Commitment to change: A strategy for promoting educational effectiveness

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Abstract
Short lecture-based courses are the most common format used in continuing medical education (CME) activities, yet they are relatively ineffective for inducing behavioral changes. This study investigates the effectiveness of the commitment to change strategy for identifying behavioral changes stimulated by such a short course. Attendees at an annual 3-day lecture-based course voluntarily committed to instituting up to four changes in their practice. Those who made commitments were surveyed 1 month following the conference. Fifty-four percent of the intended changes had already been accomplished. There was no relationship between the audience's post-lecture evaluation scores for achieving the learning objectives compared to the number of changes committed to by the attendees. An unanticipated finding was the differential participation between those professions that have more autonomy (physicians and advanced practice nurses) versus those professions with less (nurses and physician's assistants). Insufficient elapsed time was the nearly universal limitation for initiating change. Encouraging participants to make a commitment to change holds a great deal of potential for both stimulating and documenting behavioral outcomes resulting from CME activities.