How medical students’ perceptions of instructor autonomy-support mediate their motivation and psychological well-being

Abstract

Purpose: Medical student well-being is an increasing concern in medical education. Understanding the role instructors and programs have in supporting well-being is an important puzzle piece. This study explores the relationship between medical students’ perceptions of instructor autonomy-support, motivation, and well-being. Using self-determination theory, we aim to provide a practical framework through which medical instructors can support student autonomy and well-being in the learning environment.

Materials and methods: Students from the University of Saskatchewan completed a survey measuring perceptions of the learning climate (LC) (instructor autonomy-support), satisfaction/frustration of basic motivational needs (autonomy, competence, relatedness), and psychological well-being. Multiple linear regression was used to determine whether age, gender, and year of study affected students’ well-being, before a mediation model was tested to assess the direct effect of the LC and indirect effects of students’ basic need fulfillment on their well-being.

Results: The response rate was 183/400 (46%). Higher ratings of autonomy-support significantly predicted better student well-being. This was mediated completely by students’ feelings of basic need fulfillment. Relatedness satisfaction contributed most to ratings of instructor autonomy-support.

Conclusions: Cultivating autonomy-support for medical students is critical to their well-being. Learning environments that optimize autonomy-support will also support students’ feelings of relatedness and competence.

Keywords:

• Medical student
• autonomy-support
• learning environment
• motivation
• psychological well-being

Acknowledgements

The author AN would like to acknowledge Dr. Annik Mossière PhD, for her assistance with various statistical and conceptual aspects of this study.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Data availability statement

The data from this research project are available upon reasonable request.

Glossary

Autonomy-support: Represents a positive interpersonal orientation in which those in positions of authority (e.g. instructors) take learner perspectives into account. It pertains to how much learners feel their perspectives are acknowledged by their instructors and how much they believe their instructors give them choices and engage them in the learning process.

Adapted from Williams GC, Deci EL. 1998. The importance of supporting autonomy in medical education. Ann Intern Med. doi:10.7326/0003-4819-129-4-199808150-00007.

Basic psychological needs: According to self-determination theory, all human beings require satisfaction of three universal psychological needs, for optimal development, flourishing, and psychological well-being: autonomy (the need to feel in control of one's own life, behaviors, and goals), competence (the need to feel challenged and master one's environment), and relatedness (the need to feel close with and have trusting relationships with others).

Adapted from Ryan RM, Deci EL. 2017. Self-determination theory: basic psychological needs in motivation development and wellness.

Eudaimonic well-being: Centers around growth and human fulfillment, through living a life of virtue and striving toward self-actualization. According to Ryff, this encompasses an integration of self-acceptance, personal growth, personal relationships, life purpose, autonomy, and environmental mastery.

Adapted from Ryff CD, Singer BH. 2008. Know thyself and become what you are: a eudaimonic approach to psychological well-being. J Happiness Stud. 9(1):13–39. doi:10.1007/s10902-006-9019-0.

Additional information

Funding

The authors of this manuscript received funding from the College of Medicine’s Dean’s Summer Research Project Fund.

Notes on contributors

Adam Neufeld

Adam Neufeld, MSc, is a fourth-year medical student at the University of Saskatchewan.

Greg Malin

Greg Malin, MD, PhD, is a member of faculty in the Department of Academic Family Medicine at the University of Saskatchewan.