Letters to the Editor
To the Editor:
In a recent article in Academic Medicine, Biondi and colleagues1 present the applicability of self-determination theory to resident supervision in postgraduate medical education. The authors expose a discrepancy in the level of autonomy in patient care that faculty think they provide and residents think they receive. The negative effect of this on the intrinsic motivation and clinical performance of residents, though not measured, is certainly implied. According to the authors, faculty are reluctant to provide autonomy to less confident and passive residents who are unable to “show” their motivation. A recent study shows how medical school graduates feel unprepared for practice because of a lack of enough independent experience in direct patient care.2 We hypothesize that this “unpreparedness” among graduate medical students is further observed during residency as uncertainty and passiveness.
In order to solve this problem, we think that it is important to view medical education as a continuum. Scaffolding and its three cornerstones3 (contingency, fading, and transfer of responsibility) should be applied throughout undergraduate and postgraduate medical education. Scaffolding will look different for each learner depending not only on the level of prior knowledge and competence but also on the level of relatedness. Successful employment of scaffolding strategies customized to learner needs demands more research into individual differences in motivation and learning. This calls for a person-oriented approach in designing studies, meaning grouping students with similar motivational profiles using cluster analysis, for analyzing learning outcomes.4
Rashmi A. Kusurkar, MD, PhD
Assistant professor and head of research in education, VUmc School of Medical Sciences, Amsterdam, the Netherlands; R.Kusurkar@vumc.nl.
Gerda Croiset, MD, PhD
Professor of medical education and director, VUmc School of Medical Sciences, Amsterdam, the Netherlands.
1. Biondi EA, Varade WS, Garfunkel LC, et al. Discordance between resident and faculty perceptions of resident autonomy: Can self-determination theory help interpret differences and guide strategies for bridging the divide? Acad Med. 2015;90:462–471
2. Burford B, Whittle V, Vance GH. The relationship between medical student learning opportunities and preparedness for practice: A questionnaire study. BMC Med Educ. 2014;14:223
3. Van de Pol J, Volman M, Beishuizen J. Scaffolding in teacher–student interaction: A decade of research. Educ Psychol Rev. 2010;22:271–296
4. Kusurkar RA, Croiset G, Galindo-Garré F, Ten Cate O. Motivational profiles of medical students: Association with study effort, academic performance and exhaustion. BMC Med Educ. 2013;13:87