title: Commitment to Change and Challenges to Implementing Changes After Workplace-Based Assessment Rater Training.
abstract: Faculty development for clinical faculty who assess trainees is necessary to improve assessment quality and impor tant for competency-based education. Little is known about what faculty plan to do differently after training. This study explored the changes faculty intended to make after workplace-based assessment rater training, their ability to implement change, predictors of change, and barriers encountered.
  
  
  
  In 2012, 45 outpatient internal medicine faculty preceptors (who supervised residents) from 26 institutions participated in rater training. They completed a commitment to change form listing up to five commitments and ranked (on a 1-5 scale) their motivation for and anticipated difficulty implementing each change. Three months later, participants were interviewed about their ability to implement change and barriers encountered. The authors used logistic regression to examine predictors of change.
  
  
  
  Of 191 total commitments, the most common commitments focused on what faculty would change about their own teaching (57%) and increasing direct observation (31%). Of the 183 commitments for which follow-up data were available, 39% were fully implemented, 40% were partially implemented, and 20% were not implemented. Lack of time/competing priorities was the most commonly cited barrier. Higher initial motivation (odds ratio [OR] 2.02; 95% confidence interval [CI] 1.14, 3.57) predicted change. As anticipated difficulty increased, implementation became less likely (OR 0.67; 95% CI 0.49, 0.93).
  
  
  
  While higher baseline motivation predicted change, multiple system-level barriers undermined ability to implement change. Rater-training faculty development programs should address how faculty motivation and organizational barriers interact and influence ability to change.
authors.affiliation: J.R. Kogan is professor of medicine and assistant dean of faculty development, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. L.N. Conforti is research associate for milestones evaluation, Accreditation Council for Graduate Medical Education, Chicago, Illinois. When this study was conducted, she was research associate for academic programs, American Board of Internal Medicine, Philadelphia, Pennsylvania. K. Yamazaki is outcome assessment project associate, Accreditation Council for Graduate Medical Education, Chicago, Illinois. W. Iobst is vice president for academic and clinical affairs and vice dean, Commonwealth Medical College, Scranton, Pennsylvania. When this study was conducted, he was vice president of academic affairs, American Board of Internal Medicine, Philadelphia, Pennsylvania. E.S. Holmboe is senior vice president for milestones development and evaluation, Accreditation Council for Graduate Medical Education, Chicago, Illinois. When this study was conducted, he was chief medical officer and senior vice president, American Board of Internal Medicine, Philadelphia, Pennsylvania.
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Kogan
authors.forename: Lisa N
authors.initials: LN
authors.lastname: Conforti
authors.forename: Kenji
authors.initials: K
authors.lastname: Yamazaki
authors.forename: William
authors.initials: W
authors.lastname: Iobst
authors.forename: Eric S
authors.initials: ES
authors.lastname: Holmboe
mesh_terms: D000328:Adult; D003162:Competency-Based Education / Q000458:organization & administration*; D005178:Faculty / Q000523:psychology*; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency / Q000458:organization & administration*; D008297:Male; D008875:Middle Aged; D009936:Organizational Innovation; D009937:Organizational Objectives; D011231:Preceptorship / Q000458:organization & administration*; D013337:Students, Medical / Q000523:psychology*; D014481:United States; D017132:Workplace / Q000458:organization & administration*