The study, published in Global Surgical Education, the Journal of the Association for Surgical Education, was led by Joey Liang and colleagues at Duke University School of Medicine, together with senior author Ash Patel of Duke’s Division of Plastic, Maxillofacial, and Oral Surgery. The team set out to answer a deceptively simple question: do the learning objectives attached to continuing medical education sessions at a national plastic surgery meeting actually meet the guidelines promoted by the Accreditation Council for Continuing Medical Education, the body that accredits CME in the United States? To find out, they systematically audited the objectives from two consecutive years of the conference.

Learning objectives are the short, verb-driven statements that appear at the start of a lecture or session, promising what attendees will be able to do afterward. Educational researchers consider them far more than administrative boilerplate. Well-crafted objectives contextualize an educational activity, set clear expectations for the learning task, and focus both educator and learner on the intended outcome. Poorly written objectives, by contrast, leave learners guessing about what they are supposed to gain, and they make it nearly impossible to assess whether the session worked. In the CME context, where the ultimate goal is to change clinical behavior and improve patient outcomes, vague objectives may be one reason that traditional conference-style education has struggled to demonstrate lasting impact on physician practice.

The Duke team analyzed learning objectives from CME programming sessions at Plastic Surgery The Meeting in both 2023 and 2024. Sessions with missing or incomplete objectives were excluded from the analysis. The final dataset included 193 CME sessions, yielding a total of 510 individual learning objectives. Each objective was scored against two of the most widely used frameworks in health professions education: the SMART framework, which asks whether a goal is Specific, Measurable, Attainable, Relevant, and Time-Bound, and Bloom’s Taxonomy, the classic six-level hierarchy of cognitive learning that runs from remembering and understanding up through applying, analyzing, evaluating, and creating.

The results revealed a striking split. On the positive side, the objectives were generally Attainable, Relevant, and Time-Bound, meaning that session organizers were setting realistic goals tied to the content being taught within a defined timeframe. But the picture darkened considerably on the two criteria that matter most for accountability. Only 54.5 percent of objectives were judged Specific, meaning nearly half described learning goals too loosely to guide either teaching or assessment. Worse still, just 20.4 percent of objectives were Measurable, meaning that for roughly four out of every five objectives, there was no way to tell whether the promised learning had actually occurred. An objective that cannot be measured, education researchers argue, is functionally an aspiration rather than a plan.

Bloom’s Taxonomy told a similar story of low cognitive ambition. The mean Bloom’s level across all 510 objectives was just 2.02 out of a possible 6. The objectives clustered heavily at the bottom two rungs of the hierarchy: 37.3 percent targeted the Remember level, the simple recall of facts, and 40.0 percent targeted the Understand level, a step up but still far from the higher-order thinking that practicing surgeons might need to integrate new evidence into complex operative decisions. Only a small minority of objectives asked learners to apply, analyze, evaluate, or create. For an audience of experienced clinicians facing sophisticated reconstructive and aesthetic challenges, the researchers suggest, such low-level objectives may undersell both the learners and the material.

One of the study’s most technically interesting findings concerned discordant verbs. In Bloom’s framework, each cognitive level is associated with characteristic action verbs: an objective at the Remember level might use verbs like list or identify, while an Apply-level objective might use demonstrate or implement. When a writer pairs a verb from one level with a learning goal that actually belongs to another, the objective becomes internally contradictory. The researchers found that 92 objectives, or 18.0 percent of the total, used such discordant verbs. The most common mismatch, accounting for 32 of those 92 cases, was the use of verbs from the Understand category for learning goals that actually sat at the Remember level. In other words, sessions frequently promised understanding while only demanding recall, a subtle but consequential mismatch for anyone trying to gauge what a lecture will deliver.

The quality of objectives was not uniform across the conference. When the researchers compared program tracks, the different thematic streams of the meeting, they found statistically significant differences in the distribution of Bloom’s Taxonomy levels, with p values below 0.001, as well as in the proportion of Specific objectives and Measurable objectives, with p values of 0.001 or lower and 0.004 respectively. This variation suggests that the problem is not a single institutional failing but a diffuse one: some tracks consistently produce better objectives than others, and there is no shared standard being applied across the meeting’s programming. The authors argue that to enable effective implementation into clinical practice, CME activities in plastic surgery should include well-written objectives that align with the complexity and purpose of each activity, with verbs matched to their intended learning levels and outcomes that are specific and measurable.

The findings land within a broader and often sobering literature on CME effectiveness. Decades of research, including influential syntheses published in JAMA and the CHEST evidence-based guidelines, have found that passive, lecture-heavy formats like traditional conferences tend to produce modest changes in physician knowledge and even smaller changes in actual practice behavior. Educational theorists from Malcolm Knowles onward have argued that adult learners, particularly experienced professionals, learn best when objectives are explicit, self-directed, and oriented toward problems they will face in practice. Meanwhile, studies of accredited continuing professional development activities in other fields have found that the majority do not even target clinical behavior change. Poorly written objectives both reflect and reinforce that gap: if a session never commits to a measurable outcome, no one can be blamed when none occurs.

What makes this study notable is its scale and its specificity. Rather than surveying attitudes, the Duke team audited the actual written objectives from 193 sessions across two years of a major national meeting, applying standardized frameworks that are taught in every medical education curriculum. The practical implications are straightforward. Meeting organizers could require objectives to pass a SMART and Bloom’s screen before sessions are accredited; presenters could receive brief training in verb selection and objective writing; and accreditors could make measurability a hard criterion rather than a soft expectation. For the surgeons who sacrifice operating time and pay registration fees to attend, the message is equally clear: the value of a conference hour depends heavily on whether the session promised something concrete in the first place. As CME systems worldwide face pressure to demonstrate real-world impact, this audit of plastic surgery’s largest meeting offers a candid, quantifiable starting point for reform.

Subject of Research: Quality of learning objectives in continuing medical education programming at a national plastic surgery meeting

Article Title: Analysis of learning objective quality in national plastic surgery meeting continuing medical education programming sessions

Article References: Liang, J., Pillai, T., Yapuncich, G., Mohamed, L., Hibshman, N., & Patel, A. (2026). Analysis of learning objective quality in national plastic surgery meeting continuing medical education programming sessions. Global Surgical Education – Journal of the Association for Surgical Education, 5(1), Article 136. https://doi.org/10.1007/s44186-026-00540-4

Image Credits: AI Generated

DOI: 10.1007/s44186-026-00540-4

Keywords: continuing medical education, plastic surgery, learning objectives, Bloom's Taxonomy, SMART framework, medical education, ACCME, surgical education, professional development, Duke University, conference programming, clinical practice change