Category Archives: Commitment to Change

Commitment to change: good night, sweet prince?

Commitment to change (CTC) questions are the caboose of every post-activity CME evaluation – stripped of all relevancy and sustained solely by nostalgia. Thirty years since its introduction, we can now all retire this method, confident that it has served us well, but that it’s now time for something more…app-ish.  And off it goes, grumbling it’s final words toward obscurity: “…but, you never really knew me”.

Before you dismiss CTC, check out this article.   People have been studying CTC for a long time.  And there’s value to this approach – assuming you use it correctly.  Should you use a follow-up survey?  When?  How?  How should you word the questions?  Include a rating scale?  And how should you sort through and interpret the results?  This stuff all matters. And you won’t find an easier to digest summary than this 2010 article in Evaluation & the Health Professions.

So, yes, if you’re simply maintaining a “what are you going to change in your practice” question at the end of every CME evaluation – definitely send that packing.  Then read the aforementioned article.  You’ll find that CTC has limitations, but when done in accordance with the latest evidence, there’s a lot of good data to be had.

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Commitment to change (CTC) evaluation

I like this evaluation approach for large CME conferences.  A large CME conference = multiple topics + multiple speakers + multiple participating specialties (not unlike the annual Alliance meeting).

 

Here are the three steps:

 

Step #1. One week after the CME conference, contact participants and ask them to identify up to 3 changes they are considering to implement in their practice (as a result of participating).  I like to use SurveyMonkey.com for this step.  Click here for an example email invitation and here for an example survey.

 

Step #2. Four weeks after the CME conference, send a reminder of intended changes to each participant who responded to Step #1 (also include a summary of the other attendees intended changes).  Click here for an example.

 

Step #3. Three months after the CME conference, contact every participant who responded to Step #1 to see if their intended changes were realized (and if not, why).  Again, I like to use SurveyMonkey.com for this step. Click here for an example email invitation and here for an example survey.

 

Step #1 assesses “competence” changes.  Step #3 assesses “performance” change.  Step #2 is an adjunct non-educational strategy to enhance change (ACCME criteria 17).

 

When you’re ready to put it all together in a report…click here for an example.

 

 

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Filed under Commitment to Change, Methodology, Outcomes

Commitment to change (CTC) evaluation: strengths and limitations

Strengths

Limitations

Predictive of practice change [1,9]

The gap between self-reported and objectively measured practice change can be significant [5]

Successfully implemented in a variety of course settings, as well as for primary care, specialty, and multidisciplinary physician audiences [1]

Physicians are more likely to make changes in areas they can control and easily implement without affecting the work of others [1,6]

Allows for comparison between intended behavior changes and the activity’s learning objectives [3,4]

Non-responders to follow-up surveys may be non-implementers who do not want to report that they failed in making the anticipated changes [8] and / or demographics may explain the differences between responders and non-responders to CTC follow-up surveys [3]

Can identify unintended learning outcomes [3,7]

Underlying conditions (e.g., ineffective CME format) may influence CTC success [3]

May prompt practice reflection [2], reinforce behavior change [3] and increase likelihood of practice change [9]

Theoretical foundations exist, but have not been sufficiently clarified [1,9]

 

References:

1.  Wakefield JG. Commitment to change: Exploring its role in changing physician behavior through continuing education. J Contin Educ Health Prof 2004;24:197-204. (abstract)

2.  Lowe M, Rappolt S, Jaglal S, MacDonald G. The role of reflection in implementing learning for continuing education into practice. J Contin Educ Health Prof 2007;27:143-8. (abstract)

3.  White MI, Grzybowski S, Broudo M. Commitment to change instrument enhances program planning, implementation, and evaluation. J Contin Educ Health Prof 2004;24:153-62. (abstract)

4.  Lockyer JM, Fidler H, Ward R, Basson RJ, Elliot S, Toews J. Commitment to change statements: A way of understanding how participants use information and skills taught in an educational session. J Contin Educ Health Prof 2001;21:82-9. (abstract)

5.  Adams AS, Soumerai SB. Evidence of self-report bias in assessing adherence to guidelines. Int J Qual Health Care 1999;11:187-92. (abstract)

6.  Fidler H, Lockyer JM, Toews J, Violato C. Changing physicians’ practices: The effect of individual feedback. Acad Med 1999;74:702-14. (abstract)

7.  Dolcourt JL, Zuckerman G. Unanticipated learning outcomes associated with commitment to change in continuing medical education. J Contin Educ Health Prof 2003;23:173-81. (abstract)

8.  Dolcourt JL. Commitment to change: a strategy for promoting educational effectiveness. J Contin Educ Health Prof 2000;20:156-63. (abstract)

9.  Overton GK, MacVicar R. Requesting a commitment to change: Conditions that produce behavioral or attitudinal commitment. J Contin Educ Health Prof 2008;28:60-66. (abstract)

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Commitment to change (CTC) in CME literature

For those so engaged, here are a list of five “must reads”.  I especially recommend #1 (Overton and MacVicar) because it describes CTC evaluation techniques associated with physician change – that’s right, just participating in a CTC evaluation can create change.

 

1. Overton GK and MacVicar R. Requesting a commitment to change: Conditions that produce behavioral or attitudinal commitment. J Cont Educ Health Prof 2008;28:60-66. (abstract)

 

2. Wakefield JG. Commitment to change: Exploring its role in changing physician behavior through continuing education. J Contin Educ Health Prof 2004;24:197-204. (abstract)

 

3. White MI, Grzybowski S, Broudo M. Commitment to change instrument enhances program planning, implementation, and evaluation. J Contin Educ Health Prof 2004;24:153-62. (abstract)

 

4. Lockyer JM, Fidler H, Hogan DB, Pereles L, Wright B, Lebeuf C. Assessing outcomes through congruence of course objectives and reflective work. J Contin Educ Health Prof 2005;25:76-86. (abstract)

 

5. Lockyer JM, Fidler H, Ward R, Basson RJ, Elliot S, Toews J. Commitment to change statements: A way of understanding how participants use information and skills taught in an educational session. J Contin Educ Health Prof 2001;21:82-9. (abstract)

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