Autonomous motivation in medical education

Abstract

Intrinsic motivation was a reining concept for many years in self-determination theory (SDT) research. Since the last 10 years, the concept of autonomous motivation is used more commonly by some researchers. Autonomous motivation means motivation arising out of genuine interest or personal endorsement or valuing of an activity. Autonomous motivation is a combination of intrinsic motivation and identified regulation type of extrinsic motivation. This article aims to clarify and put forth the concept and use of autonomous motivation in the practice of medical education.

The great Indian Epic Mahabharata, has immortalized Arjun as an exemplary pupil in all of Indian mythology. Arjun was one of the five brothers called Pandavas and was considered as the greatest archer across the land. He lived and studied in the “Gurukul” (residency school) of Guru Dronacharya, along with many other pupils. One day, Guru Dronacharya’s other pupils came to him complaining that he was partial to Arjun and taught him more than them, which was the reason for Arjun’s unparalleled skill in archery. Guru Dronacharya, with a calm expression, explained to them that as a teacher he always imparted the same knowledge and skills to all his pupils. Arjun’s curiosity was, however, never satisfied with what he received and he always came back asking for more, and looking for other resources of knowledge and skills. It was Arjun’s intrinsic motivation that made him the best archer. Arjun’s motivation is a great example of the most self-determined form of motivation.

On another occasion, Guru Dronacharya tested all his pupils in the skill of archery. He asked his pupils to take aim at the eye of a stuffed bird mounted on a tree. His pupils came forward one by one. As they took aim, Guru Dronacharya asked them, “What do you see?”. Every time he got the same answer, “I see the bird, the tree, the forest, the sky….”. When it was Arjun’s turn, he replied, “I only see the eye of the bird”. This made Guru Dronacharya very happy. He allowed Arjun to release his arrow which pierced the bird’s eye perfectly. He turned around to all his pupils and explained to them that Arjun’s focus on what he was learning and the importance that he ascribed to learning was the reason for his skill. This is an example of personal endorsement of the value of a learning activity, which is called identified regulation of extrinsic motivation.

Intrinsic motivation and identified regulation qualities of motivation are together called autonomous motivation. Thus, autonomous motivation means motivation arising out of genuine interest or personal endorsement or valuing of an activity. This concept is described by self-determination theory (SDT) of motivation (Ryan and Deci 2000; Vansteenkiste et al. 2005; Kusurkar and Croiset 2015). On the contrary, controlled motivation means motivation that arises from internal pressure or external pressure or desire for rewards, prestige, and fame, etc. SDT endorses autonomous motivation as the type of motivation that leads to better quality of learning, creativity, better performance, persistence, resilience, well-being, and motivation for lifelong learning in comparison with controlled motivation (Ten Cate et al. 2011; Kusurkar and Croiset 2015; Van der Burgt et al. 2018)

Intrinsic motivation was a reining concept for many years in SDT research. Since the last 10 years, the concept of autonomous motivation is used more commonly by some researchers. There are several reasons for this. It is difficult for any person to be intrinsically motivated for every activity at every point in time. For example, a student may have an overarching intrinsic motivation for medical study (contextual level of motivation), but may not be interested in every topic in medical education or on every day (situational level of motivation). If I take my own example, when I was a first year medical student, I loved studying to become a doctor, but really disliked (bordering on hated) learning the Krebs cycle in Biochemistry. Unfortunately, the importance of the Krebs cycle dawned on me only when I saw patients with diabetes in the second year of medical study. After that I stopped hating the topic and saw it in a new light, thinking, “I need this knowledge to treat diabetic patients”. Thus, I personally endorsed the importance of learning the Krebs cycle instead of being forced to do it for my exams and was able to do it successfully with long-term retention of the knowledge. My motivation shifted from controlled (for obtaining grades) to autonomous (personal valuation of the activity).

Research has shown that having identified regulation for an educational activity is also associated with better learning and good academic performance, just like intrinsic motivation. I used my abovementioned experience years later when I completed my specialization in physiology and started teaching the subject to medical students. I always started my lessons with the importance of studying the topic and its applied value in patient care. I believe I was able to create a situation where my students were in the identified regulation state of motivation, hence autonomously motivated rather than the controlled motivated. This phenomenon is labeled as “internalization” by SDT. Internalizing the importance of an activity leads to cessation of dissonance and the fostering of a harmonious existence.

Autonomous motivation needs three pillars of support. A student can feel autonomously motivated for learning only if he has autonomy over his own learning, feels competent in his learning, and feels relatedness or connectedness with his peers, teachers, patients, etc. These are termed as basic psychological needs in SDT (Ryan and Deci 2000). A student who feels controlled by the grading system in her medical school, incompetent in learning due to a huge cognitive load, and no affinity towards fellow students or teachers, can never feel autonomously motivated for studying medicine. Teachers can instill the feeling of autonomy through autonomy-supportive teaching, build the feeling of competence by breaking down complex and difficult tasks into smaller steps in which competence can be gained gradually, and perpetuate the feeling of relatedness by providing emotional support and understanding to their students (Kusurkar et al. 2011; Kusurkar and Croiset 2015).

Nurturing autonomous motivation for learning among medical students is essential for developing “students for life”. For me, students for life are students who are intrinsically motivated learners, are constantly interacting with their environment, are integrating learning and practice and are investing in continuing professional development.

Autonomous motivation or self-determined motivation is well-captured in the following quote by the founders of SDT (Deci and Ryan 2006):

To be self-determined is to endorse one’s actions at the highest level of reflection. When self-determined, people experience the freedom to do what is interesting, personally important, and vitalizing. (Edward L. Deci and Richard M. Ryan)

Disclosure statement

The author reports no conflicts of interest. The author alone is responsible for the content and writing of this article.

Additional information

Notes on contributors

Rashmi A. Kusurkar

Rashmi A. Kusurkar, MD, PhD, FAMEE, is an Associate Professor and Head of Department of Research in Education at Amsterdam UMC, VUmc School of Medical Sciences, Amsterdam, the Netherlands. She is International Scholar on Self-Determination Theory and the Chief Organizer of the 7th International Conference on Self-Determination Theory 2019.