Author: Brian S McGowan, PhD

Abstract
INTRODUCTION:
This study investigates the use of a commitment to change (CTC) instrument as an integral approach to continuing medical education (CME) planning, implementation, and evaluation and as a means of facilitating physician behavior change.
METHODS:
Descriptive statistics and grounded theory methods were employed. Data were collected from 20 consecutive CME programs. Physicians were asked to list up to three things they intended to change in their clinical practice as a result of the program. A copy was sent 3 weeks later as a reminder. Six months later, a summary of peer-intended changes was sent to reinforce intended behavior change.
RESULTS:
Of 602 participants, 291 (48%) completed CTC forms, resulting in 803 citations. Responses were congruent with the educational objectives and intentions of the program planners. Using the constant comparative method of analysis, a framework was identified for interpreting physician learning strategies. It included change strategies and motivation, learning issues, better doctoring, changes to clinic practice, and diffusion.
DISCUSSION:
CTC was useful as a multipurpose tool providing planners with meaningful feedback to (1) assess congruence of intended changes in physician behavior with program objectives, (2) document unanticipated learning outcomes, and (3) enable and reinforce intended behavior change.

via Commitment to change instrument en… [J Contin Educ Health Prof. 2004] – PubMed – NCBI.

Abstract
INTRODUCTION:
Statements of commitment to change are advocated both to promote and to assess continuing education interventions. However, most studies of commitment to change have used self-reported outcomes, and self-reports may significantly overestimate actual performance. As part of an educational randomized controlled trial, this study documented changes that family physicians committed to make in their prescribing and then used third-party data to examine actual changes.
METHOD:
Following participation in a continuing medical education program using interactive small groups, physicians were asked to identify changes that they planned to make in their practices. For prescribing changes related to four conditions, data from a provincial pharmacy registry were analyzed for 6-month periods before and after the educational intervention.
RESULTS:
A total of 207 physicians participated in the project, which involved monthly meetings of 30 peer learning groups. Ninety-nine physicians received experimental case-based educational modules +/- personal prescribing feedback, and 91 of these indicated that they planned to make at least one change in practice. Of the 209 intended changes, 71% were directly related to the prescribing messages in the materials.
DISCUSSION:
In three of four indicator conditions, physicians who expressed a commitment to change were significantly more likely to change their actual prescribing for the target medications in the following 6 months. The percentage of physicians who did change their prescribing varied significantly by condition. Further study of the process of translating commitment to change into real practice change is needed.

via Commitment to change statements ca… [J Contin Educ Health Prof. 2003] – PubMed – NCBI.

Abstract

A commitment to practice change (CTC) approach may be used in educational program evaluation to document practice changes, examine the educational impact relative to the instructional focus, and improve understanding of the learning-to-change continuum. The authors reviewed various components and procedures of this approach and discussed some practical aspects of its application using an example of a study evaluating a presentation on menopausal care for primary care physicians. The CTC approach is a valuable evaluation tool, but it requires supplementation with other data to have a complete picture of the impact of education on practice. From the evaluation perspective, the self-reported nature of the CTC data is a major limitation of this method.

via Commitment to Practice Change: An Evaluator’s Perspective.

Abstract
PURPOSE:
Physicians frequently are asked to sign commitments to change practice, based upon their involvement in continuing medical education (CME) activities. Although use of the commitment-to-change model is increasingly widespread in CME, the effect of signing such commitments on rates of change is not well understood.
METHOD:
Immediately after a CME session, 110 physicians were asked to specify a change they intended to make in practice and to designate a level of commitment to change. To determine the effects of a signature on rates of change, physicians were randomly assigned to control (signature) and experimental (non-signature) groups. Follow-up surveys were conducted at two and three months to determine rates of change.
RESULTS:
In all, 88 physicians completed the first questionnaire, and 64 of them completed the follow-up. Consistent with prior studies involving the commitment-to-change model, those expressing an intention to change were significantly more likely to change on follow-up (p =.035). There was no significant difference between signature and non-signature groups (p =.99), regardless of age or gender.
CONCLUSIONS:
Signatures appear unimportant to assuring compliance with commitments to change used in CME conferences. A physician’s behavior can be expected to change if the specified change is consistent with the physician’s beliefs and sense of what is important. The relative influences of components of the commitment-to-change model require further study to determine more clearly their roles in causation and measurement.

via Effects of a signature on rates of change: a random… [Acad Med. 2001] – PubMed – NCBI.