Journal article content as a predictor of commitment to change among continuing medical education respondents

An "education for life" requirement to promote lifelong learning in an internal medicine residency program

BACKGROUND

Lifelong learning is an integral component of practice-based learning and improvement. Physicians need to be lifelong learners to provide timely, efficient, and state-of-the-art patient care in an environment where knowledge, technology, and social requirements are rapidly changing.

OBJECTIVES

To assess graduates' self-reported perception of the usefulness of a residency program requirement to submit a narrative report describing their planned educational modalities for their future continued medical learning ("Education for Life" requirement), and to compare the modalities residents intended to use with their reported educational activities.

MATERIALS AND METHODS

Data was compiled from the Education for Life reports submitted by internal medicine residents at the University of Tennessee College of Medicine Chattanooga from 1998 to 2000, and from a survey sent to the same 27 graduates 2 to 4 years later from 2000 to 2004.

RESULTS

Twenty-four surveys (89%) were returned. Of the responding graduates, 58% (14/24) found the Education for Life requirement useful for their future continued medical learning. Graduates intended to keep up with a mean of 3.4 educational modalities, and they reported keeping up with 4.2. In a multivariable analysis, the number of modalities graduates used was significantly associated with the number they had planned to use before graduation (P  =  .04) but not with their career choice of subspecialization.

CONCLUSION

The majority of residents found the Education for Life requirement useful for their future continued medical learning. Graduates, regardless of specialty, reported using more modalities for continuing their medical education than they thought they would as residents. Considering lifelong learning early in training and then requiring residents to identify ways to practice lifelong learning as a requirement for graduation may be dispositive.

Commitment to practice change: an evaluator's perspective

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.

Continued medical education provided by medical journals: the "red journal's" experience

BACKGROUND AND AIMS

A mailed survey to our readership expressed an interest in providing journal CME. In January 2006, following an assessment of the readership's educational needs and the development of educational objectives to span a 12-month program, two articles per issue were provided to participants to gain category 1 credit free of charge.

METHODS

Participants completed a mandatory electronic evaluation after each CME activity that they had completed. These prospective data were collected to determine participant demographics, satisfaction, and outcome results.

RESULTS

A total of 1,329 CME credits were provided during the 2006 volume year. Ninety-one percent of these participants were in private practice, 98% of the participants indicated a good to excellent overall satisfaction with the CME activity, 97% indicated their experience was good to excellent compared to other journals that they had participated for CME credit, and 97% of the participants indicated that they thought the CME activity increased their knowledge and/or skills related to patient care.

CONCLUSION

The results of our 1-yr outcome analysis indicate that there is a need for continued journal-based CME and that our participants are very satisfied with the process. This CME activity format also appears to have improved the participants' knowledge and their delivery of patient care.

Learning associated with participation in journal-based continuing medical education

INTRODUCTION

Medical journal reading is a standard method of increasing awareness among physicians of evidence-based approaches to medical care. Theories of physician learning and practice change have suggested that journal reading may be more influential at some stages of behavioral change than at others, but it is not clear how journal reading may influence the learning process that can lead to behavioral change.

METHODS

A random sample of 170 continuing medical education (CME) participants who had read three journal articles and completed a CME evaluation form received a CME credit certificate with a brief survey appended. The survey asked participants to report their stage of learning on each article topic before and after reading the three articles.

RESULTS

Of the 170 CME participants, 138 (81.2%) responded to the survey. Most (106 of 138; 76.8%) reported a progression in stage of learning on the topic of at least one of the three articles read for CME credit. More than one-fourth of the respondents (37 of 138; 26.8%) made a commitment to change practice related to the topic of one or more articles. CME participants were more likely (relative risk 1.14; 95% confidence interval 1.06-1.22) to report a progression in stage of learning if they had recorded a commitment to change practice related to the same article topic on the CME evaluation form.

DISCUSSION

Journal-based CME activities may be educational at all stages of the learning process, and journal-based learning episodes may result in commitments to change practice.

Commitment to change: exploring its role in changing physician behavior through continuing education

Statements of commitment to change are advocated both to promote physician change and to assess interventions designed to promote change. Although commitment to change is only one part of a complex process of change, recent progress has established a solid theoretical and research base to support this approach. Studies have demonstrated that it can be used effectively with many different types of educational activities and that statements of "plans to change " practice can predict actual changes. The importance of follow-up as part of the commitment to change model is becoming clearer, although questions remain about the most effective process to accomplish this and the optimal timing. Further research is needed to establish the effectiveness of the commitment-to-change approach itself as well as to better understand the functions (and thus the forms) of the different components of the commitment-to-change model.