Autonomy-Supportive Medical Education: Let the Force Be Within You!

Transcription

1 Self Determination Motivation Autonomy Relatedness Competence Autonomy-Supportive Medical Education: Let the Force Be Within You! Laura P. Shone, DrPH, MSW Associate Professor of Pediatrics University of Rochester Medical Center Rochester NY On behalf of: Baldwin CD, Shone LP, Harris JP, Craig M, Cellini M, Varade W. Development of a novel curriculum to enhance the autonomy and motivation of residents Self-DeterminationTheory: An Approach to Human Motivation and Personality, Baldwin CD, Shone LP, Harris JP, Craig M, Cellini M, Varade W. Development of a novel curriculum to enhance the autonomy and motivation of residents. Pediatrics. 2011; 128:

2 Self-Determination Theory: Satisfaction of three innate psychological needs drives motivation Autonomy: Desire to be the source of one s own behavior Feeling of freedom to choose one s own goals Self- Determination Competence: Desire to feel effective in actions one pursues and performs Perception of confidence and accomplishment Relatedness: Desire to feel connected with others Sense of belonging to a valued group Ryan, RM and Deci, EL. Self-Determination theory and the facilitation of intrinsic motivation, social development, and well-being. American Psychologist, 2000, 55(1):

3 Self-determination is a key factor in motivation, which fuels the drive to learn Motivation = human energy directed toward a goal: It is autonomous when the goal is chosen because of its intrinsic value to the individual It is controlled if the goal is dictated by others Many forces influence a student s motivation to learn: Personal interests and needs Influence of peers Evaluation: grades, exams System mandates: schedules, regulations, curriculum requirements, documentation In medical education, autonomous motivation is constantly challenged by external controls Internal locus of control External locus of control 3

4 Findings of motivation research show these educational associations: Skill in rote memorization and algorithmic performance Behavior dependent on contingencies Erosion of intrinsic motivation for future learning Autonomous motivation creates learners with: Higher academic achievement Higher perceived competence Preference for optimal challenge Higher self-worth Stronger sense of community More creativity Our task: To stimulate intrinsic motivation in learners, even though we teach in a highly controlling environment! Ten Cate, Kusurkar, Williams. How self-determination theory can assist our understanding of the teaching 4 and learning processes in medical education. AMEE guide No. 59. Med Teach. 2011;33:

5 Motivation Self Determination Autonomy Competence Relatedness How can you practice autonomy-supportive education? Give learners choices Acknowledge their perspectives Encourage their acceptance of personal responsibility Provide them with constructive feedback Evaluate them using individualized assessment Grant them full responsibility for specific tasks once they have demonstrated competence Self-determined learners thrive when they feel autonomous, competent and part of a community Kusurkar, Croisel, ten Cate. Twelve tips to simulate intrinsic motivation in students through autonomysupportive classroom teaching derived from Self-Determination Theory. Med Teach. 2011; 33:

6 And what about all those rules and mandates? In SDT, self-regulation (like motivation) can be controlled, or autonomous, or somewhere in between When learners are coerced, they self-regulate because of fear or shame When learners are helped to see the value of rules in a personally meaningful context, they learn to self-regulate around external controls that they have integrated into their value system Integrated self-regulation allows autonomous individuals to maintain motivation, even in a controlling environment IF the rules are in fact meaningful to them! Learners need: Autonomy support Understanding that rules can have personal meaning Self-regulation goes hand in hand with autonomy in the world of self-determined physicians who are independent, responsible, inquisitive and fulfilled 6

7 Positive Factors PERSONAL: Drive to excel Reflection Self assessment Goal setting & tracking Work/life balance Inherent or Learned SD traits ENVIRONMENTAL: Healthy work climate Peer/social support Manageable schedule Autonomy Relatedness Competence Educationally Enhanced Self- Determination EDUCATIONAL: Practice of adult learning Learning from preceptors, peers & patients Didactics & self-directed learning Learner input into learning agenda Self determined physician: independent responsible inquisitive fulfilled Negative Factors PERSONAL BARRIERS: Conflicting priorities Weak professional commitment Poor time management Lack of social support Sleep loss & burnout SYSTEM BARRIERS: Abusive hours Paperwork burden Inflexible regulations Patient safety/litigation protections Lack of continuity in patient care EDUCATIONAL BARRIERS: Passive learning Limited freedom of choice Harsh evaluation; lack of constructive feedback Insufficient time for reflection & learning 7