title: Effects of a signature on rates of change: a randomized controlled trial involving continuing education and the commitment-to-change model.
abstract: OBJECTIVE
  Physicians frequently are asked to sign commitments to change practice, based upon their involvement in continuing medical education (CME) activities. Although use of the commitment-to-change model is increasingly widespread in CME, the effect of signing such commitments on rates of change is not well understood.
  
  
  METHODS
  Immediately after a CME session, 110 physicians were asked to specify a change they intended to make in practice and to designate a level of commitment to change. To determine the effects of a signature on rates of change, physicians were randomly assigned to control (signature) and experimental (non-signature) groups. Follow-up surveys were conducted at two and three months to determine rates of change.
  
  
  RESULTS
  In all, 88 physicians completed the first questionnaire, and 64 of them completed the follow-up. Consistent with prior studies involving the commitment-to-change model, those expressing an intention to change were significantly more likely to change on follow-up (p =.035). There was no significant difference between signature and non-signature groups (p =.99), regardless of age or gender.
  
  
  CONCLUSIONS
  Signatures appear unimportant to assuring compliance with commitments to change used in CME conferences. A physician's behavior can be expected to change if the specified change is consistent with the physician's beliefs and sense of what is important. The relative influences of components of the commitment-to-change model require further study to determine more clearly their roles in causation and measurement.
authors.affiliation: Office of Continuing Medical Education, Virginia Commonwealth University, Richmond 23298-0048, USA.
authors.forename: P E
authors.initials: PE
authors.lastname: Mazmanian
authors.forename: R E
authors.initials: RE
authors.lastname: Johnson
authors.forename: A
authors.initials: A
authors.lastname: Zhang
authors.forename: J
authors.initials: J
authors.lastname: Boothby
authors.forename: E J
authors.initials: EJ
authors.lastname: Yeatts
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D016009:Chi-Square Distribution; D004311:Double-Blind Method; D004502:Education, Medical, Continuing; D005260:Female; D006040:Goals; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009936:Organizational Innovation; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D014481:United States