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ACCME Criteria Review: Criterion 2—Educational Needs

Whether you are an accredited provider such as i3 Health or you are an educational partner working with an accredited provider, it's still important to understand the criteria that underly CME activities. This is part of a periodic series of posts looking at what each criterion means in general and what it might mean for you.

In the last post in this series, we started at the beginning with Criterion 1, so it's logical to now move on to Criterion 2 (C2), and that is exactly what we'll do. C2 states:

The provider incorporates into CME activities the educational needs (knowledge, competence, or performance) that underlie the professional practice gaps of their own learners. (ACCME, 2019)

C2 is about activity design. I've already written a little bit about this criterion, with a focus on the relationship between the two parts and the mistakes I commonly see. You can find a post on best practices related to C2 here; however, I didn't go into very much detail on educational needs in that post.

We focus on three levels of educational needs. They build on each other in a very logical manner.

First, we have knowledge. That one is pretty easy to understand. What do people already know? What don't they know? That's knowledge.

Second, we have competence. This one is a little bit trickier to understand directly from the word. And that's why you don't always see it called competence. For the purposes of C2, competence means knowing how to apply knowledge. That's awkward, isn't it? That's why some providers choose not to call it competence. Another way to think of it is as the skills and/or strategies needed to apply what you know to your practice. Learners may already know a new treatment or screening tool exists, but do they know when to prescribe or order it? That's competence. Knowing how to use what you know.

Third, we have performance. That's when you know what you know, you know how to use what you know, and then you do it. This reminds me a little bit of the messaging surrounding elections. Making a plan to vote is great, but voting is only effective if you follow through on your plan. The follow-through is performance.

You can see how they build on each other in the above image.

The first part of C2 is about these educational needs. The second part is about their relationship with practice gaps, which you can read in detail here.

Practice gaps are the difference between what should be happening and what is happening. Educational needs drill down into why those gaps exist, and they help identify what needs to be taught. Using my example above, if there is a new screening test, learners may not even know it exists. The first thing that needs to happen is that they need to be taught what it is. They need knowledge. But it's one thing to know the test exists, and it's another thing to know when to use it. That's competence (or skills and/or strategies). But just because learners know when they should use the test, that doesn't mean they actually are ordering it. That's performance. One activity could address all three of these educational needs, or it could address just one.

This is where your needs assessment comes into play. What are the specific needs of your learners? Are they performance needs? Then don't spend a lot of time on knowledge and competence. By focusing on the specific educational needs of your learners, you can create content that is relevant to them and their practice.

Our ultimate goal in healthcare CPD is to improve patient outcomes, but to do that, we need to focus on all of the small pieces that build up to improved outcomes. A focus on our learners' educational needs is where we start finding those small building blocks.


ACCME (2019). Criterion 2. Available at: 

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