Have Motivation Theories Guided the Development and Reform of Medical Education Curricula? A Review of the Literature

PURPOSE: Educational psychology indicates that learning processes can be mapped on three dimensions: cognitive (what to learn), affective or motivational (why learn), and metacognitive regulation (how to learn). In a truly student-centered medical curriculum, all three dimensions should guide curriculum developers in constructing learning environments. The authors explored whether student motivation has guided medical education curriculum developments. METHOD: The authors reviewed the literature on motivation theory related to education and on medical education curriculum development to identify major developments. Using the Learning-Oriented Teaching model as a framework, they evaluated the extent to which motivation theory has guided medical education curriculum developers. RESULTS: Major developments in the field of motivation theory indicate that motivation drives learning and influences students' academic performance, that gender differences exist in motivational mechanisms, and that the focus has shifted from quantity of motivation to quality of motivation and its determinants, and how they stimulate academic motivation. Major developments in medical curricula include the introduction of standardized and regulated medical education as well as problem-based, learner-centered, integrated teaching, outcome-based, and community-based approaches. These curricular changes have been based more on improving students' cognitive processing of content or metacognitive regulation than on stimulating motivation. CONCLUSIONS: Motivational processes may be a substantially undervalued factor in curriculum development. Building curricula to specifically stimulate motivation in students may powerfully influence the outcomes of curricula. The elements essential for stimulating intrinsic motivation in students, including autonomy support, adequate feedback, and emotional support, appear lacking as a primary aim in many curricular plans.