Unanticipated learning outcomes associated with commitment to change in continuing medical education

Educator-derived, predetermined instructional objectives are integral to the traditional instructional model and form the linkage between instructional design and postinstruction evaluation. The traditional model does not consider unanticipated learning outcomes. We explored the contribution of learner-identified desired outcomes compared with learner outcomes that were not named in the instructional design.

This study was conducted at a short course in pediatrics in which 43 physicians, advanced practice nurses, nurses, and physician assistants voluntarily self-identified committed- to changes (CTCs). We compared these CTC predicates with the predetermined instructional objectives that had been published in advance in the conference brochure and syllabus. CTCs whose predicates described the same features as the instructional objectives were considered to be anticipated learning outcomes. CTCs lacking correspondence with instructional objectives were considered to represent unanticipated learning outcomes.

Of the 157 CTCs, 68% were anticipated learning outcomes because their predicates could be linked to the instructional objectives. The remaining 32% of CTCs did not correspond to any of the instructional objectives and thus represented unanticipated learning outcomes.

These findings demonstrate that evaluations based on instructional objectives, although valuable, are incomplete because educational activities may also stimulate many unanticipated learning outcomes. Continuing medical education planners can gain a fuller assessment of the effect of their educational endeavors by including predetermined instructional objectives and encouraging the constructivist practice of recognizing unanticipated learning.