Engaging students and faculty: implications of self-determination theory for teachers and leaders in academic medicine

BMC Medical Education

David R Lambert³  Christopher J Mooney³  Denham S Ward²  Stephen J Lurie³  Jeffrey M Lyness¹ 

[1] Office of Academic Affairs, University of Rochester Medical Center, 601 Elmwood Avenue, Box 706, Rochester, NY 14642, USA;Foundation for Anesthesiology Education and Research, and Department of Anesthesiology, University of Rochester Medical Center, 601 Elmwood Avenue, Box 604, Rochester, NY 14642, USA;Offices for Medical Education, University of Rochester Medical Center, 601 Elmwood Avenue, Box 601, Rochester, NY 14642, USA

关键词: Academic leadership;    Medical education;    Motivation;   

Others  :  1138518
DOI  :  10.1186/1472-6920-13-151

 received in 2013-01-24, accepted in 2013-11-08,  发布年份 2013

【 摘 要 】

Background

Much of the work of teachers and leaders at academic health centers involves engaging learners and faculty members in shared goals. Strategies to do so, however, are seldom informed by empirically-supported theories of human motivation.

Discussion

This article summarizes a substantial body of motivational research that yields insights and approaches of importance to academic faculty leaders. After identification of key limitations of traditional rewards-based (i.e., incentives, or 'carrots and sticks’) approaches, key findings are summarized from the science of self-determination theory. These findings demonstrate the importance of fostering autonomous motivation by supporting the fundamental human needs for autonomy, competence, and relatedness. In turn, these considerations lead to specific recommendations about approaches to engaging autonomous motivation, using examples in academic health centers.

Summary

Since supporting autonomous motivation maximizes both functioning and well-being (i.e., people are both happier and more productive), the approaches recommended will help academic health centers recruit, retain, and foster the success of learners and faculty members. Such goals are particularly important to address the multiple challenges confronting these institutions.

【 授权许可】

   
2013 Lyness et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Kusurkar RA, Croiset G, Mann KV, Custers E, Ten Cate O: Have motivation theories guided the development and reform of medical education curricula? A review of the literature. Acad Med 2012, 87:735-743.
• [2]Deci EL, Ryan RM (Eds): Handbook Of Self-Determination Research. Rochester, NY: University of Rochester Press; 2002.
• [3]Deci EL, Ryan RM: Intrinsic Motivation and Self-Determination in Human Behavior. New York: Plenum; 1985.
• [4]http://selfdeterminationtheory.org/
• [5]Williams GC, Deci EL: The importance of supporting autonomy in medical education. Ann Intern Med 1998, 129(4):303-308.
• [6]Williams GC, Saizow RB, Ryan RM: The importance of self-determination theory for medical education. Acad Med 1999, 74(9):992-995.
• [7]Kusurkar RA, Croiset G, Ten Cate TJ: Twelve tips to stimulate intrinsic motivation in students through autonomy-supportive classroom teaching derived from self-determination theory. Med Teach 2011, 33(12):978-982.
• [8]Kusurkar RA, Ten Cate O: Education is not filling a bucket, but lighting a fire: self-determination theory and motivation in medical students. Acad Med 2013, 88(6):904.
• [9]Ten Cate TJ, Kusurkar RA, Williams GC: How self-determination theory can assist our understanding of the teaching and learning processes in medical education. AMEE guide No. 59. Med Teach 2011, 33(12):961-973.
• [10]Wolpe J: The Practice of Behavior Therapy. New York: Pergamon; 1982.
• [11]Petry NM: Contingency management treatments. Br J Psychiatry 2006, 189:97-98.
• [12]Lussier JP, Heil SH, Mongeon JA, Badger GJ, Higgins ST: A meta-analysis of voucher-based reinforcement therapy for substance use disorders. Addiction 2006, 101(2):192-203.
• [13]Deci EL, Koestner R, Ryan RM: A meta-analytic review of experiments examining the effects of extrinsic rewards on intrinsic motivation. Psychol Bull 1999, 125(6):627-668. discussion 692–700
• [14]McDonald R, Roland M: Pay for performance in primary care in England and California: comparison of unintended consequences. Ann Fam Med 2009, 7(2):121-127.
• [15]Campbell SM, Reeves D, Kontopantelis E, Sibbald B, Roland M: Effects of pay for performance on the quality of primary care in England. N Engl J Med 2009, 361(4):368-378.
• [16]Golper TA, Feldman HI: New challenges and paradigms for mid-career faculty in academic medical centers: key strategies for success for mid-career medical school faculty. Clinical journal of the American Society of Nephrology : CJASN 2008, 3(6):1870-1874.
• [17]Deci EL: Effects of externally mediated rewards on instrinsic motivation. J Pers Soc Psychol 1971, 18(1):105-115.
• [18]Lepper MR, Greene D, Nisbett RE: Undermining children’s intrinsic interest with extrinsic rewards. J Pers Soc Psychol 1973, 28:129-137.
• [19]Dunn EW, Aknin LB, Norton MI: Spending money on others promotes happiness. Science 2008, 319(5870):1687-1688.
• [20]Kahneman D, Krueger AB, Schkade D, Schwarz N, Stone AA: Would you be happier if you were richer? A focusing illusion. Science 2006, 312(5782):1908-1910.
• [21]Amabile TM: The Social Psychology of Creativity. New York: Springer; 1983.
• [22]Deci EL, Ryan RM: The support of autonomy and the control of behavior. J Pers Soc Psychol 1987, 53(6):1024-1037.
• [23]Ariely D: The Upside of Irrationality. New York: HarperCollins; 2010.
• [24]Glucksberg S: The influence of strength of drive on functional fixedness and perceptual recognition. J Exp Psychol 1962, 63:36-41.
• [25]Deci EL, Ryan RM: The 'what’ and 'why’ of goal pursuits: human needs and the self-determination of behavior. Psychol Inq 2000, 11:227-268.
• [26]Ryan RM, Deci EL: Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol 2000, 55:68-78.
• [27]Deci EL, Flaste R: Why We Do What We do: Understanding Self-Motivation. New York: Penguin; 1996.
• [28]Pink DH: Drive: The Surprising Truth About What Motivates Us. New York: Riverhead Books; 2009.
• [29]Ryan RM: Psychological needs and the facilitation of integrative processes. J Pers 1995, 63(3):397-427.
• [30]White RW: Motivation reconsidered: the concept of competence. Psychol Rev 1959, 66:297-333.
• [31]Phillips RH: Environmental mastery and personality development. Arch Gen Psychiatry 1961, 5:146-150.
• [32]Ryff CD, Keyes CL: The structure of psychological well-being revisited. J Pers Soc Psychol 1995, 69(4):719-727.
• [33]Gladwell M: Outliers: The Story of Success. New York: Little, Brown and Company; 2008.
• [34]Bowlby J: Attachment and Loss, Vol. 1. Loss. New York: Basic Books; 1969.
• [35]Baumeister RF, Leary MR: The need to belong: desire for interpersonal attachments as a fundamental human motivation. Psychol Bull 1995, 117(3):497-529.
• [36]Maslow AH: A theory of human motivation. Psychol Rev 1943, 50:370-396.
• [37]Sheldon KM, Ryan RM, Reis HT: What makes for a good day? Competence and autonomy in the day and in the person. Personal Soc Psychol Bull 1996, 22:1270-1279.
• [38]Reis HT, Sheldon KM, Gable SL, Roscoe J, Ryan RM: Daily well-being: the role of autonomy, competence, and relatedness. Personal Soc Psychol Bull 2000, 26:419-435.
• [39]Reeve J: Self-determination theory applied to educational settings. In Handbook of Self-Determination Research. Edited by Deci EL, Ryan RM. Rochester, NY USA: University of Rochester Press; 2002:183-203.
• [40]Black AE, Deci EL: The effects of instructors’ autonomy support and students’ autonomous motivation on learning organic chemistry: a self-determination theory perspective. Sci Educ 2000, 84:740-756.
• [41]Williams GC, Deci EL: Internalization of biopsychosocial values by medical students: a test of self-determination theory. J Pers Soc Psychol 1996, 70(4):767-779.
• [42]Williams GC, Niemiec CP, Patrick H, Ryan RM, Deci EL: The importance of supporting autonomy and perceived competence in facilitating long-term tobacco abstinence. Ann Behav Med 2009, 37(3):315-324.
• [43]Ryan RM, Patrick H, Deci EL, Williams GC: Facilitating health behaviour change and its maintenance: interventions based on self-determination theory. Eur Health Psychol 2008, 10:2-5.
• [44]Fortier MS, Sweet SN, O’Sullivan TL, Williams GC: A self-determination process model of physical activity adoption in the context of a randomized controlled trial. Psychol Sports Exercise 2007, 8:741-757.
• [45]Williams GC, Rodin GC, Ryan RM, Grolnick WS, Deci EL: Autonomous regulation and long-term medication adherence in adult outpatients. Health Psychol 1998, 17(3):269-276.
• [46]Kusurkar RA, Ten Cate TJ, van Asperen M, Croiset G: Motivation as an independent and a dependent variable in medical education: a review of the literature. Med Teach 2011, 33(5):e242-e262.
• [47]Henning MA, Krägeloh CU, Hawken SJ, Doherty I, Zhao Y, Shulruf B: Motivation to learn, quality of life and estimated academic achievement: medical students studying in New Zealand. Med Sci Educ 2011, 21(2):142-150.
• [48]Reeve J, Bolt E, Cai Y: Autonomy-supportive teachers: how they teach and motivate students. J Educ Psychol 1999, 91(3):537-548.
• [49]AAMC: The Case for Strategic Talent Management in Academic Management. Washington, D.C: Association of American Medical Colleges; 2011.
• [50]Dolmans DH, De Grave W, Wolfhagen IH, van der Vleuten CP: Problem-based learning: future challenges for educational practice and research. Med Educ 2005, 39(7):732-741.
• [51]Albanese MA, Mitchell S: Problem-based learning: a review of literature on its outcomes and implementation issues. Acad Med 1993, 68(1):52-81.
• [52]Norman GR, Schmidt HG: The psychological basis of problem-based learning: a review of the evidence. Acad Med 1992, 67(9):557-565.
• [53]Norman GR, Schmidt HG: Effectiveness of problem-based learning curricula: theory, practice and paper darts. Med Educ 2000, 34(9):721-728.
• [54]Deci EL, Eghrari H, Patrick BC, Leone DR: Facilitating internalization: the self-determination theory perspective. J Pers 1994, 62(1):119-142.
• [55]Atkinson JW: Motivational determinants of risk-taking behavior. Psychol Rev 1957, 64, Part 1(6):359-372.
• [56]Ryan RM: Control and information in the intrapersonal sphere: an extension of cognitive evaluation theory. J Pers Soc Psychol 1982, 43:450-461.
• [57]Kluger AN, Van Dijk D: Feedback, the various tasks of the doctor, and the feedforward alternative. Med Educ 2010, 44(12):1166-1174.
• [58]Vallerand RJ, Reid G: On the causal effects of perceived competence on intrinsic motivation: a test of cognitive evaluation theory. J Sports Psychol 1984, 6:94-102.
• [59]Deci EL, Spiegel NH, Ryan RM, Koestner R, Kauffman M: Effects of performance standards on teaching styles: behavior of controlling teachers. J Educ Psychol 1982, 74(6):852-859.
• [60]Suchman AL, Markakis K, Beckman HB, Frankel R: A model of empathic communication in the medical interview. JAMA 1997, 277(8):678-682.
• [61]Epstein RM, Street RLJ: Patient-Centered Communication in Cancer Care: Promoting Healing and Reducing Suffering. Bethesda, MD: National Cancer Institute NIH Publication No. 07–6255; 2007.
• [62]Willis SC, Jones A, Bundy C, Burdett K, Whitehouse CR, O’Neill PA: Small-group work and assessment in a PBL curriculum: a qualitative and quantitative evaluation of student perceptions of the process of working in small groups and its assessment. Med Teach 2002, 24(5):495-501.
• [63]Kruglanski AW, Van Lange PAM, Higgins ET: Handbook of Theories of Social Psychology Volume One. Thousand Oaks, CA: SAGE Publications; 2011.
• [64]Bunton SA, Corrice AM, Pollart SM, Novielli KD, Williams VN, Morrison LA, Mylona E, Fox S: Predictors of workplace satisfaction for U.S. medical school faculty in an Era of change and challenge. Acad Med 2012, 87:574-581.
• [65]Corrice AM, Fox S, Bunton SA: Retention of full-time clinical M.D. faculty at U.S. medical schools. In Analysis In Brief. Vol. 11. Washington, D.C: AAMC; 2011:1-2.