Self-determination theory in ophthalmology education: factors influencing autonomy, competence and relatedness in medical students

Figures & data

Figure 1. Relationship between types of motivation and locus of causality according to self-determination theory.

Table 1. Steps of analysis in phenomenography research as outlined by Dahlgren and Fallsberg [50] with elaboration of the procedure in this study. DDCSD, HR and SC are authors of the present study.

Steps	Description	Procedure in this study
1. Familiarisation	Reading through all interviews	All interviews were transcribed and read by DDCSD
2. Compilation	Organising student responses according to each interview question and identifying significant elements in responses	Transcripts organised and significant elements of each answer noted by DDCSD
3. Condensation	Reducing answers to discern central meaning units	Preliminary meaning units of answers of two transcripts identified by DDCSD Discussion and agreement between DDCSD, HR and SC on meaning units of initial two transcripts. Disagreement was resolved by discussion between authors and revisiting the transcript data. DDCSD completed condensation of remainder transcripts. Meaning units of all transcripts were confirmed independently by DDCS, HR and SC. Disagreement was resolved by discussion between authors and revisiting the transcript data. Meaning units often identified factors that affected motivation
4. Preliminary grouping	Allocating similar meaning unit into groups of meaning	Arranging meaning units of answers into preliminary dimensions of variation by DDSD, maintaining factors that affected motivation previously identified Hierarchical conceptions within these dimensions of variation emerged, and were noted by DDCSD Preliminary dimensions of variation and hierarchical conceptions were confirmed independently by HR and SC
5. Preliminary comparison	Differentiating groups of meaning, ensuring each is unique	DDCSD carefully delineated each dimension of variation and conceptions to ensure each was specific and unique Meaning units were independently scrutinised by DDCSD, HR and SC to ensure they belonged to specific dimension of variation and conceptions Refinement of preliminary grouping was Factors that affected motivation were differentiated and their relationship to each dimension and conception was identified The above was done iteratively by DDCSD, HR and SC independently until a more optimal distinction of meaning units, dimensions and conceptions could not be realised.
6. Naming	Assigning meaningful labels to each group	Dimension of variation and conceptions were named according to the terminology of Self-Determination Theory by DDCSD Factors that affected motivation were named to represent their true meaning by DDCSD All names were reviewed and agreed upon independently by DDCSD, HR and SC Steps 1–6 were done iteratively, until researchers deemed there to be true distinctions between names of factors of motivation, dimensions and conceptions and their associated meanings.
7. Contrastive comparison	Contrasting and describing groups of meaning according to their essence of meaning and identifying relationships between them.	Emergence of an outcome space through study of the relationships between conceptions in dimension of variation, noted by DDCSD Factors that affected motivation were represented according to their impact on each their relationship to each dimension and conception was identified, noted by DDCSD The outcomes space and factors that affected motivation carefully scrutinised independently by DDCSD, HR and SC

Table 2. Motivation space in ophthalmology education (MSOE): dimensions of variation and hierarchical conceptions of students’ experiences.

Dimension of variation	Amotivation	External locus extrinsic motivation	Internal locus extrinsic motivation	Intrinsic motivation
Autonomy: desire to initiate one’s own behaviour	A1: No perception of control during their ophthalmology rotation	A2: Desire to act according to a structured timetable and ophthalmology curriculum	A3: Feeling of uninhibited exploration of the ophthalmology curriculum	A4: Innate interest to engage in activities within and beyond the ophthalmology curriculum
Competence: desire to feel effective	C1: Feeling of inability to achieve proficiency of ophthalmology	C2: Desire to learn for fulfilling set curriculum standards	C3: Drive to understand core concepts in ophthalmology	C4: Constant desire to achieve, maintain and enhance confidence and effectiveness in their ophthalmology knowledge and skill
Relatedness: desire to belong and feel connected	R1: Perception of alienation from mentors and ophthalmology as a discipline	R2: Accepting of mentors as authoritative and paternalistic	R3: Perception of belonging within the ophthalmology rotation as in the role of a student	R4: Strong sense of acceptance and connection to peers and mentors during their ophthalmology rotation

Figure 2. Factors that impact on students’ perception of autonomy, competence and relatedness, (-) indicates factors with a negative impact.

Table

Box 1: Recommendations for educators to foster intrinsic motivation in medical students studying undergraduate ophthalmology Organise a curriculum with ample of opportunity for supported self-direction and problem solving Listen and act to minimise perceptions of pressure and apprehension in students Allow students to actively contribute to patient care in clinical placements Assign appropriate assessments that purposefully reflect curriculum goals Provide constructive formal and informal feedback on students’ ophthalmic knowledge and procedural skills in-class and placements Provide non-judgemental guidance in lectures, tutorials, workshops, clinical placements and informally Cultivate motivation and well-being within yourself to ensure you are best positioned to invest in and respect your students

Dahlgren L-O, Fallsberg M. Phenomenography as a qualitative approach in social pharmacy research. J Soc Adm Pharm. 1991;8(4):150–156.

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