Issues such as, over commitment, insufficient time, and lack of funding, threaten physicians' entry and sustainability in a research career pathway. Social cognitive career theory is presented as a conceptual framework to critically examine the limitations of the National Institutes of Health's (NIH) efforts to promote the career development of physician-scientists. Special attention is given to the unique challenges of promoting this career pathway for women and underrepresented minorities. The authors propose enhanced recommendations for the career development of physician-scientists and research questions for future studies and program development aimed at advancing the nation's efforts to promote clinical research.

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 as 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. Keywords commitment to practice change; program evaluation; continuing educationThe translation of new knowledge into clinical practice can be a slow process, often taking a decade or more for research findings to find their way into routine patient care (Sussman, Valente, Rohrbach, Skara, & Pentz, 2006). The resulting gaps in the quality of healthcare have led to calls for action in many parts of the world (Committee on Quality of Healthcare in America, 2001;Legido-Quigley, McKee, Nolte, & Glinos, 2008). The traditional role of continuing medical education (CME)-updating physicians on the latest scientific evidenceis not sufficient to respond to this reality (Marinopoulos et al., 2007). Therefore, in the past five years there has been a marked shift toward focusing CME activities on improving practice rather than disseminating information (Davis, Davis, & Bloch, 2008;Regnier, Kopelow, Lane, & Alden, 2005). This shift in the goals of CME programming has resulted in a concomitant shift in how CME activities need to be evaluated. Evaluators must now go beyond measuring learner satisfaction and change in medical knowledge to the level of physician performance and patient outcomes. To date, only a limited number of CME evaluations have assessed impact at this level (Tian, Atkinson, Portnoy, & Gold, 2007). There is a pressing need to equip evaluators with valid, reliable and feasible methods of assessing practice and/or patient outcomes (Davis, Barnes, & Fox, 2003;Marinopoulos et al., 2007).The commitment to change (CTC) approach is one tool available to CME evaluators for assessing the impact of education on clinical practice. The central, distinguishing feature of the CTC approach is that it asks participants in an educational activity to write down descriptions of the changes they propose to make as a result of what they learned during the (Purkis, 1982). Since 1982, when the CTC approach was introduced to medical educators as an evaluation method (Purkis, 1982), it has been increasingly used in the CME field to both facilitate and measure practice change (Wakefield, 2004). This trend is likely due, in part, to the perception that the CTC approach is relatively easy to implement and low-cost (Curry & Purkis, 1986;Jones, 1990). There are, however, significant...