In Reply to Rodgers : Academic Medicine

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In Reply to Rodgers

Dzara, Kristina PhD, MMSC1; Gooding, Holly C. MD, MSc2

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Academic Medicine 98(3):p 294, March 2023. | DOI: 10.1097/ACM.0000000000005109
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We read Rodgers’ thoughtful response to our AM Last Page with great interest. As the author points out, we purposefully chose to feature Bloom’s cognitive domain because it is the most frequently referenced. We agree with Rodgers that the other 2 domains described by Bloom—affective and psychomotor—are essential for educators to know how and when to apply.

We appreciate the detailed descriptions Rodgers included of these domains. For example, a faculty development session designed to address implicit bias may begin at the bottom of the affective domain pyramid with the outcome of raising awareness about the topic, or it may aim for the highest level of the pyramid with the outcome of internalizing antiracist values that lead to sustained change in faculty behavior. For the psychomotor domain, a procedural workshop for inserting central venous catheters may begin at the bottom of the pyramid by having learners imitate the instructor’s physical movements, or it may aim for the highest level of the pyramid with the outcome of natural movement patterns that are adaptive to patient situations in real time. For all learning experiences, educators should choose the educational pyramid that best aligns with their intended outcome: learner cognition, affect, psychomotor skills (Bloom) or clinical performance (Miller) or programmatic effectiveness (Kirkpatrick).

We thank the author for extending our work and for offering interested readers an opportunity to better understand the landscape of pyramids relevant to educators.

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