Rationale, aims and objectivesThe authors undertook this qualitative study as part of a larger evaluation of the effect of eight clinical practice guidelines issued by an arm's-length government agency in a Canadian province. Using Orlandi and colleagues' version of the Rogers diffusion of innovation model as a framework, the authors mapped doctors' views on implementation of clinical practice guidelines. Methods In semi-structured interviews with 45 representative doctors, the authors elicited doctors' framework of meaning for behaviour change in general and for clinical practice guideline uptake in particular. These were then compared with the adapted Orlandi/Rogers diffusion of innovation model to confirm, amend or challenge that model. Results Doctors identified the following influences on changes to their clinical practice and on clinical practice guideline uptake, within a five-step innovation model: 1 innovation: evidence change is required, perceived need for change; 2 communication: awareness of innovation; 3 adoption: evidence of improved outcomes without increased patient risk, opinion leader support, consistency with current trends; 4 implementation: patient and family acceptability; and 5 maintenance: system support, patient and family support, observed improved patient outcomes without increased risk Conclusions Innovation for doctors is a complex decision process rather than a single decision point. Change occurs in the context of professional networks and patient and family support and demand.

The authors surveyed Canadian medical schools to identify gaps in current continuing professional development (CPD) with reference to social accountability and compared the results to best practices identified in a literature review. The literature review identified 15 relevant articles. Several themes on best practices emerged. In a fundamental social contract with society, physicians receive privileges in return for responding to social needs. CPD is part of this contract. To meet the terms of the contract, CPD must be credible, unbiased and respond to social needs. Physicians have a responsibility to maintain quality; CPD is one tool to do that. CPD should be measured against values of relevance, quality, cost effectiveness, and equity. The survey asked all 17 Canadian medical schools to report CPD initiatives that respond to societal needs. Eleven schools responded with descriptions of 28 such initiatives. Most initiatives focused on values of quality and relevance; fewer focused on cost effectiveness. Most often, initiatives addressed medical expertise and interprofessional collaboration, least often health advocacy. Faculty initiated most initiatives, rather than students, community or society. These findings lead to recommendations for future directions of CPD.

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