Is There a Place for Knowledge Change Today?

A major change in continuing medical education (CME) over the past five years is the shift from knowledge-based learning to competence-based learning. This move was fueled in part by a decision from the Accreditation Council for Continuing Medical Education (ACCME) to require educational activities to include competence, performance, and patient outcomes objectives. While this move has been extremely positive—activities focused on changing competencies have been repeatedly shown to improve physician performance and patient outcome—it is important that the role of knowledge improvement in educational activities not be forgotten.

Competence is knowledge put into action, but not all knowledge is ready for action. When a physician learns about a newly approved treatment or a strategy for improving a patient’s quality of life, it is important that they are able to apply this knowledge to patient care. However, not all information will have an immediate impact on patient care. Results from a phase I clinical trial are rarely clinically applicable, and the goal in learning about these results is not to cause an immediate change in clinical practice. Instead, physicians learn about early phase clinical trials to familiarize themselves with the evolving treatment landscape and to be aware of potential future advances. A physician who learns about the results seen with a novel agent in a phase I trial will be more likely to enroll a patient in a beneficial phase II or III trial, and will have an increased comfort level with the agent if it becomes clinically available. Likewise, learning about the mechanism of action of a newly developed treatment or advances in understanding of disease pathogenesis is not something that can be measured in terms of competence, but this knowledge allows the physician to have a deeper understanding of their patient’s condition and potential treatment options.

The shift from knowledge to competence in CME is a rational goal, as knowing about a new treatment is of little use if the physician cannot apply that knowledge to patient care. However, complete elimination of knowledge as an educational objective may cause important topics and concepts to be left aside, ultimately to the detriment of the learner. A careful balance of education focused on knowledge, competence, and patient outcomes is the best strategy to ensure a well-educated physician able to provide the best possible patient care.