Intrinsic motivation and perceived competence among junior doctors in managing ophthalmic disease
DOI:
https://doi.org/10.11157/fohpe.v25i2.771Keywords:
opthalmology, medical education, motivation, self-determination theory, junior medical officersAbstract
Introduction: Perceived competence among junior medical officers (JMOs) in managing ophthalmic disease remains low, and attempts to address this in ophthalmology education often neglect student motivation. This study aims to investigate whether JMOs’ perceived competence in managing ophthalmic patients could be predicted by their levels of motivation while studying ophthalmology as medical students.
Methods: Seventy-one JMOs completed a 7-point Likert scale 34-item questionnaire. Intrinsic motivation as a medical student was measured using the Intrinsic Motivation Inventory (IMI), which included autonomy, competence, relatedness, interest and pressure subscales. Perceived competence in managing ophthalmic disease was measured using the Perceived Competence Scale (PCS). Linear regression analysis was used to determine if intrinsic motivation during medical school predicted perceived competence as JMOs.
Results: Mean IMI scores and PCS scores were low, at 59 (out of 133) and 14 (out of 28), respectively. PCS scores were positively correlated with IMI scores (r = 0.61, p < 0.001), competence (r = 0.59, p < 0.001), relatedness (r = 0.49, p < 0001) and interest (r = 0.61, p < 0.001) and negatively correlated with pressure (r = -0.31, p = 0.009) and female gender (r = -0.30, p = 0.011). Linear regression analysis showed that IMI scores (β = 0.79, p < 0.001) significantly predicted PCS scores. Subscale analysis showed that there was significant predictive value in competence (β = 0.32, p = 0.009) and interest (β = 0.39, p = 0.035) for PCS scores.
Conclusion: This study shows that intrinsic motivation of medical students studying ophthalmology is significantly predictive of their perceived competence as JMOs managing ophthalmic disease. These results point to the importance of fostering medical student intrinsic motivation in an effort to improve perceived competence in JMOs.
References
Atta, I. S., & Alghamdi, A. H. (2018). The efficacy of self-directed learning versus problem-based learning for teaching and learning ophthalmology: A comparative study. Advances in Medical Education and Practice, 9, 623–630. https://doi.org/10.2147/AMEP.S171328
Bandhu, H. C., Bandhu, S. D., Raje, S., & Singh, G. (2020). A study of self-perceived competence of medical interns in India. South Asian Research Journal of Humanities and Social Sciences, 2(4), 37–43. https://sarpublication.com/media/articles/SARJAMS_24_37-43.pdf
Bandura, A., Freeman, W. H., & Lightsey, R. (1999). Self-efficacy: The exercise of control. W H Freeman/Times Books/Henry Holt & Co.
Barnsley, L., Lyon, P. M., Ralston, S. J., Hibbert, E. J., Cunningham, I., Gordon, F. C., & Field, M. J. (2004). Clinical skills in junior medical officers: A comparison of self-reported confidence and observed competence. Medical Education, 38(4), 358–367. https://doi.org/10.1046/j.1365-2923.2004.01773.x
Baylis, O., Murray, P. I., & Dayan, M. (2011). Undergraduate ophthalmology education: A survey of UK medical schools. Medical Teacher, 33(6), 468–471. https://doi.org/10.3109/0142159x.2010.540594
Bransford, J. D., Brown, A. L., & Cocking, R. R. (2000). How people learn: Brain, mind, experience, and school. The National Academies Press. https://doi.org/10.17226/9853
Carmody, D. F., Jacques, A., Denz-Penhey, H., Puddey, I., & Newnham, J. P. (2009). Perceptions by medical students of their educational environment for obstetrics and gynaecology in metropolitan and rural teaching sites. Medical Teacher, 31(12), e596–e602. https://doi.org/10.3109/01421590903193596
Cheung, V., Critchley, L. A. H., Hazlett, C., Wong, E. L. Y., & Oh, T. E. (1999). A survey of undergraduate teaching in anaesthesia. Anaesthesia, 54(1), 4–12. https://doi.org/10.1046/j.1365-2044.1999.00640.x
Deci, E. L., Eghrari, H., Patrick, B. C., & Leone, D. R. (1994). Facilitating internalization: The self‐determination theory perspective. Journal of Personality, 62(1), 119–142. https://doi.org/10.1111/j.1467-6494.1994.tb00797.x
Deci, E. L., & Ryan, R. M. (1985). Intrinsic motivation and self-determination in human behavior. Springer.
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. https://doi.org/10.1207/s15327965pli1104_01
Deci, E. L., & Ryan, R. M. (2008). Self-determination theory: A macrotheory of human motivation, development, and health. Canadian Psychology, 49(3), 182–185. https://doi.org/10.1037/a0012801
Dolmans, D. H. J. M., Wolfhagen, I. H. A. P., & Van Der Vleuten, C. P. M. (1998). Thinking about student thinking: Motivational and cognitive processes influencing tutorial groups. Academic Medicine, 73(10), S22–S24. https://doi.org/10.1097/00001888-199810000-00034
Dornan, T., Boshuizen, H., King, N., & Scherpbier, A. (2007). Experience-based learning: A model linking the processes and outcomes of medical students' workplace learning. Medical Education, 41(1), 84–91. https://doi.org/10.1111/j.1365-2929.2006.02652.x
Dornan, T., Littlewood, S., Margolis, S. A., Scherpbier, A., Spencer, J., & Ypinazar, V. (2006). How can experience in clinical and community settings contribute to early medical education? A BEME systematic review. Medical Teacher, 28(1), 3–18. https://doi.org/10.1080/01421590500410971
Duong, A. T., Van Tassel, S. H., Fernandez, A. G. A., Amin, A., Chadha, N., Glass, L. R. D., Dersu, I., Goyal, A., Graubart, E. B., & Elkin, Z. P. (2020). Medical education and path to residency in ophthalmology in the COVID-19 era: Perspective from medical student educators. Ophthalmology, 127(11), e95–e98. https://doi.org/10.1016/j.ophtha.2020.07.036
Dutt, D. D. C. S., Carr, S. E., Scott, T. M., Petsoglou, C., Grigg, J., & Razavi, H. (2023). Educators’ consideration of learner motivation in ophthalmology education in medical school: Influences on teaching practice and course design. Medical Teacher, 46(3), 387–398. https://doi.org/10.1080/0142159X.2023.2256956
Dutt, D. D. C. S., Razavi, H., & Carr, S. E. (2023). Self-determination theory in ophthalmology education: Factors influencing autonomy, competence and relatedness in medical students. Medical Education Online, 28(1), Article 2258633. https://doi.org/10.1080/10872981.2023.2258633
Epstein, R. M. (2007). Assessment in medical education. New England Journal of Medicine, 356(4), 387–396. https://doi.org/10.1056/nejmra054784
Fan, J. C., Sherwin, T., & McGhee, C. N. (2007). Teaching of ophthalmology in undergraduate curricula: A survey of Australasian and Asian medical schools. Clinical & Experimental Ophthalmology, 35(4), 310–317. https://doi.org/10.1111/j.1442-9071.2006.01414.x
Helena, B., Miller, G. C., Henderson, J., Bayram, C., Valenti, L., Harrison, C., Charles, J., Pan, Y., Wong, C., & Pollack, A. J. (2014). General practice activity in Australia 2013–14 (Vol. 36). Sydney University Press. https://ses.library.usyd.edu.au/bitstream/2123/11882/4/9781743324226_ONLINE.pdf
Hill, S., Dennick, R., & Amoaku, W. (2017). Present and future of the undergraduate ophthalmology curriculum: A survey of UK medical schools. International Journal of Medical Education, 8, 389–395. https://doi.org/10.5116/ijme.59ac.f69b
Huang, Z., Li, M., Zhou, Y., Ao, Y., Xin, W., Jia, Y., Yang, Y., Cai, Y., Xu, C., Yang, Y., & Lin, H. (2016). Modified team-based learning in an ophthalmology clerkship in China. PLoS One, 11(4), Article e0154250. https://doi.org/10.1371/journal.pone.0154250
Johnson, R. B., & Christensen, L. (2019). Educational research: Quantitative, qualitative, and mixed approaches (5th ed.). Sage publications.
Jones, A., McArdle, P. J., & O'Neill, P. A. (2001). How well prepared are graduates for the role of pre-registration house officer? A comparison of the perceptions of new graduates and educational supervisors. Medical Education, 35(6), 578–584. https://doi.org/10.1046/j.1365-2923.2001.00955.x
Kelley, K., Clark, B., Brown, V., & Sitzia, J. (2003). Good practice in the conduct and reporting of survey research. International Journal for Quality in Health Care, 15(3), 261–266. https://doi.org/10.1093/intqhc/mzg031
Kunanitthaworn, N., Wongpakaran, T., Wongpakaran, N., Paiboonsithiwong, S., Songtrijuck, N., Kuntawong, P., & Wedding, D. (2018). Factors associated with motivation in medical education: A path analysis. BMC Medical Education, 18, Article 140. https://doi.org/10.1186/s12909-018-1256-5
Kusurkar, R., Croiset, G., Mann, K. V., Custers, E., & ten Cate, O. T. J. (2012). Have motivation theories guided the development and reform of medical education curricula? A review of the literature. Academic Medicine, 87(6), 735–743. https://doi.org/10.1097/ACM.0b013e318253cc0e
Kusurkar, R., Croiset, G., & ten Cate, O. (2013). Implications of gender differences in motivation among medical students. Medical Teacher, 35(2), 173–174. https://doi.org/10.3109/0142159x.2012.737056
Kusurkar, R., Croiset, G., & ten Cate, O. 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), 978–982. https://doi.org/10.3109/0142159x.2011.599896
Kusurkar, R., ten Cate, O. T. J., van Asperen, M., & Croiset, G. (2011). Motivation as an independent and a dependent variable in medical education: A review of the literature. Medical Teacher, 33(5), e242–e262. https://doi.org/10.3109/0142159x.2011.558539
Li, B., Curts, D., Iordanous, Y., Proulx, A., & Sharan, S. (2016). Evaluation of Canadian undergraduate ophthalmology medical education at Western University. Canadian Journal of Ophthalmology, 51(5), 373–377. https://doi.org/10.1016/j.jcjo.2016.04.024
McAuley, E., Duncan, T., & Tammen, V. V. (1989). Psychometric properties of the Intrinsic Motivation Inventory in a competitive sport setting: A confirmatory factor analysis. Research Quarterly for Exercise and Sport, 60(1), 48–58. https://doi.org/10.1080/02701367.1989.10607413
Meece, J. L., & Painter, J. (2008). Gender, self-regulation, and motivation. Lawrence Erlbaum Associates Publishers.
Moulaert, V., Verwijnen, M. G., Rikers, R., & Scherpbier, A. J. (2004). The effects of deliberate practice in undergraduate medical education. Medical Education, 38(10), 1044–1052. https://doi.org/10.1111/j.1365-2929.2004.01954.x
Moxon, N. R., Goyal, A., Giaconi, J. A., Rosenberg, J. B., Graubart, E. B., Waxman, E. L., Knoch, D., Forster, S. H., Sankar, P. S., & Mirza, R. G. (2020). The state of ophthalmology medical student education in the United States: An update. Ophthalmology, 127(11), 1451–1453. https://doi.org/10.1016/j.ophtha.2020.05.001
Neufeld, A., & Malin, G. (2020). How medical students’ perceptions of instructor autonomy-support mediate their motivation and psychological well-being. Medical Teacher, 42(6), 650–656. https://doi.org/10.1080/0142159x.2020.1726308
Norman, G. R., & Schmidt, H. G. (1992). The psychological basis of problem-based learning: A review of the evidence. Academic Medicine, 67(9), 557–565. https://journals.lww.com/academicmedicine/Fulltext/1992/09000/The_psychological_basis_of_problem_based_learning_.2.aspx
Orsini, C., Binnie, V. I., & Wilson, S. L. (2016). Determinants and outcomes of motivation in health professions education: A systematic review based on self-determination theory. Journal of Educational Evaluation forHealth Professions, 13, Article 19. https://doi.org/10.3352/jeehp.2016.13.19
Park, J., Chung, S., An, H., Park, S., Lee, C., Kim, S. Y., Lee, J.-D., & Kim, K.-S. (2012). A structural model of stress, motivation, and academic performance in medical students. Psychiatry Investigation, 9(2), 143–149. https://doi.org/10.4306/pi.2012.9.2.143
Pelaccia, T., Delplancq, H., Triby, E., Bartier, J.-C., Leman, C., & Dupeyron, J.-P. (2009). Impact of training periods in the emergency department on the motivation of health care students to learn. Medical Education, 43(5), 462–469. https://doi.org/10.1111/j.1365-2923.2009.03356.x
Petrarca, C. A., Warner, J., Simpson, A., Petrarca, R., Douiri, A., Byrne, D., & Jackson, T. L. (2018). Evaluation of eLearning for the teaching of undergraduate ophthalmology at medical school: A randomised controlled crossover study. Eye, 32(9), 1498–1503. https://doi.org/10.1038/s41433-018-0096-1
Pierce, J. L., Kostova, T., & Dirks, K. T. (2001). Toward a theory of psychological ownership in organizations. The Academy of Management Review, 26(2), 298–310. https://doi.org/10.5465/amr.2001.4378028
Plant, R. W., & Ryan, R. M. (1985). Intrinsic motivation and the effects of self‐consciousness, self‐awareness, and ego‐involvement: An investigation of internally controlling styles. Journal of Personality, 53(3), 435–449. https://doi.org/10.1111/j.1467-6494.1985.tb00375.x
Pouget, A., Drugowitsch, J., & Kepecs, A. (2016). Confidence and certainty: Distinct probabilistic quantities for different goals. Nature Neuroscience, 19(3), 366–374. https://doi.org/10.1038/nn.4240
Quillen, D. A., Harper, R. A., & Haik, B. G. (2005). Medical student education in ophthalmology: Crisis and opportunity. Ophthalmology, 112(11), 1867–1868. https://doi.org/10.1016/j.ophtha.2005.05.005
Ryan, R., & Deci, E. (1987). When free-choice behavior is not intrinsically motivated: Experiments on internally controlling regulation. Unpublished manuscript, University of Rochester.
Ryan, R. M. (1982). Control and information in the intrapersonal sphere: An extension of cognitive evaluation theory. Journal of Personality and Social Psychology, 43(3), 450–461. https://doi.org/10.1037//0022-3514.43.3.450
Ryan, R. M., Connell, J. P., & Plant, R. W. (1990). Emotions in nondirected text learning. Learning and Individual Differences, 2(1), 1–17. https://doi.org/10.1016/1041-6080(90)90014-8
Ryan, R. M., & Deci, E. L. (2000a). Intrinsic and extrinsic motivations: Classic definitions and new directions. Contemporary Educational Psychology, 25(1), 54–67. https://doi.org/10.1006/ceps.1999.1020
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), 68–78. https://doi.org/10.1037//0003-066x.55.1.68
Ryan, R. M., Mims, V., & Koestner, R. (1983). Relation of reward contingency and interpersonal context to intrinsic motivation: A review and test using cognitive evaluation theory. Journal of Personality and Social Psychology, 45(4), 736–750. https://doi.org/10.1037//0022-3514.45.4.736
Sahoo, S. (2016). Finding self-directed learning readiness and fostering self-directed learning through weekly assessment of self-directed learning topics during undergraduate clinical training in ophthalmology. International Journal of Applied & Basic Medical Research, 6(3), 166–169. https://journals.lww.com/ijab/fulltext/2016/06030/finding_self_directed_learning_readiness_and.5.aspx
Sahoo, S., Venkatesan, P., Myint, K. T., & Moe, S. (2015). Peer-assisted learning activities during undergraduate ophthalmology training: How the medical students of Asia Pacific region perceive. Asia-Pacific Journal of Ophthalmology, 4(2), 76–79.
Scott, T. M., Succar, T., & Petsoglou, C. (2022). Ophthalmology teaching in Australian medical schools: A national survey. Medical Teacher, 44(10), 1173–1178. https://doi.org/10.1080/0142159X.2022.2072283
Shah, M., Knoch, D., & Waxman, E. (2014). The state of ophthalmology medical student education in the United States and Canada, 2012 through 2013. Ophthalmology, 121(6), 1160–1163. https://doi.org/10.1016/j.ophtha.2013.12.025
Sim, D., Hussain, A., Tebbal, A., Daly, S., Pringle, E., & Ionides, A. (2008). National survey of the management of eye emergencies in the accident and emergency departments by senior house officers: 10 years on—has anything changed? Emergency Medicine Journal, 25(2), 76–77. https://doi.org/10.1136/emj.2007.049999
Sobral, D. T. (2004). What kind of motivation drives medical students' learning quests? Medical Education, 38(9), 950–957. https://doi.org/10.1111/j.1365-2929.2004.01913.x
Spooner, A., Chapple, A., & Roland, M. (2001). What makes British general practitioners take part in a quality improvement scheme? Journal of Health Services Research & Policy, 6(3), 145–150. https://doi.org/10.1258/1355819011927396
Succar, T., Beaver, H. A., & Lee, A. G. (2022). Impact of COVID-19 pandemic on ophthalmology medical student teaching: Educational innovations, challenges, and future directions. Survey of Ophthalmology, 67(1), 217–225. https://doi.org/10.1016/j.survophthal.2021.03.011
Succar, T., & Grigg, J. (2010). A new vision for teaching ophthalmology in the medical curriculum: The Virtual Ophthalmology Clinic. In C. H. Steel, M. J. Keppell, P. Gerbic & S. Housego (Eds.), Curriculum, technology & transformation for an unknown future (pp. 944–947). Proceedings ascilite Sydney. https://www.ascilite.org/conferences/sydney10/procs/Succar-poster.pdf
Succar, T., & Grigg, J. (2019). Strategies for fostering inclusive classrooms in higher education: International perspectives on equity and inclusion. Emerald Publishing Limited. https://doi.org/10.1108/S2055-364120190000016014
Succar, T., Zebington, G., Billson, F., Byth, K., Barrie, S., McCluskey, P., & Grigg, J. (2013). The impact of the Virtual Ophthalmology Clinic on medical students’ learning: A randomised controlled trial. Eye, 27(10), 1151–1157. https://doi.org/10.1038/eye.2013.143
Swarna, N. (2013). Intrinsic motivation: How can it play a pivotal role in changing clinician behaviour? Journal of Health Organization and Management, 27(2), 266–272. https://doi.org/10.1108/14777261311321815
Tan, M., Driscoll, P., & Marsden, J. (1997). Management of eye emergencies in the accident and emergency department by senior house officers: A national survey. Emergency Medicine Journal, 14(3), 157–158. https://doi.org/10.1136/emj.14.3.157
ten Cate, O. T. J., Kusurkar, R. A., & Williams, G. C. (2011). How self-determination theory can assist our understanding of the teaching and learning processes in medical education. AMEE Guide No. 59. Medical Teacher, 33(12), 961–973. https://doi.org/10.3109/0142159X.2011.595435
Tran, E. M., Tran, M. M., Clark, M. A., Scott, I. U., Margo, C. E., Cosenza, C., Johnson, T. P., & Greenberg, P. B. (2020). Assessing the quality of published surveys in ophthalmology. Ophthalmic Epidemiology, 27(5), 339–343. https://doi.org/10.1080/09286586.2020.1746359
Tsigilis, N., & Theodosiou, A. (2003). Temporal stability of the intrinsic motivation inventory. Perceptual and Motor Skills, 97(1), 271–280. https://doi.org/10.2466/pms.2003.97.1.271
Vermunt, J. D. (1996). Metacognitive, cognitive and affective aspects of learning styles and strategies: A phenomenographic analysis. Higher Education, 31(1), 25–50. https://doi.org/10.1007/bf00129106
Vernon, S. (1988). Eye care and the medical student: Where should emphasis be placed in undergraduate ophthalmology? Journal of the Royal Society of Medicine, 81(6), 335–337. https://doi.org/10.1177/014107688808100612
Williams, G. C., & Deci, E. L. (1996). Internalization of biopsychosocial values by medical students: A test of self-determination theory. Journal of Personality and Social Psychology, 70(4), 767–779. https://doi.org/10.1037//0022-3514.70.4.767
Williams, G. C., Freedman, Z. R., & Deci, E. L. (1998). Supporting autonomy to motivate patients with diabetes for glucose control. Diabetes care, 21(10), 1644–1651. https://doi.org/10.2337/diacare.21.10.1644
Williams, G. C., Wiener, M. W., Markakis, K. M., Reeve, J., & Deci, E. L. (1994). Medical students’ motivation for internal medicine. Journal of General Internal Medicine, 9(6), 327–333. https://doi.org/10.1007/BF02599180
Wu, D. J., & Greenberg, P. B. (2016). A self-directed preclinical course in ophthalmic surgery. Journal of Surgical Educucation, 73(3), 370–374. https://doi.org/10.1016/j.jsurg.2015.11.005
Yau, S., Wong, M., & Cervin, A. (2021). A survey of Queensland medical education in otolaryngology. Australian Journal of Otolaryngology, 4 (1), 12–20. https://doi.org/10.21037/ajo-20-87
Zhang, H. H., Hepschke, J. L., Shulruf, B., Francis, I. C., Spencer, S. K., Coroneo, M., & Agar, A. (2018). Sharpening the focus on ophthalmology teaching: Perceptions of medical students and junior medical officers. Clinical & Experimental Ophthalmology, 46(9), 984–993. https://doi.org/10.1111/ceo.13342
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