Sources and Changes in Medical Student Motivation: A Longitudinal Self-Determination Theory Analysis

Motivation is a key determinant of engagement, learning, and well-being for medical students. Guided by Self-Determination Theory, this study examined the intrinsic and extrinsic contributions to motivation across the medical school curriculum using the Work Extrinsic and Intrinsic Motivation Scale (WEIMS).

This longitudinal study surveyed medical students using the 18-item WEIMS at 5 timepoints: 0 months (matriculation), 12 months, 18 months, 30 months, and 48 months (graduation). Subscales represented 6 motivational types: Intrinsic, Integrated, Identified, Introjected, External, and Amotivation. While the first three subscales reflect forms of autonomous or self-driven motivation, the latter three capture motivation influenced by external pressures or the absence of motivation, altogether. Composite indices included the Work Self-Determination Index (W-SDI), which summarizes how much a person's motivation comes from within themselves versus outside pressures. Reliability was assessed with Cronbach's alpha, and longitudinal differences were evaluated with 1-way analysis of variance and Welch t-test (Holm-corrected).

A total of 1828 surveys were analyzed. Overall, Work Self-Determined Motivation was significantly higher than Work Non-Self-Determined Motivation at all measured timepoints. W-SDI scores were significantly higher at matriculation (mean (SD): 15.387 (5.99)) compared to 18 months (12.13 (6.94), P < .0001), 30 months (12.50 (7.16), P < .0001), and 48 months (13.59 (6.89), P < .01). This decrease in W-SDI arose from significant (P < .0001) increases in external regulation at 18 months (0.52), 30 months (0.54), and 48 months (0.52), as well as a significant increase in amotivation at 18 months (0.32, P < .01) and 30 months (0.29, P = .012).

Medical students' motivation is dynamic throughout training. Self-determined motivation is higher than non-self-determined motivation at all time points but declined slightly throughout training. These results may help guide the development of curricula that enhance autonomy, competence, and relatedness to sustain intrinsic motivation throughout medical education.