Category Archives: Limitations

Commitment to change (CTC) evaluation: strengths and 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]



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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