Preceptor Pearl: Moving Motivation - FAO UNC Eshelman School of Pharmacy

Charlene Williams, PharmD, BCACP, CDE

A commonly requested topic in experiential education is “learner motivation.” Understanding the psychological origins of motivation may lead to strategies to promote it. Motivation is on a continuum and is not a permanent state or characteristic; therefore, an individual’s motivation may vary based on the individual task or over time.¹

Basic Motivation Types¹^-5:

Intrinsic motivation is fostered in conditions that support the psychological needs of competence (self-efficacy), autonomy (self-organizing experience and behavior and aligning activity with one’s sense of self), and relatedness (sense of belonging in the social environment) according to Self-Determination Theory.^2,4 Since not all learning activities are enjoyable or interesting to promote intrinsic motivation, it is important to consider that autonomy, competence, and relatedness also promote the internal processes that transform extrinsically motivated behavior as emanating from self instead of externally and enhance personal commitment.⁴ An example of this is learning a patient interviewing skill because of the value it brings to patient care. Table 1 describes some teaching behaviors that promote competence, autonomy, and relatedness.^1,6

Teaching Behaviors that Promote Movement Along the Motivation Continuum

(adapted from Cate et al¹ and Kusurkar et al⁶)

Teaching Behavior	Description
Deliver feedback that promotes competence, autonomy, and relatedness¹	Feedback is given in the spirit to improve competence¹
Focus on the activity instead of the individual¹	“This [task or activity] can be difficult. Let’s see how we can accomplish it.”¹
Promote self-efficacy through questioning versus instructional messages¹ Focus on the learner perspective instead of the provider perspective¹	“How do you plan to manage this next time? I am here if you need me.”¹
Include the learner as part of the professional group in discussions¹	“This is something as pharmacists we must all go through and practice to achieve this skill.”¹
Determine what learners need and want⁶	Discuss learner learning goals, career aspirations, and preferred modes of learning Use learner evaluations to modify learning activities⁶
Actively involve learners in the learning process⁶	Allow learners to teach portions of discussions⁶ Promote “doing” activities with coaching after modeling the way
Encourage learners to accept responsibility for learning⁶	Have learners self-identify questions that remain after a case or activity and report findings back to you⁶
Provide guidance and structure⁶	Allow learners to take the lead when able yet gently provide expertise to support when needed or if the learner goes down the wrong path⁶
Provide challenges that slightly push learners out of their comfort zones⁶	If a learner is progressing well in the experience, provide optional activities that aren’t too easy or too difficult that they can choose to do (which are just above their current level of achievement)⁶
Provide emotional support⁶	Create a welcoming environment that promotes the sharing of ideas⁶
Acknowledge negative attitudes or disinterest⁶	Empathize to show you understand the learner’s perspective when a learner shares disinterest or dislike of an activity⁶
Share the value of activities⁶	Provide the rationale/relevance of learning activities⁶

References

Cate TT, Kusurkar RR, Williams GF. How self-determination theory can assist our understanding of the teaching and learning processes in medical education. AMME Guide No. 59. Med Teach 2011; 33: 961–973.
Ryan RM and Deci EL. Intrinsic and extrinsic motivations: classic definitions and new directions. Contemp Educ Psychol 2000; 25;54-67).
Deci EL Ryan RR. The “what” and “why” of goal pursuits: human needs and self-determination of behavior. Psychological Inquiry 2000;11(4):227-268.
Ryan RM, Deci EL. Self-determination theory and facilitation of intrinsic motivation, social development and well-being. Am Psychol 2000;55(1):68-78.
Kusurkar RA, Ten Cate O, van Asperen MA, Croiset G. Motivation as a dependent and independent variable in medical education: a review of the literature. Med Teach 33(5):242-262.
Kusurkar RA, Croiset G, Cate TT. Twelve tips to stimulate intrinsic motivation in students through autonomy-supportive classroom teaching derived from self-determination theory. Med Teach 2011; 33:978–982.