Linlea Armstrong MD (biography and disclosures)
What I did before
Telling our students that “it will be on the exam”, may give us a sense that the students will learn it. This line tends to get used when there is an important topic that the teacher suspects students might otherwise not sufficiently attend to. Yet the strategy is unlikely to inspire deep and long-term learning, the kind of learning that students will later be able to retrieve and apply to patient care (Kusurkar et al., 2011; Jarvis-Selinger, 2012).
What changed my practice
I have become more aware of the importance of motivation in adult learning, and specifically the differences between extrinsic and intrinsic motivation. Intrinsic motivation for learning is the drive that comes from interest in mastering a topic itself. An intrinsically motivated learner learns for mastery; intrinsic motivation has been shown to be associated with deep learning, better performance, and well-being (Kusurkar et al., 2011; Ryan & Deci, 2000a; Ryan & Deci, 2000b).
An extrinsic motivator is an external incentive. It can operate as a supplement or be an alternative to intrinsic motivation. Examples include a grade, threat of remediation or failure, money (e.g. a scholarship), a license to practice, reinforcement by a mentor, or the need to present one’s work in front of others. When a learner is focused on attaining or avoiding something peripheral to the core intended competency, the learner will likely work to the minimum requirements of that motivator. In other words, seeking praise or avoiding punishment moves an individual’s focus away from deep learning (Jarvis-Selinger, 2012; Ryan & Deci, 2000a).
Learners admitted to the Faculty of Medicine are experienced and savvy as students and exam takers even before admission. Additionally, the heavy demands of the program require students to find efficiencies and prioritize. Thus, if teachers do not invest in supporting the development of the intrinsic motivation in students, it should be no surprise when well meaning students find ways of “gaming our system”. If students are obtaining the solutions to cases or problem sets from more senior students, they are simply responding to external motivations, are not engaged in meaningful learning and therefore have probably not been sufficiently convinced of the value of the learning process itself. Assuming we are teaching valuable skills and knowledge, we need to make them more aware of how their current attempts at short-term benefits will likely disadvantage them in the long term.
What I do now
1) Invest in helping students to generate intrinsic motivation in the topic (Kusurkar et al., 2011):
- Be transparent about the goals and the objectives of the session;
- Help students see the relevance of current knowledge and skills to their future professional roles;
- Support student self assessment and self-reflection;
- Ensure each student believes that he/ she will be able to learn the topic in a meaningful way.
2) Use extrinsic motivators more sparsely and with more awareness. In addition, complement this approach with efforts to stimulate a learner’s intrinsic motivation. There is no denying that an upcoming licensing exam can focus a student’s attention. But simply relying on this motivator will most likely only end in a ‘cram and regurgitate’ approach, which leads to poor long-term retention. A teacher who helps a learner recognize how the material being studied is relevant to future practice, motivates deep, enduring learning.
3) Recognize that there may be a separate problem requiring attention (Pratt et al., 2001), if I am failing to instill intrinsic motivation in my learner(s):
- The learner may have a personal distraction, a learning difficulty, etc.;
- The learning context may be overwhelming or inappropriate;
- The content may be overwhelming or inappropriate.
In summary, signaling that something will be on the exam is an indirect way of signaling that the topic is important, but explaining how and why it is relevant to a student’s future practice is a more powerful approach. When a teacher finds herself heavily dependent on extrinsic motivators to drive learning, she may need to reflect upon whether she is doing enough to instill intrinsic motivation, or if there are inhibitors with her approach, or with the learners, the context, or the content.
Deci, E. L., Koestner, R., & Ryan, R. M. (1999). A meta-analytic review of experiments examining the effects of extrinsic rewards on intrinsic motivation. Psychological bulletin, 125(6), 627.
Deci, E. L., & Ryan, R. M. (2000). The” what” and“ why” of goal pursuits: Human needs and the self-determination of behavior. Psychological inquiry, 11(4), 227–268.
Ryan, R. M., & Deci, E. L. (2000). Intrinsic and extrinsic motivations: Classic definitions and new directions. Contemporary educational psychology, 25(1), 54–67.
Ryan, R. M., & Deci, E. L. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American psychologist, 55(1), 68.
Jarvis-Selinger, S. (2012). What We Should Know About Learning to Be Better Teachers. Emerging Leaders Program Library, The American Orthopaedic Association www.aoassn.org.
Kusurkar, R. A., Croiset, G., & Ten Cate, T.J. (2011). Twelve tips to stimulate intrinsic motivation in students through autonomy-supportive classroom teaching derived from self-determination theory. Medical Teacher. 33(12). 978-82.
Pratt, D. D., Arseneau, R., & Collins, J. B. (2001). Reconsidering “Good Teaching” Across the Continuum of Medical Education. The Journal of Continuing Education in the Health Professions. 21(2). 70–81.
Ryan, R. M., & Deci, E. L. (2000a). Intrinsic and extrinsic motivations: Classic definitions and new directions. Contemporary educational psychology, 25(1). 54–67.
Ryan, R. M., & Deci, E. L. (2000b). Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American psychologist, 55(1). 68.