A self-determination theory‑informed transition to clerkship course for medical students

The transition from preclinical to clinical training is a critical and challenging phase in medical education, during which students encounter new clinical, professional, and organizational demands. Transition to Clerkship Courses (TCC) have been developed to support students during this transition, but relatively few have explicitly incorporated a motivational framework into curriculum development. This study describes the development and implementation of a Self-Determination Theory (SDT) informed TCC and reports students’ descriptive post-course motivational characteristics. This curriculum design and implementation study was conducted at Al-Subtain University of Medical Sciences, Karbala, Iraq, involving 108 medical students transitioning to clerkship. The TCC was developed using Kern’s six-step model: (1) problem identification and general needs assessment through literature review; (2) targeted needs assessment via focus groups; (3) formulation of goals and objectives; (4) development of SDT-informed educational strategies; (5) implementation through a structured three-module course; and (6) evaluation. The curriculum was explicitly aligned with SDT’s psychological needs (autonomy, competence, and relatedness) and delivered using autonomy-supportive teaching strategies. The curriculum incorporated autonomy-supportive practices (e.g., offering meaningful choices and rationales), competence-supportive strategies (e.g., scaffolded skill practice and formative feedback), and relatedness-supportive approaches (e.g., small-group learning and near-peer mentoring) to create a need-supportive learning environment. Evaluation was conducted descriptively using the Academic Motivation Scale. The literature review identified recurring educational needs related to clinical logistics, procedural preparation, and formative learning support. The targeted needs assessment informed curriculum priorities that were subsequently mapped onto SDT’s concepts of autonomy, competence, and relatedness. A three-module TCC addressing hospital orientation, procedural skills, and professionalism and communication was implemented for 108 students. The post-course AMS results showed relatively higher scores across intrinsic motivation and identified regulation alongside relatively high controlled forms of motivation, with amotivation showing the lowest mean score. This study illustrates how Kern’s six-step curriculum-development framework can be combined with SDT principles to inform the design and implementation of a transition to clerkship curriculum. The approach provides an example of how motivational theory can be incorporated into curriculum development for the transition to clinical training.