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The spectrum of motivation according to SDT. Adapted from Ryan RM, Deci EL. 2000. Self-determination Theory and the facilitation of intrinsic motivation, social development and well-being. Amer Psych 55 (1) 68-78.
Source publication
Self-determination Theory (SDT), designed by Edward Deci and Richard Ryan, serves among the current major motivational theories in psychology. SDT research has been conducted in many areas, among which are education and health care, but its applications in medical education are rare. The potential of SDT to help understand processes in medical educ...
Contexts in source publication
Context 1
... out of interest, curiosity or enjoyment, and autonomous forms of self-regulation are associated with better learning, better conceptual understanding, better academic performance and achievement and higher levels of well-being than high extrinsic motivation. (7) The regulation of behaviour and the ascribed cause of one's behaviour match the type of motivation ( Figure 1). The full series of four types of regulation within extrinsic motivation are referred to as: ...
Context 2
... reader should be aware that SDT designates the term 'self-regulation' to any form of behaviour regulation that is carried out by the individual, even if the origin of the regulation lies externally (called external control) or is partially internalised (called introjection). Identified self-regulation and integrated self-regulation are further internalised self- regulations along the extrinsic self-regulation continuum (Figure 1). Thus, even external control and introjected behaviour regulations are called self-regulations, because the individual has chosen this behaviour, but the reasons the person is showing the behaviour is because they feel like they are outside of the self (under external control) or only partially within the self (introjected). ...
Context 3
... may think that a person engages in a behaviour because he values and endorses his cultural values, another deliberately decides to engage in a particular behaviour because the society expects so; a third may counter-react to values of a previous generation while feeling 'free' to act her 'own' way. SDT hypothesises that the general framework of Figure 1 holds true in non-Western cultures as well. Studies with Russian, Chinese and Pakistani students show that autonomous self-regulation has similar beneficial effects (Stewart et al. 2000;Chirkov & Ryan 2001;Vansteenkiste et al. 2005). ...
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Citations
... Self-determination theory (SDT) provides an explanation for human motivation. It posits that humans are growth-orientated and that three innate psychological needs foster this -autonomy, competence, and relatedness [12]. A subtheory, organismic integration theory, describes three different regulatory structures that underpin motivation. ...
... This exemplifies how the educational milieu in which a student learns, and specifically their relationships with peers, influences motivation through the process of internalisation. 'Significant others' are recognised as being potential catalysts for the creation of introjected modes of motivation by externally controlling it with rules -'it's what you need to do to pass' [12]. Students in differing year groups share 'social congruence' -the sharing of similar social roles and a familiarity with the local -this has been recognised as promoting transition of knowledge between cohorts [18]. ...
Background
Online question banks are the most widely used education resource amongst medical students. Despite this there is an absence of literature outlining how and why they are used by students. Drawing on Deci and Ryan’s self-determination theory, our study aimed to explore why and how early-stage medical students use question banks in their learning and revision strategies.
Methods
The study was conducted at Newcastle University Medical School (United Kingdom and Malaysia). Purposive, convenience and snowball sampling of year two students were employed. Ten interviews were conducted. Thematic analysis was undertaken iteratively, enabling exploration of nascent themes. Data collection ceased when no new perspectives were identified.
Results
Students’ motivation to use question banks was predominantly driven by extrinsic motivators, with high-stakes exams and fear of failure being central. Their convenience and perceived efficiency promoted autonomy and thus motivation. Rapid feedback cycles and design features consistent with gamification were deterrents to intrinsic motivation. Potentially detrimental patterns of question bank use were evident: cueing, avoidance and memorising. Scepticism regarding veracity of question bank content was absent.
Conclusions
We call on educators to provide students with guidance about potential pitfalls associated with question banks and to reflect on potential inequity of access to these resources.
... Upon achieving a specific study goal, students tend to reward and punish themselves accordingly, hence showing an element of self-control [65]. This is in line with reports from other studies concerning the balance between self-reward and punishment [66]. Students had minimum supervision at home over their studies compared to the time they were on campus; hence, some controlled their actions by reward and punishment mechanisms to boost motivation and self-discipline, respectively [67]. ...
In March 2020, universities in Zimbabwe temporarily closed and switched to remote learning to contain the spread of SARS Cov2 infections. The sudden change to distance learning gave autonomy to students to direct their own learning. To understand how the students at the University of Zimbabwe and Midlands State University adapted to emergency remote learning, focus group discussions and a self-administered questionnaire survey based on the self-regulated learning inventory were conducted to capture cognitive, motivational, and emotional aspects of anatomy learning during the COVID-19 pandemic. Thematic analysis was used to identify patterns among these students’ lived experiences. Two coders analyzed the data independently and discussed the codes to reach a consensus. The results showed that students at the two medical schools cognitively and meta-cognitively planned, executed and evaluated self-regulated strategies in different ways that suited their environments during the COVID-19 lockdown. Several factors, such as demographic location, home setting/situation, socioeconomic background and expertise in using online platforms, affected the students’ self-directed learning. Students generally adapted well to the constraints brought about by the lockdown on their anatomy learning in order to learn effectively. This study was able to highlight important self-regulated learning strategies that were implemented during COVID-19 by anatomy learners, especially those in low-income settings, and these strategies equip teachers and learners alike in preparation for similar future situations that may result in forced remote learning of anatomy.
... Unfortunately, the medical students in the study generally found the robotic surgery learning environment to be demotivating [38]. It is hard to separate if these feelings are specific to the robotic surgery learning environment or generalized recognized themes among medical students such as the lack of self-determination, with no ability to develop their autonomy, motivation through skill competence, or regular communication with the attending surgeon [39]. ...
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... However, the higher rate of failure seen in the intrinsic only group suggests that there may be a threshold effect where a single extrinsic motivation is protective. Although self-determination theory and the learning literature note the importance of internal motivation for learning, [16][17][18][19][20] these results reinforce that at least some elements of extrinsic motivation are important for learning outcomesin other words, "stakes matter." [21][22][23][24] It seems plausible that some Diplomates with solely intrinsic motivations are at higher risk of examination failure, perhaps because they may not have immediate external consequences if they fail to recertify. ...
... Therefore, in an effort to improve students' PSA in learning the topic of environmental pollution, besides requiring PBL treatment, it also requires integration with the STEM approach. Students investigate authentic and meaningful problems [23], and students become independent learners [24] which is the hallmark of PBL. ...
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... On the other hand, the constructivist model focuses on communication as a support for patient autonomy, where the patient becomes an active agent in their self-care, and the HCP is a facilitator. This premise is supported by the self-determination theory, which argues that patient autonomy results from a process of adaptation and self-management [19]. In this sense, our results suggest that communication occurs bidirectionally, where the exchange of information between HCPs and patients is dynamic and non-hierarchical, as observed in Figure 1. ...
This study aimed to analyze the communication process of healthcare professionals for the promotion of health literacy. It is a qualitative study that utilized individual online interviews with 46 healthcare professionals working in Brazil. The thematic content analysis technique proposed by Bardin was employed, and Atlas Ti software assisted in the assessment and interpretation of the texts. Content categorization revealed 26 sub-themes, and the coding of these identified nine themes and three categories. The communication process in health literacy education was composed of a set of interdependent and interrelated variables termed emotions, professional preparedness, interprofessional collaboration, patient needs assessment, building rapport, family inclusion in the educational process, environmental aspects, strategies, and resources for teaching and learning. These data may support the analysis of health communication in healthcare services, the creation of data collection instruments, and the development of training programs to enhance skills within the context of the identified variables.
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Background
Medical school curricula strive to train community-engaged and culturally competent physicians, and many use service learning to instill these values in students. The current standards for medical service learning frameworks have opportunities for improvement, such as encouraging students to have more sustainable and reciprocal impact and to ingrain service learning as a value to carry throughout their careers rather than a one-time experience. PEDS 220: A COVID-19 Elective is a Stanford University course on the frontlines of this shift; it provides timely education on the COVID-19 pandemic, integrating community-oriented public health work to help mitigate its impact.
Methods
To analyze our medical service learning curriculum, we combined qualitative and quantitative methods to understand our students’ experiences. Participants completed the Course Experience Questionnaire via Qualtrics, and were invited to complete an additional interview via Zoom. Interview transcripts were analyzed using an interactive, inductive, and team-based codebook development process, where recurring themes were identified across participant interviews.
Results
We demonstrate through self-determination theory that our novel curriculum gives students valuable leadership and project management experience, awards strong academic and community-based connections, and motivates them to pursue future community-engaged work.
Conclusions
This educational framework, revolving around students, communities, and diversity, can be used beyond the COVID-19 pandemic at other educational institutions to teach students how to solve other emergent global health problems. Using proven strategies that empower future physicians to view interdisciplinary, community-engaged work as a core pillar of their responsibility to their patients and communities ensures long-term, sustainable positive impact.
Trial registration
N/A.
... In the context of acceptable and unacceptable professional behaviors, we obtained the lowest score in the domain of lack of engagement, such as arriving late or missing classes or other assigned activities, and not participating in curricular and extracurricular activities. The cause of this may be ascribed to inadequate motivation [6]. Signs of disengagement may manifest as a prelude to avoiding interactions with patients, failing to contribute to patient care, leaving the hospital during a shift, and demonstrating poor levels of involvement. ...
Background
Accreditation councils across the world constantly examine policies and practices in professionalism in their medical curriculum. The National Medical Commission (NMC) in India has recognized the pressing need to reform and include professionalism in its undergraduate curriculum.
Objectives
The objective of this study was to explore the perspectives of medical and nursing students on professional behavior, suitable teaching-learning methods, and assessment strategies for curriculum integration.
Methodology
The study utilized a concurrent triangulation mixed method design, collecting both qualitative and quantitative data simultaneously to gain a comprehensive understanding of medical and nursing students' perceptions of professionalism. It included 83 final-year undergraduate medical students and 42 final-year undergraduate nursing students. The approval of the Institutional Review Board of Meenakshi Medical College Hospital & Research Institute was obtained. A semi-structured questionnaire consisting of demographic characteristics and opinions regarding academic professional behavior, teaching-learning, and evaluation of professionalism was used. Perceptions regarding the meaning of professionalism, behavior of professionalism to be emphasized in teaching, and pressing challenges of professionalism were explored. Students were also asked to rank the best behavior associated with professionalism. Frequency and percentages were used for descriptive statistics. Means and standard deviations were calculated for continuous variables. An unpaired t-test was used to determine a statistically significant difference between the means in the two groups. The quantitative data was analyzed with R programming and content analysis was performed for the qualitative data using ATLAS.ti qualitative data analysis software.
Results
Unexplained/unauthorized absence from academic activities (2.39 ± 1.553), not following the timeline (2.41 ± 1.560), making fun of patients and peers (2.16 ± 1.619), cheating in the exams (2.37 ± 1.651), and inebriation (2.39 ± 1.666) were unacceptable behaviors by undergraduate medical students compared with nursing students. Clinical experience (1.54 ± 0.857) and role models (1.74 ± 0.935) were the highly acceptable methods of teaching professionalism and interprofessional interactions (1.58 ± 0.650) and awards (1.98 ± 1.100) were the most common suggestions to improve the course curriculum by both groups. Community/field activity (1.78 ± 0.860) and clinical examination (1.89 ±1.123) were the most preferred methods of evaluation of professionalism. According to the students, dedication, honesty, respect, and self-improvement were identified as the best behaviors associated with professionalism.
Conclusions
The study revealed that students had a wide range of perspectives about professionalism. Different unprofessional acts were acceptable to students. The causes of these perspectives need to be explored and resolved to promote professionalism. Students identified the need for strong positive role models and frequent clinical experiences, along with improved interprofessional interactions and awards to improve teaching and learning professionalism. Community/field activity was the preferred assessment method proposed by the students. Medical institutions must promote these components in curriculum, faculty development, and clinical settings to foster the development of professionalism among students.
... 43,44 Self-determination theory is a general theory of motivation that can be applied to all areas of life. 42,45 According to selfdetermination theory, motivation exists on a dynamic continuum that is influenced by the learning environment, in which students may be unmotivated, extrinsically motivated, or intrinsically motivated. Self-determination theory also posits that 3 psychological needs must be fulfilled to stimulate and sustain intrinsic motivation: autonomy, competence, and relatedness. ...
OBJECTIVES
Self-directed learning (SDL) competency is important for physicians to stay abreast of advances in their field and to provide the best available evidence-based care to their patients. Therefore, an essential responsibility of medical educators is to ensure the development of SDL skills in their students. The first objective of this study was to investigate longitudinally the degree to which medical students were ready to engage in SDL. The second objective was to examine students’ perceptions of their SDL development throughout training.
METHODS
A 2-part study of preclinical and clinical medical students was carried out at a midwestern U.S. university. In Study A, a longitudinal assessment of preclinical medical students’ readiness to engage in SDL was conducted by administering an SDL readiness survey (SDLRS). In Study B, third- and fourth-year medical students were asked to reflect on their SDL development, in addition to completing the SDLRS.
RESULTS
After validating the Hendry and Ginns version of the SDLRS in preclinical medical students during Study A, we found that 3 of the 4 subscales remained constant over the 3 iterations of the survey while the self-determination subscale increased significantly between the first and third iteration of the survey. In Study B, an analysis of the clinical medical students’ comments indicated a perceived increase in their SDL abilities and a growing appreciation of SDL. However, the SDLRS scores of clinical students did not differ from the results observed in preclinical students in Study A.
CONCLUSIONS
The results of the SDLRS indicated that the experience of students in our medical school has a positive influence on self-determination by the end of the preclinical years. Furthermore, analysis of the reflections of clinical students indicated ongoing development of SDL skills throughout their medical school training that were influenced by a wide range of experiences.
... Additionally, the study's design, allowing students to choose their preferred method of accessing online lectures, aimed to fulfill students' autonomy needs but introduced potential selection bias. Nevertheless, adhering to the self-determination theory, meeting the need for autonomy is anticipated to enhance intrinsic motivation (IM), positively correlating with academic performance [47]. Another limitation pertains to the inability to ascertain the individual duration students spent on asynchronous online videos or whether they completed entire lectures. ...
Background
The abrupt onset of the COVID-19 pandemic compelled universities to swiftly establish online teaching and learning environments that were not only immediately deployable but also conducive to high-quality education. This study aimed to compare the effectiveness of the online synchronous and asynchronous teaching formats in the dermatology lecture for undergraduate medical students, including academic performance, self-efficacy, and cognitive load.
Methods
A total of 170 fourth-year undergraduate medical students attending the dermatology lecture were included. The lecture was delivered using both the synchronous method (live online lecture via Webex meeting) and the asynchronous method (lecture videos shared on YouTube). The students had the freedom to choose their preferred method of attending the online lecture. The study assessed three main aspects: (1) learning outcomes measured through pretest, posttest, and retention test scores; (2) cognitive load experienced by students, including mental load and mental effort measured using eight items; and (3) satisfaction levels with each online teaching format.
Results
In this study, 70 students opted for the synchronous online lecture, while 100 students chose the asynchronous online lecture. Both synchronous and asynchronous teaching methods exhibited significant improvements in post and retention test scores compared to the pretest. Satisfaction levels, rated on a scale of 0–5, were generally high for both teaching methods, with no significant differences observed (4.6 for synchronous, 4.53 for asynchronous; p =.350). Regarding cognitive load, the synchronous method showed a significantly lower level than the asynchronous method (p =.0001). Subgroup analysis revealed no difference in mental effort (p =.0662), but the level of mental load was lower in the synchronous method (p =.0005).
Conclusions
Both synchronous and asynchronous online teaching methods demonstrated improvements in learning outcomes and high levels of student satisfaction. However, the cognitive load experienced by students was lower in the synchronous setting compared to the asynchronous setting. These findings remind health professions educators that they would consider the students’ cognitive load when designing online curricula.
