Moore's Expanded Outcomes Framework: A Practical Guide to Measuring Learning Impact

What is Moore's Expanded Outcomes Framework?

In the world of continuing medical education (CME) and healthcare professional development, measuring whether learning actually works has always been challenging. Dr. Donald Moore Jr. addressed this gap by developing the Expanded Outcomes Framework—a seven-level model that traces the journey from simple participation all the way to improved community health outcomes.

Unlike simpler models that stop at "did they learn it?", Moore's framework asks the harder questions: Did they apply it? Did patient care improve? Did the community benefit?

The Seven Levels Explained

Level 1: Participation

The foundation level simply measures whether learners attended or completed the educational activity. While basic, it's essential for accreditation reporting and understanding reach.

Example metrics: Completion rates, attendance numbers, time spent in activity

Level 2: Satisfaction

Did learners find the experience valuable? This level captures the subjective quality of the learning experience through post-activity evaluations.

Example metrics: Course ratings, Net Promoter Scores, qualitative feedback

Level 3A: Declarative Knowledge

Can learners recall and state what they learned? This measures the acquisition of facts, concepts, and information—the "knowing what."

Example metrics: Pre/post test scores, knowledge assessments, quiz performance

Level 3B: Procedural Knowledge

Can learners demonstrate how to do something? This goes beyond recall to measure practical application skills—the "knowing how."

Example metrics: Simulation performance, case-based assessments, skills demonstrations

Level 4: Competence

Can learners apply their knowledge in realistic scenarios? This level bridges classroom learning with real-world practice through standardized assessments.

Example metrics: OSCE scores, standardized patient encounters, competency checklists

Level 5: Performance

Are learners actually applying what they learned in their daily practice? This is where the rubber meets the road—measuring behavior change in the real clinical environment.

Example metrics: Chart audits, practice pattern analysis, self-reported behavior change, peer observations

Level 6: Patient Health

Did the education ultimately improve patient outcomes? This level measures the impact on the people healthcare professionals serve.

Example metrics: Clinical quality indicators, patient satisfaction, health outcomes data

Level 7: Community Health

Did the education contribute to broader population health improvements? The ultimate measure of educational impact at scale.

Example metrics: Population health statistics, public health outcomes, epidemiological data

Pros of Moore's Framework

• Comprehensive scope: Covers the full spectrum from participation to population impact
• Healthcare-specific: Designed specifically for medical and health professions education
• Research-backed: Developed through extensive research and adopted by major accrediting bodies
• Behavior focus: Emphasizes the critical gap between knowing and doing
• Outcomes-oriented: Keeps the ultimate goal (patient care) front and center
• ACCME alignment: Directly maps to accreditation requirements for CME providers

Cons of Moore's Framework

• Implementation complexity: Measuring all seven levels requires significant resources
• Longitudinal data needs: Levels 5-7 require tracking over extended time periods
• Attribution challenges: Isolating educational impact from other variables at higher levels
• Data access barriers: Patient and population health data may be difficult to obtain
• Resource intensive: Full implementation requires substantial organizational commitment

Alternatives to Consider

Kirkpatrick's Four Levels

The classic training evaluation model (Reaction, Learning, Behavior, Results) is simpler and more widely known, making it easier to implement. However, it lacks the healthcare-specific nuances and granular knowledge distinctions of Moore's framework.

Miller's Pyramid

Focuses specifically on clinical competence with four levels: Knows, Knows How, Shows How, and Does. Excellent for skills-based assessment but doesn't extend to patient or community outcomes.

Phillips ROI Model

Extends Kirkpatrick with a fifth level focused on return on investment. Useful when cost-justification is a primary concern, but less applicable to healthcare quality improvement.

When to Use Moore's Framework

Moore's framework is ideal when:

• You're developing CME/CE for healthcare professionals
• Accreditation requirements demand outcomes measurement
• You want to demonstrate educational impact on patient care
• Long-term behavior change is the goal, not just knowledge transfer
• You have resources to collect longitudinal data

Practical Implementation Tips

1. Start where you are: You don't need to measure all seven levels immediately. Begin with Levels 1-3 and expand over time.
2. Build in measurement from the start: Design assessments and data collection into your educational activities from the planning phase.
3. Partner for higher levels: Collaborate with quality improvement teams and health systems to access practice and outcomes data.
4. Use technology: Learning management systems and analytics platforms can automate much of the data collection for Levels 1-4.
5. Focus on commitment to change: Between Levels 4 and 5, capture learner intentions and follow up to measure actual behavior change.

The Bottom Line

Moore's Expanded Outcomes Framework provides a rigorous, comprehensive approach to measuring educational impact in healthcare. While implementing all seven levels requires significant investment, even partial adoption helps shift focus from "Did we teach it?" to "Did it make a difference?"

For CME providers committed to demonstrating real-world impact, Moore's framework offers both the conceptual foundation and practical structure to move beyond satisfaction scores toward meaningful outcomes measurement.