Medical education is a continuum of 3 parts; undergraduate medical school education, postgraduate training, and continuing medical education (CME). CME differs from the other 2 educational components in that it has generally not been based on an explicit curriculum. Recently, CME has increasingly focused on addressing professional practice gaps, defined as the difference between what clinicians are currently doing and what they should or could be doing.
An outcomes framework has been proposed for CME, in the form of a pyramid (Figure) that provides a perspective on how the increased emphasis on addressing professional practice gaps might be accomplished.1 The pyramid is based on 7 levels of outcomes that are associated with the decisions of a clinician to participate in learning, to engage in learning, to use what he or she learned, and, at the summit, the effects of learning on patients and community. CME has traditionally been focused on learning (level 3) and in some cases on competence (level 4), which is similar to the “shows how” level of the pyramid in which a learner demonstrates to a teacher that he or she can do what has been learned.2