The Academic Rationale for ChangeCME

The influx of medical knowledge through research is constant and astounding. As such, the translation of this knowledge into clinical practice can often be a slow process, sometimes taking a decade or more for new research to find its way into routine patient care (Sussman et al 2006). Traditionally knowledge has been disseminated through presentations at continuing medical education(CME)conferences. However, this method is insufficient to respond to the reality of this constant influx of knowledge (Marinpopulous et al 2007). Conference-based CME has a moderate effect on improving physician knowledge; yet, it appears to have a small, inconsistent effect on physician performance and patient outcomes (Cervero & Gaines 2015). For this reason, in the last several years there has been a shift towards improving clinical practice through motivational educational activities. Much of this work revolves around encouraging physician behavioral change through a “commitment to change”(CTC) concept (Wakefield 2004, Gibbs & Price 2012, Cunningham et al 2014, Lowe et al 2007, Reed et al 2012).

Originally described by Purkis in the 1980s, the concept is grounded in “Goal Setting Theory”(Locke &Latham2002) and involves 2 steps; first the physicians are asked “as a result of this educational activity, (be it a workshop, conference, seminar, etc.), do you plan to make a change to your way of practice and to describe what these changes would be”. Second, in the following weeks or months, participants are surveyed if the intended change or changes were made (Wakefield 2004). Consistently, studies have demonstrated that physicians who make a CTC statement are more likely to experience practice changes than those who do not (Wakefield 2004, Pereles et al 1996, Pereles et al 1997, Gibbs &Price2012, Dolcourt 2003, White et al 2004, Williams et al 2015, Lockyer et al 2001).

The “commitment to change”concept has been rigorously investigated and their use has demonstrated behavioral change in health care professionals. “Commitment to change”statements that are specific, measurable, attainable, realistic and timely are more likely to be accomplished (Reed et al. 2012). An important trigger of a CTC statement should be to induce reflection. Reflection in health care is significant in helping professionals implement learning from continuing education into practice. Research has demonstrated that those that reflected on what they learned and what they intended to change were more likely to make the changed behavior(Lowe et al 2007). Following up with participants or sending them reminders are a crucial aspect of the CTC concept. Writing down a CTC statement with an informed follow up reminder is more likely to create a drive to follow through with their expressed intention to make a change(Overton et al. 2008).