Self-determination in medical school: medical students' perspectives

Medical students enter medical school with varied backgrounds and learning expectations. Tensions arise between medical students’ expectations and expectations of the teachers and program, which impacts motivation. In self-determination theory people are motivated by satisfaction of three psychological needs: autonomy, competence, and relatedness, which enhance self-determination, but when hindered decrease motivation and well-being. The purpose of this study was to explore medical students' perspectives of their self-determination during medical school by exploring medical students’ perspectives of autonomy-supportiveness, competence-supportiveness, and relatedness with their teachers in their medical education program, and the impact on their learning. I used mixed methods design with two phases. In Phase I, medical students from a single institution completed three surveys all derived from self-determination theory, which investigated causality orientation, autonomy-supportiveness of teachers, and motivation to engage in learning. In Phase II, two World Café events were held at two sites. Medical students’ discussed their perspectives of autonomy, competence, and relatedness in their medical education. I used deductive content analysis to organize the findings into themes. In Phase I, 178 students responded (57% female). Survey scores were compared by gender, year in program, years of university before medical school, and distributed program site. The results indicated that medical students were autonomously oriented. Females were more autonomy-oriented than males, and engaged in learning for more autonomous reasons. Students in the distributed site perceived their teachers to be less autonomy supportive. In Phase II, 64 students attended two World Café events. Themes were categorized according to psychological need. The students identified several teacher actions and curricular structures that supported and hindered their self-determination. The themes across distributed sites were consistent; however, students in the distributed site perceived lower autonomy and less relatedness with their teachers. This study used qualitative methods to explore students’ perspectives of self-determination, which is unique to the self-determination literature. Educators often emphasize teaching methods to maximize cognitive and motivational outcomes. However, medical students emphasized specific teacher actions and curricular supports as most important for establishing the motivational context for learning. This research will help medical teachers to intentionally create appropriate motivational contexts for learners