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©2023 American Medical Writers Association. All rights reserved.  
ISSN 2163-5315

AMWAJournal.org     47

ABSTRACT 
Medical writers are instrumental in developing accredited 
continuing medical education (CME) for physicians and 
continuing education (CE) for nurses, pharmacists, and 
other health professionals. To ensure that CME/CE content 
meets the learning needs of health professionals, expands 
knowledge, and builds skills, medical writers should be 
knowledgeable about adult learning principles and emerg-
ing insights from the learning sciences. In this article, I 
review these principles and describe a suite of practical 
strategies that medical writers can use to write CME/CE 
materials that optimize learning.

Continuing medical education (CME) for physicians and 
continuing education (CE) for nurses, pharmacists, and 
other health professionals must meet standards for trans-
parency and integrity as outlined by education accrediting 
bodies such as the Accreditation Council for Continuing 
Medical Education.1 Medical writers are instrumental in 
developing accredited CME/CE materials with integrity 
for health professionals by ensuring balanced, valid, and 
unbiased content.2 To ensure that CME/CE content also 
meets the learning needs of health professionals (other-
wise known as learners), expands knowledge, and builds 
skills, medical writers in the field of CME/CE should be 
knowledgeable about adult learning principles (ALPs) and 
emerging insights from the learning sciences. This knowl-
edge is necessary because incorporating ALPs into educa-
tion content is likely to increase the effectiveness of CME/
CE activities and their impact on the behavior of clinicians 
and patient health outcomes.3 The Alliance for Continuing 
Education in the Health Professions, a leading organization 
that promotes best practices in CME/CE, identifies ALPs 
as a core knowledge domain for professionals involved in 
CME/CE content development.

LEARNING FRAMEWORKS AND EDUCATION 
FORMATS
CME/CE activities help health professionals stay current 

with the exponentially expanding biomedical and clini-
cal information required to deliver optimal health care.4 
However, the relentless accretion of this information can 
exceed a person’s cognitive capacity—our brains can only 
absorb a certain amount of information at a time. Clinicians 
compare the experience of staying current with medical sci-
ences and clinical practice updates with “drinking from a 
firehose.”5 At the same time, health care professionals need 
more from CME/CE than just information and facts. They 
also need to learn how to apply that information in clinical 
settings, exercise analytic and diagnostic skills, and com-
municate and coordinate with other members of the health 
care team.
 To better support knowledge and skills application, 
the CME/CE field has embraced a lifelong, continuous, 
competency-based approach to education.6 Additionally, 
Interprofessional Continuing Education (IPCE) has 
emerged as an education framework in which 2 or more 
professions (eg, nursing, medicine, pharmacy) share a 
common learning process to learn with, from, and about 
each other. The goal of IPCE is to foster interprofessional 
communication and teamwork and the effective coordi-
nation of patient care.7 IPCE differs from multidisciplinary 
education, which involves health professionals learning 
separately about patient needs within the context of their 
own professional roles and responsibilities.
 Modes of education delivery and formats have moved 
away from didactic lectures toward more interactive and 
engaging formats that can be delivered online. Many health 
professionals are digital natives and increasingly expect 
to receive much of their CME/CE via online activities and 
digital platforms (eg, e-learning modules, webinars, online 
games, patient simulations). The COVID-19 pandemic 
accelerated this trend toward online learning in accredited 
CME/CE.8 CME/CE now also measures learning outcomes 
via distinct frameworks that are sensitive to knowledge 
uptake, skills acquisition, and changes in clinical practice, 
performance, and patient outcomes.3,9 Moore’s Model of 
Outcomes Assessment is a commonly used learning and 
performance outcome framework in CME/CE.9

Practical Strategies for Creating CME/CE Content: Insights From Adult 
Learning Scholarship
Alexandra Howson, PhD / Write Medicine, Snoqualmie, WA

CE CRAFT CORNER

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ADULT LEARNING PRINCIPLES
Medical writers involved in developing CME/CE materials 
for health care professionals need to be able to incorpo-
rate ALPs into content to optimize learning outcomes. ALPs 
draw on legacy assumptions from twentieth-century edu-
cators and psychologists, including Malcolm Knowles, John 
Dewey, and others. These educators argued that teaching 
adults (andragogy) and adult learning differs from teaching 
children (pedagogy) and childhood learning. As such, adult 
learning requires a distinct education approach.10

 Andragogy posits that adult learners learn best when 
they are self-directed in their approach to learning and 
intrinsically motivated to learn. Intrinsic motivation refers 
to the interest, pleasure, and satisfaction of learning itself.10 
Extrinsic motivation refers to outcomes associated with 
learning (eg, clinical practice demands, improved patient 
care). In addition, adult learners actively seek learning 
when they have specific problems to solve and want to 
immediately apply what they have learned to real-life situa-
tions. Adult learners also bring a rich reservoir of life expe-
rience to the learning process that provides an important 
context for learning and a foundation for reflection. Finally, 
adult learners learn best when they have control over the 
timing, nature, and direction of the learning process.10  
Box 1 summarizes practical applications of ALPs in CME/
CE Writing.

INSIGHTS FROM ADULT LEARNING SCHOLARSHIP
Early twentieth-century adult learning theory focused pri-
marily on differentiating adult learning from learning in 
childhood. A century later, adult learning scholarship now 
embraces cognition, memory, and brain structure and  
function, as well as how sociocultural, professional, and 
organizational contexts and social/emotional factors  
(eg, demographics, technology, stress) shape adult learn-
ing.10 The learning sciences are multidisciplinary and 
draw on scholarship from cognitive psychology, sociology, 
neuroscience, anthropology, behavioral economics, and 
other academic disciplines.12 What follows is a sampling 
of insights and strategies from adult learning scholarship 
that medical writers can use to create CME/CE content that 
enriches adult learning.

Cognitive Learning Theory and Science of Memory 
Insights
What happens in our brains when we are in learning mode? 
Cognitive learning theories focus on the internal dynamics 
of learning and how people process, structure, and retrieve 
information. We absorb information via the senses (ie, sen-
sory memory), which is processed in working (ie, short-term) 
memory and organized into schemas of increasing com-
plexity.13 This processing builds on prior knowledge and is 
affected by cognitive load, which involves intrinsic load (the 
volume of information to be processed) and extrinsic load 
(the work required to process the information). Box 2 high-
lights tactics medical writers can use to manage cognitive 
load for learners and ease processing.
 In learning mode, our brains work hard to encode, orga-
nize, and consolidate perceptions and experiences so we 
can retrieve that material in the right context, for the right 
purpose.13 Short-term and long-term memory work together 
with cues and context so that new information can be inte-
grated with prior knowledge and consolidated or embedded 
more deeply into our internal archives or memory traces. 

Retrieval Practice: Before reading the next section, 
pause for a moment to think about the schemas or 
ideas you have about adult learning. Compare your 
schemas with the following information. What are 
the similarities? What are the differences?

Adult Learning Principles 
1. Adult learners are self-directed. 
2. Learning should be relevant to professional needs or  

social roles.
3. Learning should be problem-oriented and supports the 

immediate application of knowledge.
4. Adult learners appreciate opportunities for feedback  

and reflection.
5. Adult learners prefer control over the timing and direc-

tion of learning.

Practical Applications 
Ensure that content is learner-centric, problem-oriented, rel-
evant to practice, based on educational need, and aligned 
with anticipated outcomes.

1. Consult the needs assessment. Familiarize yourself 
with the knowledge/skill needs and the clinical prac-
tice/performance gaps presented in the needs assess-
ment. A comprehensive needs assessment will help you 
understand the clinical gaps and anticipated outcomes 
that the education is targeting.11

2. Identify your audiences. Who are the learners? What 
are their needs? What experience or background do 
they bring to the educational activity?

3. Review the anticipated outcomes. Identify the problem 
that the content needs to address. What do learners 
need to know or be able to do when they have read the 
material? 

4. Apply SMARTER goals to the content. Keep the con-
tent Specific, Measurable, Action-oriented, Relevant 
to the learner, learning objectives, and anticipated out-
comes, Time-specific, Evaluable, and Realistic.

Box 1. Practical Applications of ALPs in CME/CE Writing

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AMWAJournal.org     49Practical Strategies For Creating CME/CE Content

Forgetting and unlearning are also important in the process 
of learning new information.13

 The multidisciplinary field of learning sciences, as 
described above, offers many empirically tested strate-
gies that yield deep, durable learning.14 An important prin-
ciple that Brown et al argue in Make It Stick: The Science 
of Successful Learning is that interactivity correlates with 
higher learning impact. The more actively learners engage 
with educational content, the more likely they are to retrieve 
and apply information in the appropriate context.13 To this 
end, instructional designers boost interactivity in e-learn-
ing by building effortful and repeated recall, recognition, 
and retrieval tactics into learning activities.15 Similarly, 
microlearning—delivering short bursts of content that are 
media-rich and spaced out over time—is thought to boost 
interactivity and retention by reactivating memory, avoiding 
cognitive fatigue, and more efficiently moving new informa-
tion from short- to long-term memory.16 Box 2 summarizes 
tactics medical writers can use to bolster retention and aug-
ment interactivity.  

Experiential, Emotional, and Social Learning Insights
Competency-based education and IPCE also benefit from 
insights on the experiential, emotional, and social nature of 
learning. In experiential learning, experience is considered 
an important baseline for reflection. Put simply, we encoun-
ter a problem (a concrete learning event); we take stock of 
our options for addressing this problem (we reflect); and we 
actively experiment in designing solutions to the problem 
(sometimes called “knowing-in-action”).17-18 Experiential 
learning often includes activities that involve self-appraising 

current practice, identifying a problem in that practice, and 
problem-based learning as an individual or within in a team.
 Emotional learning is another important consideration 
in adult learning. Working in settings and situations as any 
kind of clinician is often stressful and, at the very least, can 
provoke powerful emotions. Emotions affect how and what 
we learn via physiologic responses to situations and subjec-
tive experience of that response (ie, mood).14 For instance, 
when our mood is positive, we are more likely to absorb, 
retain, and retrieve information (ie, cognitive flexibility). 
We are more likely to see the bigger picture and apply new 
information to practice. Role play is an example of a CME/
CE activity that might be used to explore how emotional 
states can impact both clinical practice and learning.
 Emotional learning is grounded in social cognitive 
theory, which suggests that we learn more effectively when 
we are observing and interacting with others.19 Social learn-
ing occurs when we belong to a community of learners or a 
community of practice. Communities of practice are often 
self-organized and emphasize participation and collabora-
tion as the key drivers of learning. Examples of CME/CE that 
optimize communities of practice include journal clubs and 
discussions via social media groups.
 In competency-based education for health profession-
als, learners also need to be able to develop expertise and 
progress from novice to mastery levels of competence. The 
trajectory toward mastery requires deliberate practice, a key 
ingredient in information processing and skills acquisition 
that involves effort, repetition, and feedback.20 Deliberate 
practice is a common characteristic of virtual simulations or 
case- and vignette-based activities. Cases and vignettes are 
designed to mirror real-world challenges in health care and 
enable learners to practice reasoning, communication, and 
procedural skills. In online environments, patient cases are 
often highly interactive and are accompanied by feedback 
that offers insight into the consequences of learner choices, 
guides the learner toward an end goal, and allows room for 
failure and course corrections.20-21 Examples of written feed-
back include expert or virtual patient commentary or notes 
about clinical outcomes that occurred because of decisions 
the learner made in the activity. Box 3 highlights tactics 
medical writers can use to incorporate experiential, emo-
tional, and social learning insights into the development of 
CME/CE activities.

CONCLUSION
CME/CE continues to grow as a field and as a market for 
medical writers. Market forecasts project a 5.9% growth 
($2,715.22 million to $3,830.46 million) between 2022 and 
2027.22 Health professionals are required to earn CME/CE 
credits as part of maintaining their professional licenses 

• Stay on track. Ensure that written content addresses the 
learning objectives.

• Edit ruthlessly. Reduce distractions and eliminate extrane-
ous information.

• Be bold. Highlight essential points for the learner.
• Build iteratively. Sequence the presentation of ideas from 

simple to more complex.
• Parse it out. Chunk complex ideas into bite-sized portions 

of text.
• Pair image with text. Embed images, graphics, audio, or 

video clips to text where appropriate.
• Offer opportunities for retrieval practice. Include ques-

tions to encourage long-term memory retrieval and help 
learner connect new information with prior knowledge.

• Promote active discovery. Include exercises or activities 
such as matching, polling, or multiple-choice questions to 
help learners identify gaps between what they thought 
they knew and what they ought to know.

Box 2. Practical Applications of Cognitive Learning Theory 
and Science of Memory in CME/CE Writing

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AMWAJournal.org     50Practical Strategies For Creating CME/CE Content

but are extremely busy, and their in-the-moment learning 
capacity is affected by many factors, including specialty, 
proficiency level, and workplace setting. Our goal as CME/
CE writers is to help health professionals process, synthe-
size, and apply new information effectively in the relevant 
context. We can help to move learners from what they know 
and can already do toward what they need to know and 
apply in practice by using ALP strategies to guide content 
development.

Acknowledgments
Thanks to Haifa Kassis, MD, and Crystal R. Herron, PhD, for 
the review of and recommendations for the manuscript.

Author declaration and disclosures: The author notes no  
commercial associations that may pose a conflict of interest in 
relation to this article.

Author contact: alex@alexhowson.com

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ARIsAHVymmRpK5KMdZfRcDU9hvG8dvBxin5Hy456Ee0G0RTZT
LyaMU_OxVVmXhMaAjw6EALw_wcB

• Build reflection into the text. Use open-ended or polling 
questions to encourage learners/readers to actively think 
about how to apply the presented information to clinical 
practice.

• Flex your metaphor muscles. Metaphors can help learners 
integrate new information into clinical practice.

• Emphasize context. Where possible, describe the clinical, 
professional, and organizational context in which learners 
are expected to apply new information or skills. This helps to 
situate learning in relationships and communities of practice.

• Use storytelling to engage learners. A story-based approach 
to content through patient cases or vignettes promotes  
clinical problem-solving and deliberate practice. Storytelling 
also establishes learner empathy with patient experience.

• Deliver concrete, constructive feedback. Feedback  
delivered in small, digestible chunks diffuses defensiveness, 
minimizes negative emotional responses, and reduces  
cognitive load.21 

Box 3. Practical Applications of Experiential, Emotional, and 
Social Learning Insights in CME/CE Writing

http://www.amwajournal.org
https://accme.org/publications/standards-for-integrity-and-independence-accredited-continuing-education-pdf
https://accme.org/publications/standards-for-integrity-and-independence-accredited-continuing-education-pdf
https://accme.org/publications/standards-for-integrity-and-independence-accredited-continuing-education-pdf
https://accme.org/sites/default/files/2022-10/2021%20ACCME%20Data%20Report_967_20221005.pdf
https://accme.org/sites/default/files/2022-10/2021%20ACCME%20Data%20Report_967_20221005.pdf
https://www.researchandmarkets.com/reports/5544417/u-s-continuing-medical-education-market?gclid=Cj0KCQjwrs2XBhDjARIsAHVymmRpK5KMdZfRcDU9hvG8dvBxin5Hy456Ee0G0RTZTLyaMU_OxVVmXhMaAjw6EALw_wcB
https://www.researchandmarkets.com/reports/5544417/u-s-continuing-medical-education-market?gclid=Cj0KCQjwrs2XBhDjARIsAHVymmRpK5KMdZfRcDU9hvG8dvBxin5Hy456Ee0G0RTZTLyaMU_OxVVmXhMaAjw6EALw_wcB
https://www.researchandmarkets.com/reports/5544417/u-s-continuing-medical-education-market?gclid=Cj0KCQjwrs2XBhDjARIsAHVymmRpK5KMdZfRcDU9hvG8dvBxin5Hy456Ee0G0RTZTLyaMU_OxVVmXhMaAjw6EALw_wcB
https://www.researchandmarkets.com/reports/5544417/u-s-continuing-medical-education-market?gclid=Cj0KCQjwrs2XBhDjARIsAHVymmRpK5KMdZfRcDU9hvG8dvBxin5Hy456Ee0G0RTZTLyaMU_OxVVmXhMaAjw6EALw_wcB



