Experience in using commitment-to-change statements in the AO faculty education program

Introduction The AO Foundation endeavours to deliver quality education to Orthopaedics surgeons worldwide. To achieve this, the AO Faculty Education Program (FEP) was initiated to elevate and standardize the teaching quality of its faculty. Effecting a change in teaching behaviour after the FEP course is a common challenge. Commitment-to-change (CTC) statements are proven to increase the likelihood of a change in behaviour. We describe our experience in implementing CTC statements in the AO FEP and the effect on change in behaviour.  Methodology The FEP course runs over six-weeks. It includes five weeks of online learning beginning with a self-assessment, and then one-and-a-half days of live event followed by one week of online follow-up, which includes a post-course self-assessment. The intended learning outcomes of the FEP include: prepare and present a lecture, moderate a small group discussion, instruct in practical exercises, motivate learners, encourage interaction, receive and give feedback, evaluate and improve one’s own teaching, work with outcomes in teaching strategies, set reasonable expectations of a teaching or learning activity, use information about learners e.g. learners’ needs and cultural context in the educational process and also manage time and logistics.  At the end of the offline event, each participant filled in a CTC statement describing one or more changes in teaching behaviour that he/she would commit to. One copy of this was returned to the participant and another retained by AO. Three months after the course, an email questionnaire was sent to each participant to follow-up on his/her CTC. Extent of change in behaviour was categorically divided into “full”, “partial” or “nil”.  The reasons were documented using free text and the number of learners taught by the participant within this same period was recorded. The effect of CTC statements on change in behaviour was evaluated. Convenience sampling of 71 participants (with 100% response rate) from five FEP courses conducted from 2018 to 2023 was analysed.  Results Full CTC was reported by 38 participants (53.5%). Partial CTC was reported by 28 participants (39.4%). No CTC was reported by 5 participants (7%). Thus, 66 participants (93%) made some changes in their teaching behaviour after the FEP course. Common barriers to change include “no opportunity to use”, “too busy” and “staged (incremental) changes”. Other barriers include “comfortable with previous style”, “lack of feedback” and lack of favourable response to attempted change in behaviour. Overall, 2431 learners were taught by the participants in the same period. Discussion CTC statements promote reflection, motivation and accountability to change behaviour. Barriers to change may be internal or external. Completing the FEP, followed by post-course coaching, may be even more useful in effecting change in teaching behaviour. The AO foundation should actively engage FEP participants as faculty in AO teaching activities immediately after they complete their FEP courses. Conclusion It is feasible to include CTC statements in FEP courses. CTC increases the likelihood of change in behaviour. Better awareness of the barriers to change allows the AO foundation to address these barriers and further increase the likelihood of change.