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. 2021 Oct 14;31(6):2017-2031.
doi: 10.1007/s40670-021-01396-7. eCollection 2021 Dec.

A Mixed-Methods Exploration of the Developmental Trajectory of Autonomous Motivation in Graduate Medical Learners

Susan E Hansen  1   2 , Nicole Defenbaugh  3 , Susan Snyder Mathieu  1   2 , Linda Contillo Garufi  4 , Julie A Dostal  2
Affiliations

A Mixed-Methods Exploration of the Developmental Trajectory of Autonomous Motivation in Graduate Medical Learners

Susan E Hansen et al. Med Sci Educ. .

Abstract

Introduction: Self-determination theory (SDT), when applied to curricular construction, emphasizes curiosity, self-awareness, and resilience. Physicians need these qualities to face the challenges of clinical practice. SDT offers a lens for medical educators to track learner development toward sustainable, rewarding careers. This study describes the changes observed in learner communications about feelings of competence, relatedness, and autonomy across a 3-year family medicine training program designed to develop activated, lifelong learners.

Methods: This retrospective, mixed-methods case study uses a phenomenological approach to explore how 51 learners described their experiences at various intervals in residency training. Data collected from 2009 to 2015 from resident focus groups, competency assessment meetings, and faculty assessment reports inform a 3-stage analysis process to determine learner motivation levels along the SDT continuum.

Results: Aggregated qualitative and quantitative data show residents' progression from introjection (controlled motivation) in PGY1, to identification (autonomous motivation) in PGY2, and integration (autonomous) by the end of PGY3. The examination of a single learner's data set reveals an advanced motivation level in PGY1 (identification), followed by a period of retrograde in PGY2 (introjection), then rebounding in PGY3 (identification), which illustrates how motivation level can be affected by external competency requirements and challenges related to career transitions.

Discussion: The examination of self-motivation in medical learners has implications for curriculum development, assessment, teaching and self-directed learning, and resilience training. Learner awareness of intrinsic motivation, and the curriculum designed around it, can better prepare residents for challenges during residency and help them flourish in twenty-first-century medicine.

Keywords: Clinical education; Curriculum; Graduate medical education; Instructional materials/methods; Medical education; Motivation; Primary care education; Qualitative research methods; Quantitative research methods; Self-determination theory.

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Conflict of interest statement

Conflict of InterestThe authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Ryan & Deci’s Self-determination theory. Adapted from Ryan, R. M., and Deci, E. L. (2000) American psychologist; © 2017 Center for Self-Determination Theory
Fig. 2
Fig. 2
Self-determination theory constructs of motivation
Fig. 3
Fig. 3
Methods flowchart
See this image and copyright information in PMC

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