Educational Terms: Knowledge, Competence, Performance, and Patient Outcomes

Published Date

An exploration of the key terms of the ACCME Criteria — knowledge, competence, performance, and patient outcomes — in the context of adult education, with Steve Singer, PhD, ACCME Vice President for Education & Outreach. This video was produced to be used in conjunction with participation in the ACCME's CME as a Bridge to Quality™ Accreditation Workshop.


ACCME’s requirements are intended to support your educational leadership; to help you create high-quality, effective continuing medical education, or CME. But, we can’t take re-sponsibility for these insights, however; this ‘roadmap’ for learning and improvement is based upon the research literature describing how education can best promote adult learning and behavior change. Several ACCME requirements use the terms knowledge, competence, performance and patient outcomes, whether to describe learners’ educa-tional needs of “knowledge, competence, and performance” or the aspirations of your CME mission statement to change “learners’ competence, performance and patient out-comes.” Let’s explore what these terms mean in the context of adult education so that they can be a support to your educational planning.

Adults are pragmatic about learning. They are motivated by questions that arise from what they do each day. Consider an instructor that needs to teach a class on a new subject she’s never taught before. If you were the instructor, you might be thinking, “I’ve never taught this topic before. Where do I start?” For the instructor, the learning journey to teach a new topic begins with seeking new knowledge—facts, data, information that help her to understand the new topic. But knowledge is only part of the journey. Adult learners synthesize new knowledge with what they already know and this judgement helps, over time, to form wisdom; understanding how new information fits with existing knowledge.

At this point in the journey, the learner reaches an important milestone—competence—figuring out how to put the knowledge into action. When the ACCME uses the term compe-tence, we’re talking about this important transition; forming a strategy that turns “what you know” into a plan for “what you’re going to do.” As our learner travels along her learning journey, the strategies she picks up for how she will teach the new topic, that’s gaining competence.

The final leg of the journey is putting strategy, or competence, into practice. Our instructor can learn about the topic and she can create a plan for how she’s going to teach the mate-rial. But, actually teaching the course—doing the instruction—that’s what ACCME means when we use the term “performance.”

Now that we understand knowledge, competence and performance in an adult learning context, where do patient outcomes fit into the learning journey? As you might expect, having an impact on the patient is often the result of more than just a single practitioner’s performance. So, when the ACCME refers to patient outcomes, we’re talking about any of the potential impacts that you—the educator—may want to look at as targets for CME ac-tivities to address for patients. The delivery of safe and effective care,  Patient health sta-tus, Patient satisfaction, or even patient engagement. It’s up to you to define what kinds of patient-related outcomes are important to your CME mission.