Between 1980 and 1993, only 19% of medical school graduates chose faculty appointments with research responsibilities. Women and minorities represent only a small fraction of these, despite their growing numbers. The authors' goal is to study the effects of human agency, particularly self-efficacy, on the career development of physician researchers, especially women and people of color; therefore, we developed a reliable and valid inventory for assessing clinical research self-efficacy in a population of physicians training for clinical research careers. Scale items were pooled from expert knowledge, relevant literature, and existing inventories to create a 92-item Clinical Research Appraisal Inventory that was factor analyzed and refined to include 88 items. Although instruments have been developed to successfully assess research self-efficacy, this is the first instrument designed to assess self-efficacy in the clinical research domain using a population of academic physicians.

Introduction-Performance Improvement Continuing Medical Education (PI CME) is a mechanism for bringing quality improvement (QI) in health care and continuing medical education (CME) systems together. Although QI practices and CME approaches have been recognized for years, what emerges from their integration is largely unfamiliar, because it requires the collaboration of CME providers and stakeholders within the healthcare systems who traditionally have not worked together on closing performance gaps and may not have the same understanding of QI issues. This study describes how an academic institution and a communitybased primary care practice collaborated to enhance patient care in the area of hypertension. It offers lessons learned from a PI CME activity in the area of hypertension.

These cases highlight the value of collaboration, identify influences of operational and educational designs on variation in compliance with performance measures, and lead to a discussion of similarities in barriers, successes, and lessons for future practice.