Beyond the Cognitive Domain: Including All of Bloom’s Learning Domains in Objective Development : Academic Medicine

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Beyond the Cognitive Domain: Including All of Bloom’s Learning Domains in Objective Development

Rodgers, David L. EdD1

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Academic Medicine 98(3):p 294-295, March 2023. | DOI: 10.1097/ACM.0000000000005108
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To the Editor:

Dzara and Gooding’s AM Last Page1 presented an informative graphic on 3 education pyramids they described as foundational concepts every educator should know. However, Bloom’s taxonomy is much broader than the single pyramid depicted in the graphic. The authors adeptly detailed Bloom’s cognitive domain but did not address his other 2 learning domains: affective and psychomotor.2 The cognitive domain, as described by Dzara and Gooding, is the most frequently referenced and concerns mental knowledge, such as the ability to demonstrate closed-loop communication. Depending on the desired learning outcomes, the affective and psychomotor domains may have equal or even greater importance. Each domain of Bloom’s taxonomy addresses a different type of learning outcome, each requiring its own taxonomy.

The affective domain concerns attitudes, such as advocating for social justice. Too often, affect is defined as “feelings.” It is frequently omitted from learning objectives, often because educators have difficulty in teaching or assessing it.3 As described by Bloom and colleagues, affect has 5 levels in the taxonomy: (1) characterization (highest level)—consistently demonstrates values; (2) organization—reorganizes work to better use values; (3) valuing—exhibits worth or importance of subject; (4) responding—participates in activities on the subject; (5) receiving (lowest level)—is aware, listens about the subject.

The psychomotor domain concerns physical skills, such as suturing with precision. Unfortunately, Bloom never published Handbook III for the psychomotor domain. The result is several competing taxonomies trying to fill that gap.4–7 Although each has its merits and all were published during Bloom’s lifetime, the taxonomy presented by Dave4 has a unique connection as he was a student of Bloom’s. As published, Dave’s taxonomy is a brief 2 pages of bullet points: (1) naturalization (highest level)—automatic with little mental effort; (2) articulation—combines skills, uses in different situations; (3) precision—builds independent accuracy with the skill; (4) manipulation—follows instructions for skill performance; (5) imitation (lowest level)—copies an observed performance.

Looking at Bloom’s taxonomies as a set of intertwined learning domains enhances an educator’s ability to fine-tune objectives and move learning into practice, thus supporting the other 2 pyramids (Miller and Kirkpatrick) presented by Dzara and Gooding.


1. Dzara K, Gooding H. A guide to educational pyramids commonly used in medical education programs. Acad Med. 2022;97:313.
2. Bloom B, Englelhart M, Furst E, Hill W, Krathwohl D. Taxonomy of educational objectives: The classification of educational goals. Handbook I: Cognitive Domain. New York, NY: David McKay Company; 1956.
3. Krathwohl D, Bloom B, Masia B. Taxonomy of educational objectives: The classification of educational goals. Handbook II: The Affective Domain. New York, NY: David McKay Company; 1964.
4. Dave R. Psychomotor levels. Armstrong R. In: Developing and Writing Behavioral Objectives. Tucson, AZ: Educational Innovators Press; 1970:20–21.
5. Simpson EJ. The Classification of Educational Objectives in the Psychomotor Domain: The Psychomotor Domain. Vol. 3. Washington, DC: Gryphon House; 1972.
6. Harrow AJ. A Taxonomy of the Psychomotor Domain: A Guide for Developing Behavioral Objectives. New York, NY: David McKay Co; 1974.
7. Gronlund NE. Stating Behavioral Objectives for Classroom Instruction. New York, NY: Macmillan; 1970.
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