refer to: Pennington FC: Planning continuing medical education activities (Medical Education). West J Med 128:558-562, Jun 1978
Planning Continuing Medical Education Activities FLOYD C. PENNINGTON, PhD, Ann Arbor, Michigan
A review of program development literature in adult education and continuing medical education (CME) indicates the pervasive influence of a single approach to designing instructional activities. An examination of the assumptions of this model indicates several weaknesses. An alternative model is proposed that recognizes the importance and impact of the planners' interaction with representatives of the learner group, institutional colleagues and persons in outside agencies. Results of previous research, experience in planning, observations of the planning processes of others and discussions with expert continuing medical educators show that planning is a dynamic process of suggesting and selecting from many alternatives those instructional activities with the greatest potential for effecting the desired changes in learners. Through a series of deliberations, needs are specified, instructional activities are designed, goals and objectives are stated, and evaluation techniques are selected. CME planners direct the process and constantly focus on the immediate impact on the learners and ultimately on the learners' practice behavior. PLANNING EFFECTIVE continuing medical education programs is an art and a science. Current emphasis focuses to a great extent on the sciencereliable needs assessments, objectives stated behaviorally and outcomes measured by changes in performance. Focusing singly on the science of program development fails to recognize the importance of the human interactions essential to developing learner focused instructional activities. There is no beginning or ending point to planning continuing medical education instructional activities just as there are no temporal boundaries to an individual's learning behaviors. This article blends the art and science of planning into a dynamic program development model focusing on the planner and that planner's concern for the individual physician as a learner. Dr. Pennington is Director, Office of Continuing Education, The University of Michigan Medical Center, Ann Arbor. Reprint requests to: Floyd Pennington, PhD, Director, Office of Continuing Education, The Towsley Center for Continuing Medical Education, The University of Michigan Medical Center, Ann Arbor, MI 48104.
558
JUNE 1978 * 128 * 6
The Planning Process There are no shortcuts to planning effective continuing medical education instructional activities. Planners, however, are not without adequate knowledge resources to use in understanding the program development process. Conceptual tools to guide the process are available in the continuing education literature as well as a few articles in the literature of continuing medical education. While this information suggests a variety of operational strategies it does not adequately describe the hard work of taking vague and esoteric ideas about what ought to make up continuing medical education instructional activities and translating them, through human interactions, into specific learning activities that can effect changes to improve patient care. The process of planning continuing medical education instructional programs is similar to general processes by which effective programs
PLANNING CME ACTIVITIES
for adults in any setting are developed, and to what elementary and secondary education refer to as curriculum development. For many years successful curriculum development models have been based on the thinking of a generation of theorists from Franklin Bobbitt to Ralph Tyler. The logical operations of this classical model are determining objectives, stating them in appropriate form, devising learning experiences to attain given outcomes and evaluating those experiences. Program development models presented in adult and continuing education literature illustrate the influence of the logical operations of the classical model on the field of continuing education.1-3 With the addition of a few operations which describe, assess and involve the client in the planning process these models are basically classical curriculum development statements.
The Classical Planning Model Two planning models presented in the continuing medical education literature are based on the classical model. The bi-cycle process4 approaches planning as a problem-solving strategy and includes the basic steps in the classical model. Hutchison's; statement on program development combines several credos of adult education with the operations of the classical model to describe a way to plan effective programs for health professionals. Accreditation systems currently employed by a variety of organizations in Medicine include requirements to adhere to most of the operations in the classical curriculum development model. With these resources planners of continuing medical education activities could acquire information about effective planning strategies. Most planners of continuing medical education programs say that they plan by the "seat of their pants" using no systematic approach." Several reasons for not using available knowledge resources could be suggested, including lack of time, interest or knowledge of resources. Another reason is the inherent problems in the classical model itself and the application of that model to planning in continuing medical education.7'8 The classical model assumes that it is possible to predict accurately what the outcomes of an instructional activity will be-behavioral change. In the real world, however, the outcomes of instruction are far too complex and dynamic for
behavioral objectives to specify. For many continuing medical education activities the assessment of behavioral outcomes from a single program is inappropriate since the learning that occurs as a result of the instruction is but one input into many information seeking behaviors of the learners. It is the composite of the many experiences that effect behavioral change. In some content areas of continuing medical education it is possible to be precise in specification of outcomes. In others it is not possible or desirable since a consensus in the profession does not exist and could possibly stifle progressive thinking that might lead to innovation and discovery. A second problem with the behavioral orientation of the classical approach is the assumption that achievement of objectives can be used as the standard for judging program success or failure based on the accumulation of objective evidence. This emphasis fails to distinguish between the application of a standard and making judgments. The application of a standard requires agreement on the defined quantity by which other qualities can be compared. Not all outcomes in continuing medical education programs are amenable to measurement. Even if measurable standards were available the patience and resources of most continuing education providers to measure long-term, readily observable and measurable behavioral change does not exist. Finally, there is a real danger that planners and instructional faculty do not completely understand the objectives, especially their broad implications in the clinical setting, even when they were instrumental in preparing them. In the classical model objectives are stated very early in the planning process and often overlooked until the evaluation. Too early a statement of objectives obscures other potentially significant learning outcomes that do not become apparent until later because they are seldom anticipated. The logical flow of activities in the classical model seems a reasonable approach to program development. The procedure of first identifying objectives and then designing instruction is defensible; however, it is not necessarily the most psychologically efficient way to proceed for the planner or the learner the program is designed for.
The Naturalistic Planning Model Walker9 proposes a framework that provides an alternative to the classical model which recognizes the planning process as one of human interTHE WESTERN JOURNAL OF MEDICINE
559
PLANNING CME ACTIVITIES
action. This naturalistic model consists of three elements: platform, deliberation and design. Each element describes a set of constructs that, in practice, have an impact on planning continuing medical education activities.
The Platform for Program Development The platform is the belief and value system that the planner brings to and uses to guide the program development process. This includes the planner's idea of what health care is and what it ought to be, including his attitudes about continuing education, the learner, and the relationship of both to the improvement of patient care.
Deliberation in Program Planning Deliberation is that process through which competing ideas for instructional activities are considered, priorities are selected and consequences are projected before decisions are made about what will be included in the program. Deliberation is a natural occurrence in program planning that generates alternative solutions, weighs pros and cons, and considers costs and consequences. It results in choosing not the right alternative, for there is no such thing, but the most appropriate one that will result, it is hoped, in an instructional activity providing the participants with a learning experience that they can use to improve their practice. Program Design A program's design is the learning activities and the materials-in-use that have been selected to influence the learners' behavior. The focus of all planning for continuing medical education should be on what the program can be expected to do to facilitate positive changes in the learner's knowledge, skills or sensitivities which can be used to improve that person's patient care activities. Planning continuing medical education programs using the "operations" of the "naturalistic model" includes four basic functions. First the identification of potential program goals. Goals of some magnitude exist for programs even if systematic planning is not carried out. The planning process enables the planner to select particular goals, from a universe of goals, that seem to be appropriate for the program. The second function defines alternative means for reaching potential goals. Systematic planning necessitates that planners have an array of al560
JUNE 1978 * 128 * 6
ternatives to select from in designing effective continuing medical education instructional activities. Too often those of us who plan these programs make decisions based on a very limited knowledge of alternative ways to achieve the same desirable outcomes. Planners also define the possible consequences of each competing alternative. Common practice is to choose a single activity, implement it and analyze the consequence of that choice without considering other viable options. In continuing medical education we can no longer enjoy the luxury of this procedure. In terms of cost alone (not merely dollars and cents), planners need to be as fully apprised as possible of the probable consequences of programs and activities before
acting. Finally, planners must determine the allocation of resources. As alternatives are considered and deliberation occurs, the resources required to implement each alternative must be considered. Planning, therefore, can and should lead to a more efficient and effective allocation of resources. Systematic planning minimizes' haphazard and episodic allocation of resources (funds and personnel) to activities with no real potential for improving professional competence and patient care. This approach to planning accepts the fact that varying viewpoints about what should be achieved as a result of continuing medical education will emerge. It focuses on the learner and what instructional activities, among many, might reasonably be expected to effect changes in patient care. Objectives become the end product of planning rather than the beginning. The selection of the right instructional activity is not required, rather the selection of an appropriate activity from among many results in the program. In the real world of planning continuing medical education these activities are typical. The statement and measurement of behavioral objectives as the beginning and end point of programs is the exception.
A Program Development Model Most planners of continuing medical education instructional activities recognize that the operations of the classical model must be completed and that the human interactions of the naturalistic model cannot be avoided. Figure 1 depicts a program development model that grows out of data from previous research,'" conversations with con-
PLANNING CME ACTIVITIES
* data from national, state or local sources describing some aspect of patient care or health behavior.
Figure 1.-Program development model. See text for explanation.
tinuing medical education planners, selected literature and experience as a planner of instructional activities for the continuing education of health professionals. Figure 1 shows the two major dimensions of planning continuing medical education activitiesthe operations of the classical planning model and the interactions with the resource systems required to complete the planning. The lower part of the model portrays planning functions critical to any planning process. The upper part of the model portrays the major resource systems a planner can recruit and engage in deliberation to plan, implement and evaluate any continuing medical education activity. Program Origin The Program Origin includes the variety of sources planners trust as dependable data upon which further planning can be based. These sources typically include the following: * data from formal needs assessments (audits, peer review and the like); * requests from current or potential clients; * guidelines for current or potential research; * legislative mandates; * suggestions from academic physicians, and
Specific Program Idea The cluster labeled Specific Program Idea represents those deliberations planners engage in to narrow the boundaries of the original idea, consider appropriate alternatives, and test how marketable the program is and predict its impact before resources are allocated to the activity. Included are several activities used to specify program ideas: * testing the idea and alternative approaches with potential clients to explore the extent of interest in the clinical practice setting; * testing the idea with faculty colleagues or a planning committee to ascertain interest and other sources of information; * reviewing relevant literature; * ascertaining if the program fits organizational and institutional purposes, and * projecting impacts of reasonable alternatives. Through a series of successive approximations, a Commitment to the Program will be made. When that decision is made, a number of activities may occur rather quickly: * deciding whether to use internal or external resources for instruction; * conducting a thorough analysis of the potential client group (who do we think will or should attend), and * initiating program logistics, such as publicity, arrangements for facilities and contracting for food, printing, mailing and the like. In the midst of the previous activities, the Course Development process has been underway. This includes the following: * enlisting learners' representatives to assist in
planning; * assessing the precise educational need; * selecting and stating priority objectives from competing alternatives; * designing the teaching and learning transactions to effect the desired learning outcomes; * selecting-appropriate instructional formats; * choosing or preparing effective materials, and * selecting and enlisting teaching faculty. THE WESTERN JOURNAL OF MEDICINE
561
PLANNING CME ACTIVITIES
The Teaching-Learning Transaction is the result of all planning and preparation. This is the program but planning is still not complete. In the midst of this planned encounter flexibility must be maintained that will permit mid-course adjustments that make the program most responsive to the learners' educational needs. The planning is complete when the last participant leaves the hall. Much evaluation is conducted as a postprogram analysis and requires planning the following: * a determination of methods for judging the success of intended program outcomes; * development of evaluation instruments; * determination of what to evaluate including appropriateness of objectives, effectiveness of planning and instruction, and outcomes; * determination of who will use the evaluation data, and * conducting, summarizing, and report results. Learner System The Learner System incorporates professionals who might be recruited to participate in the learning activity. A credo in adult education encourages the involvement of representatives of the client system in the entire planning and evaluation process. '2
Internal Resource System The Internal Resource System is composed of the resources available in the sponsoring organization. These include faculty, facilities, instructional media, instructional materials, support staff and other essential human and physical resources. External System The External System includes the unlimited resources available to the planner outside the sponsoring organization. Resources can be sought from medical centers, universities, government, professional societies, employers, the public, private enterprise and many others. Every planner knows the available resource systems and how these resources can contribute to their planning efforts. Each role perspective will have unique expectations and requirements. Planners must project how these expectations will affect the alternative plans under consideration. In many instances no outside resources will be deemed appropriate, consequently leaving total program control to the sponsor. 562
JUNE 1978 * 128 * 6
Summary There are no shortcuts to planning effective continuing medical education instructional activities. No recipe can be conjured that will consistently produce a fail-safe program in every setting. There are resources to use and planning tasks that must be completed for every program development effort. The planner must be flexible and innovative in linking the resources to the problem, creating alternatives and projecting potential outcomes. This is the action of program development. The learner and the teaching-learning transaction are the focal point for all planning efforts. Continuing medical education programs will be judged on how well the learner applies what is taught, not on how well objectives were stated, how brilliant the design was or how outstanding the lecturer was. To this end the program development process must not only include the operations of the classical model but must also include a dynamic that focuses on how the programming efforts can contribute to facilitating within the learner self-evaluating and self-correcting behaviors. The model presented in this paper is descriptive, not prescriptive. There is no place for universal prescriptions in planning continuing medical education activities. Each planner must carefully determine the sequence of resource acquisition and performance of planning tasks, recognizing that his programs accountability is a reciprocal of the excellence exercised in program development. REFERENCES 1. Houle C: The Design of Education. San Francisco, Jossey Bass Inc., Publishers, 1972 2. Knowles M: The Modern Practice of Adult Education. New York, Association Press, 1970 3. Knox AB: Designing Effective Programs of Continuing Professional Education. Teachers College, Columbia University, unpublished manuscript, 1967 4. Brown C, Uhl H: Mandatory continuing education: Sense or nonsense? JAMA 213:1660-1669, Sep 1970 5. Hutchison DJ: The process of planning programs of continuing education for health manpower, In Charters H, Blakely RJ (Eds): Fostering the Growing Need to Learn. Syracuse University Contract No. HSM 110-71-147, Regional Medical Programs Service, US Dept of Health, Education and Welfare, The Public Health Service, 1973, pp 133-176 6. Pennington FC, Green J: Comparative analysis of program development processes in six professions. Adult Education 27: 13-23, Fall 1976 7. Atkin JM: Some evaluation problems in a course content improvement project. J Res Science Teaching 1:129-132, 1963 8. Eisner E: Educational objectives: Help or hindrance? School Review 75:250-260, 1967 9. Walker D: Naturalistic model for curriculum development. School Review 80:51.65, Nov 1971 10. Pennington FC: Program Development in Continuing Professional Education: A Comparative Analysis of Process in Medicine, Social Work and Teaching, unpublished doctoral dissertation. University of Illinois at Urbana-Champaign, 1976
Refer to: Pennington FC: Planning continuing medical education activities (Medical Education). West J Med 128:558-562, Jun 1978
Planning Continuing Medical Education Activities FLOYD C. PENNINGTON, PhD, Ann Arbor, Michigan
A review of program development literature in adult education and continuing medical education (CME) indicates the pervasive influence of a single approach to designing instructional activities. An examination of the assumptions of this model indicates several weaknesses. An alternative model is proposed that recognizes the importance and impact of the planners' interaction with representatives of the learner group, institutional colleagues and persons in outside agencies. Results of previous research, experience in planning, observations of the planning processes of others and discussions with expert continuing medical educators show that planning is a dynamic process of suggesting and selecting from many alternatives those instructional activities with the greatest potential for effecting the desired changes in learners. Through a series of deliberations, needs are specified, instructional activities are designed, goals and objectives are stated, and evaluation techniques are selected. CME planners direct the process and constantly focus on the immediate impact on the learners and ultimately on the learners' practice behavior. PLANNING EFFECTIVE continuing medical education programs is an art and a science. Current emphasis focuses to a great extent on the sciencereliable needs assessments, objectives stated behaviorally and outcomes measured by changes in performance. Focusing singly on the science of program development fails to recognize the importance of the human interactions essential to developing learner focused instructional activities. There is no beginning or ending point to planning continuing medical education instructional activities just as there are no temporal boundaries to an individual's learning behaviors. This article blends the art and science of planning into a dynamic program development model focusing on the planner and that planner's concern for the individual physician as a learner. Dr. Pennington is Director, Office of Continuing Education, The University of Michigan Medical Center, Ann Arbor. Reprint requests to: Floyd Pennington, PhD, Director, Office of Continuing Education, The Towsley Center for Continuing Medical Education, The University of Michigan Medical Center, Ann Arbor, MI 48104.
558
JUNE 1978 * 128 * 6
The Planning Process There are no shortcuts to planning effective continuing medical education instructional activities. Planners, however, are not without adequate knowledge resources to use in understanding the program development process. Conceptual tools to guide the process are available in the continuing education literature as well as a few articles in the literature of continuing medical education. While this information suggests a variety of operational strategies it does not adequately describe the hard work of taking vague and esoteric ideas about what ought to make up continuing medical education instructional activities and translating them, through human interactions, into specific learning activities that can effect changes to improve patient care. The process of planning continuing medical education instructional programs is similar to general processes by which effective programs
PLANNING CME ACTIVITIES
for adults in any setting are developed, and to what elementary and secondary education refer to as curriculum development. For many years successful curriculum development models have been based on the thinking of a generation of theorists from Franklin Bobbitt to Ralph Tyler. The logical operations of this classical model are determining objectives, stating them in appropriate form, devising learning experiences to attain given outcomes and evaluating those experiences. Program development models presented in adult and continuing education literature illustrate the influence of the logical operations of the classical model on the field of continuing education.1-3 With the addition of a few operations which describe, assess and involve the client in the planning process these models are basically classical curriculum development statements.
The Classical Planning Model Two planning models presented in the continuing medical education literature are based on the classical model. The bi-cycle process4 approaches planning as a problem-solving strategy and includes the basic steps in the classical model. Hutchison's; statement on program development combines several credos of adult education with the operations of the classical model to describe a way to plan effective programs for health professionals. Accreditation systems currently employed by a variety of organizations in Medicine include requirements to adhere to most of the operations in the classical curriculum development model. With these resources planners of continuing medical education activities could acquire information about effective planning strategies. Most planners of continuing medical education programs say that they plan by the "seat of their pants" using no systematic approach." Several reasons for not using available knowledge resources could be suggested, including lack of time, interest or knowledge of resources. Another reason is the inherent problems in the classical model itself and the application of that model to planning in continuing medical education.7'8 The classical model assumes that it is possible to predict accurately what the outcomes of an instructional activity will be-behavioral change. In the real world, however, the outcomes of instruction are far too complex and dynamic for
behavioral objectives to specify. For many continuing medical education activities the assessment of behavioral outcomes from a single program is inappropriate since the learning that occurs as a result of the instruction is but one input into many information seeking behaviors of the learners. It is the composite of the many experiences that effect behavioral change. In some content areas of continuing medical education it is possible to be precise in specification of outcomes. In others it is not possible or desirable since a consensus in the profession does not exist and could possibly stifle progressive thinking that might lead to innovation and discovery. A second problem with the behavioral orientation of the classical approach is the assumption that achievement of objectives can be used as the standard for judging program success or failure based on the accumulation of objective evidence. This emphasis fails to distinguish between the application of a standard and making judgments. The application of a standard requires agreement on the defined quantity by which other qualities can be compared. Not all outcomes in continuing medical education programs are amenable to measurement. Even if measurable standards were available the patience and resources of most continuing education providers to measure long-term, readily observable and measurable behavioral change does not exist. Finally, there is a real danger that planners and instructional faculty do not completely understand the objectives, especially their broad implications in the clinical setting, even when they were instrumental in preparing them. In the classical model objectives are stated very early in the planning process and often overlooked until the evaluation. Too early a statement of objectives obscures other potentially significant learning outcomes that do not become apparent until later because they are seldom anticipated. The logical flow of activities in the classical model seems a reasonable approach to program development. The procedure of first identifying objectives and then designing instruction is defensible; however, it is not necessarily the most psychologically efficient way to proceed for the planner or the learner the program is designed for.
The Naturalistic Planning Model Walker9 proposes a framework that provides an alternative to the classical model which recognizes the planning process as one of human interTHE WESTERN JOURNAL OF MEDICINE
559
PLANNING CME ACTIVITIES
action. This naturalistic model consists of three elements: platform, deliberation and design. Each element describes a set of constructs that, in practice, have an impact on planning continuing medical education activities.
The Platform for Program Development The platform is the belief and value system that the planner brings to and uses to guide the program development process. This includes the planner's idea of what health care is and what it ought to be, including his attitudes about continuing education, the learner, and the relationship of both to the improvement of patient care.
Deliberation in Program Planning Deliberation is that process through which competing ideas for instructional activities are considered, priorities are selected and consequences are projected before decisions are made about what will be included in the program. Deliberation is a natural occurrence in program planning that generates alternative solutions, weighs pros and cons, and considers costs and consequences. It results in choosing not the right alternative, for there is no such thing, but the most appropriate one that will result, it is hoped, in an instructional activity providing the participants with a learning experience that they can use to improve their practice. Program Design A program's design is the learning activities and the materials-in-use that have been selected to influence the learners' behavior. The focus of all planning for continuing medical education should be on what the program can be expected to do to facilitate positive changes in the learner's knowledge, skills or sensitivities which can be used to improve that person's patient care activities. Planning continuing medical education programs using the "operations" of the "naturalistic model" includes four basic functions. First the identification of potential program goals. Goals of some magnitude exist for programs even if systematic planning is not carried out. The planning process enables the planner to select particular goals, from a universe of goals, that seem to be appropriate for the program. The second function defines alternative means for reaching potential goals. Systematic planning necessitates that planners have an array of al560
JUNE 1978 * 128 * 6
ternatives to select from in designing effective continuing medical education instructional activities. Too often those of us who plan these programs make decisions based on a very limited knowledge of alternative ways to achieve the same desirable outcomes. Planners also define the possible consequences of each competing alternative. Common practice is to choose a single activity, implement it and analyze the consequence of that choice without considering other viable options. In continuing medical education we can no longer enjoy the luxury of this procedure. In terms of cost alone (not merely dollars and cents), planners need to be as fully apprised as possible of the probable consequences of programs and activities before
acting. Finally, planners must determine the allocation of resources. As alternatives are considered and deliberation occurs, the resources required to implement each alternative must be considered. Planning, therefore, can and should lead to a more efficient and effective allocation of resources. Systematic planning minimizes' haphazard and episodic allocation of resources (funds and personnel) to activities with no real potential for improving professional competence and patient care. This approach to planning accepts the fact that varying viewpoints about what should be achieved as a result of continuing medical education will emerge. It focuses on the learner and what instructional activities, among many, might reasonably be expected to effect changes in patient care. Objectives become the end product of planning rather than the beginning. The selection of the right instructional activity is not required, rather the selection of an appropriate activity from among many results in the program. In the real world of planning continuing medical education these activities are typical. The statement and measurement of behavioral objectives as the beginning and end point of programs is the exception.
A Program Development Model Most planners of continuing medical education instructional activities recognize that the operations of the classical model must be completed and that the human interactions of the naturalistic model cannot be avoided. Figure 1 depicts a program development model that grows out of data from previous research,'" conversations with con-
PLANNING CME ACTIVITIES
* data from national, state or local sources describing some aspect of patient care or health behavior.
Figure 1.-Program development model. See text for explanation.
tinuing medical education planners, selected literature and experience as a planner of instructional activities for the continuing education of health professionals. Figure 1 shows the two major dimensions of planning continuing medical education activitiesthe operations of the classical planning model and the interactions with the resource systems required to complete the planning. The lower part of the model portrays planning functions critical to any planning process. The upper part of the model portrays the major resource systems a planner can recruit and engage in deliberation to plan, implement and evaluate any continuing medical education activity. Program Origin The Program Origin includes the variety of sources planners trust as dependable data upon which further planning can be based. These sources typically include the following: * data from formal needs assessments (audits, peer review and the like); * requests from current or potential clients; * guidelines for current or potential research; * legislative mandates; * suggestions from academic physicians, and
Specific Program Idea The cluster labeled Specific Program Idea represents those deliberations planners engage in to narrow the boundaries of the original idea, consider appropriate alternatives, and test how marketable the program is and predict its impact before resources are allocated to the activity. Included are several activities used to specify program ideas: * testing the idea and alternative approaches with potential clients to explore the extent of interest in the clinical practice setting; * testing the idea with faculty colleagues or a planning committee to ascertain interest and other sources of information; * reviewing relevant literature; * ascertaining if the program fits organizational and institutional purposes, and * projecting impacts of reasonable alternatives. Through a series of successive approximations, a Commitment to the Program will be made. When that decision is made, a number of activities may occur rather quickly: * deciding whether to use internal or external resources for instruction; * conducting a thorough analysis of the potential client group (who do we think will or should attend), and * initiating program logistics, such as publicity, arrangements for facilities and contracting for food, printing, mailing and the like. In the midst of the previous activities, the Course Development process has been underway. This includes the following: * enlisting learners' representatives to assist in
planning; * assessing the precise educational need; * selecting and stating priority objectives from competing alternatives; * designing the teaching and learning transactions to effect the desired learning outcomes; * selecting-appropriate instructional formats; * choosing or preparing effective materials, and * selecting and enlisting teaching faculty. THE WESTERN JOURNAL OF MEDICINE
561
PLANNING CME ACTIVITIES
The Teaching-Learning Transaction is the result of all planning and preparation. This is the program but planning is still not complete. In the midst of this planned encounter flexibility must be maintained that will permit mid-course adjustments that make the program most responsive to the learners' educational needs. The planning is complete when the last participant leaves the hall. Much evaluation is conducted as a postprogram analysis and requires planning the following: * a determination of methods for judging the success of intended program outcomes; * development of evaluation instruments; * determination of what to evaluate including appropriateness of objectives, effectiveness of planning and instruction, and outcomes; * determination of who will use the evaluation data, and * conducting, summarizing, and report results. Learner System The Learner System incorporates professionals who might be recruited to participate in the learning activity. A credo in adult education encourages the involvement of representatives of the client system in the entire planning and evaluation process. '2
Internal Resource System The Internal Resource System is composed of the resources available in the sponsoring organization. These include faculty, facilities, instructional media, instructional materials, support staff and other essential human and physical resources. External System The External System includes the unlimited resources available to the planner outside the sponsoring organization. Resources can be sought from medical centers, universities, government, professional societies, employers, the public, private enterprise and many others. Every planner knows the available resource systems and how these resources can contribute to their planning efforts. Each role perspective will have unique expectations and requirements. Planners must project how these expectations will affect the alternative plans under consideration. In many instances no outside resources will be deemed appropriate, consequently leaving total program control to the sponsor. 562
JUNE 1978 * 128 * 6
Summary There are no shortcuts to planning effective continuing medical education instructional activities. No recipe can be conjured that will consistently produce a fail-safe program in every setting. There are resources to use and planning tasks that must be completed for every program development effort. The planner must be flexible and innovative in linking the resources to the problem, creating alternatives and projecting potential outcomes. This is the action of program development. The learner and the teaching-learning transaction are the focal point for all planning efforts. Continuing medical education programs will be judged on how well the learner applies what is taught, not on how well objectives were stated, how brilliant the design was or how outstanding the lecturer was. To this end the program development process must not only include the operations of the classical model but must also include a dynamic that focuses on how the programming efforts can contribute to facilitating within the learner self-evaluating and self-correcting behaviors. The model presented in this paper is descriptive, not prescriptive. There is no place for universal prescriptions in planning continuing medical education activities. Each planner must carefully determine the sequence of resource acquisition and performance of planning tasks, recognizing that his programs accountability is a reciprocal of the excellence exercised in program development. REFERENCES 1. Houle C: The Design of Education. San Francisco, Jossey Bass Inc., Publishers, 1972 2. Knowles M: The Modern Practice of Adult Education. New York, Association Press, 1970 3. Knox AB: Designing Effective Programs of Continuing Professional Education. Teachers College, Columbia University, unpublished manuscript, 1967 4. Brown C, Uhl H: Mandatory continuing education: Sense or nonsense? JAMA 213:1660-1669, Sep 1970 5. Hutchison DJ: The process of planning programs of continuing education for health manpower, In Charters H, Blakely RJ (Eds): Fostering the Growing Need to Learn. Syracuse University Contract No. HSM 110-71-147, Regional Medical Programs Service, US Dept of Health, Education and Welfare, The Public Health Service, 1973, pp 133-176 6. Pennington FC, Green J: Comparative analysis of program development processes in six professions. Adult Education 27: 13-23, Fall 1976 7. Atkin JM: Some evaluation problems in a course content improvement project. J Res Science Teaching 1:129-132, 1963 8. Eisner E: Educational objectives: Help or hindrance? School Review 75:250-260, 1967 9. Walker D: Naturalistic model for curriculum development. School Review 80:51.65, Nov 1971 10. Pennington FC: Program Development in Continuing Professional Education: A Comparative Analysis of Process in Medicine, Social Work and Teaching, unpublished doctoral dissertation. University of Illinois at Urbana-Champaign, 1976
