Understanding how the motivational dimension of learning is influenced by clinical teaching in medical education: A prospective cohort study.

Introduction: Many changes of medical curricula have been conducted in the past years. Based on learning psychology, three dimensions of learning have to be covered, in order to create the best possible curricula: Cognitive, metacognitive and motivational. The metacognitive and cognitive dimension (what/how to teach) have always been considered and the motivational dimension has been neglected, although the importance and benefits of motivation in learning have been emphasized repeatedly. One way to influence motivation in medical curricula are the teaching formats, as it has been shown that the construction of a curriculum can influence students' motivation. So far, evidence about the motivational effects of teaching formats are scarce.

Methods: In a prospective interventional cohort study, 145 3rd year medical students were sampled. The effects of a 3-day bedside teaching in the operating theatre and two simulation-based trainings on students' motivation (outcome measure) were analysed. It was hypothesized, that the simulation training and the bedside teaching enhance autonomous motivation and decrease controlled motivation.

Results: The bedside-teaching decreased external (controlled) motivation (-0.14,  = .013, 95% CI [-0.24, -0.03]), alongside with identified (autonomous) motivation (-0.22,  < .001, 95% CI [-0.34, -0.10]). The simulation-based trainings did not change students' motivation.

Conclusion: To prevent the unintended decrease of identified (autonomous) motivation, undergraduates should be supervised and introduced carefully, when attending bedside teaching in unknown medical fields. Simulation-based medical education certainly has plenty of benefits in medical education but its effects on the motivational dimension of learning needs further investigations.