The importance of self-determination theory for medical education

While some theories of human motivation focus exclusively on levels of moti vation, self-determination theory argues that different types of motivators , even when the resulting motivation is high, will lead to very different o utcomes. This theory differentiates between two primary kinds of motivation , controlled and autonomous. Controlled motivation depends either on explic it or implicit rewards or punishment or on people's internalized beliefs ab out what is expected of their. Learning in controlled situations, in which students act under pressure and anxiety, is likely to be rote, short-lived, and poorly integrated into students' long-term values and skills, In contr ast, autonomous motivation, as its name implies, is personally endorsed and reflects what people find interesting and important. While controlled moti vation involves compliance with pressures, autonomous motivation involves b ehaving with a sense of volition, agency, and choice. Autonomously motivate d learning leads to better educational outcomes. There is evidence that med ical students who learn in autonomy-supportive environments act in more aut onomy-supportive ways in their interactions with patients. Because the reli able implementation of practice guidelines and physicians' use of an autono my-supportive style have been associated with more positive health outcomes (particularly in the behavior-related areas of smoking cessation, weight l oss, etc.), more autonomy-supportive medical education may result in more e ffective health care delivery.