Beyond “You Can Do It!” — Supporting Learner Autonomy

by Jessica Biggs, Pharm.D., PGY2 Pediatric Pharmacy Practice Resident, University of Maryland School of Pharmacy

If you are a teacher reading this blog now, I’m sure you would agree that some students seem more motivated than others. While this may be the case, not all students respond the same way to motivators. In other words, motivation is not fully explained by HOW motivated students are, but also by WHAT is motivating them. Are they studying diligently for that pharmacology test with the hopes of getting an A to please their parent? Are they studying because they have a genuine interest in the topic? Or is it a combination of these factors? Autonomous motivation, or a desire to learn due to a genuine interest, has been associated with greater effort and higher academic performance.^1,2 Unfortunately, many educators fail to create an environment that fosters learner autonomy.

According to the self-determination theory (SDT), some learners are motivated primarily by controlled motivation.  Others are motivated more by autonomous motivation.  Controlled motivation refers to a student learning something due to external pressures (such as a parent or teacher), internal pressures (such as guilt or stress), or to gain a reward (such as a passing grade or screen time).³ This form of motivation can be seen in B.F. Skinner’s behaviorism studies.  Behaviorists often use a system of rewards (and punishments) to motivate learner participation. On the opposite end of the spectrum, autonomous motivation refers to learning that resulted from a genuine, internally perceived personal value or interest.³ Simply put, controlled factors are not the primary, or sole, source of motivation. In reality, for most students, the source of motivation is not so black and white.  Motivators often overlap.

What exactly does the term “autonomy” refer to? Autonomy is synonymous with volition. When students are autonomous, they act on their internal desire to align the learning activities with their sense of self.³ It is important to note that autonomous learning does NOT require students to work alone or without assistance.

At this point you may be thinking: How is it possible for students to be autonomously motivated?  There’s no way that they will be interested in absolutely everything I teach?  Autonomous motivation is still possible even if the student is not truly interested in the subject matter because autonomous learners are able to identify the value and personal importance of what they are learning.³ For example, as a pharmacy resident, I am not genuinely interested in learning how to perform open-heart surgery.  I do not wish to be a surgeon. On the other hand, I would gladly accept the opportunity to shadow a cardiac surgeon performing open-heart surgery because I see the value in understanding the complexity of the heart and the cardiac anatomy.  This kind of knowledge would be relevant so that I better understand the cardiac medications that I work with and would be useful during my patient education sessions. I am able to see the value in this learning experience.

Even though I am early in my career, I already see the importance of fostering a sense of learner autonomy. In medical education, autonomous learning has been associated with enhanced learner effort, superior performance academically, as well as reduced learner exhaustion.^1,2  Since I was given opportunities to act autonomously both as a pharmacy student and as a first-year resident, I can attest that I have more energy to take on learning tasks that align with my goals and my performance is better.

So how can we support this type of learning? Small group teaching, problem or case-based learning, and a gradual escalation in learner responsibility and tasks are all appropriate methods.³ Asking students to lead patient case discussions in a small group environment (with other students or pharmacy residents) is an effective tactic. With increased autonomy however, it is also essential to provide constructive feedback, acknowledge students’ perspectives, and ask for learner goals and preferences.⁶ All of these learning opportunities should be done in a structured manner with an appropriate level of learner challenge because allowing a student to “run wild” with their own learning is not what is meant by autonomous learning.

Admittedly, it is often a struggle to achieve a balance between fostering learner autonomy and providing adequate supervision. How can a resident (or pharmacy student) gain real-life experience, including the opportunity to take care of patients autonomously, while also being appropriately supervised to ensure patient safety?⁵  Many teachers struggle with this balance and some micro-manage student activities when it comes to patient care. In these situations learners may feel their ability to make their own choices and decisions, one of the important aspects of autonomy, is compromised.¹

As a second-year pharmacy resident I have witnessed the progression of learner autonomy, both as a learner and now as a supporter of students who seek greater autonomy. Personal experience has proven to me that practicing in an environment that fosters autonomy will give a learner the best chance to shine and demonstrate their intrinsic motivation. It is the job of educators to support learner autonomy – to help students view the materials they are studying or the tasks that they are completing as opportunities that will pave the way to the future goals that they hope to achieve.

References

1. Kusurkar RA, Croiset G, Galindo-Garre F, Ten Cate TJ. Motivational profiles of medical students: association with study effort, academic performance and exhaustion. BMC Med Educ. 2013; 13: 87.
2. Kusurkar RA, Ten Cate, TJ, Vos CM, Westers P, Croiset G. How motivation affects academic performance: a structural equation modelling analysis. Adv Health Sci Educ. 2013; 18: 57-69.
3. Kusurkar RA and Croiset G. Autonomy support for autonomous motivation in medical education. Med Educ Online. 2015; 20: 27591.
4. Deci EL, Ryan RM. The “what” and “why” of goal pursuits: human needs and the self-determination of behavior. Psychol Inq. 2000; 11: 227-68.
5. Hoffman BD. Using self-determination theory to improve residency training: learning how to make omelets without breaking eggs. Acad Med. 2015; 90: 408-410.
6. Cate TJ, Kusurkar RA, Williams GC. How self-determination theory can assist our understanding of the teaching and learning processes in medical education. AMEE Guide. 2011; 33: 961-973.