Department of Family Medicine, Maastricht University, Maastricht, the Netherlands.
School of Health Professions Education (SHE), Maastricht University, Maastricht, the Netherlands.
BMC Prim Care. 2022 Dec 1;23(1):307. doi: 10.1186/s12875-022-01908-3.
More and more patients need complex care, especially the elderly. For various reasons, this is becoming increasingly difficult. The onus is essentially on family physicians to provide this care and family medicine residency programs should therefore prepare their residents for this task. We know from self-determination theory (SDT) that motivation plays a key role in learning and that in order to boost motivation, fulfillment of 3 basic psychological needs - for autonomy, competence, and relatedness - is crucial. As residents often lack motivation, residency programs face the important challenge to motivate them to learn about and engage in complex elderly care. How to do so, however, is not yet sufficiently understood.
We conducted a qualitative multi-institutional case study across four universities in Belgium and the Netherlands. In the period between June, 2015, and May, 2019, we triangulated information from semi-structured interviews, document analysis, and observations of educational moments. Guided by SDT concepts, the analysis was performed iteratively by a multidisciplinary team, using ATLAS.ti, version 8. In this process, we gained more insights into residents' motivation to learn complex elderly care.
We scrutinized 1,369 document pages and 4 films, observed 34 educational moments, and held 41 semi-structured interviews. Although we found all the 3 basic psychological needs postulated by SDT, each seemed to have its own challenges. First, a tension between the need to guide residents and to encourage their independent learning complicated fulfillment of the need for autonomy. Second, the unpredictability of complex care led to reduced feelings of competence. Yet, guidelines and models could help residents to capture and apprehend its complexity. And third, family medicine practice, patients, and educational practice, by either satisfying or thwarting the need for relatedness, were identified as key mediators of motivation. By setting the right example and encouraging residents to discuss authentic dilemmas and switch their health care approach from cure to care, educators can boost their motivation.
Our study has demonstrated that the degree of perceived autonomy, guidance by the education program, use of authentic dilemmas, as well as involvement of group facilitators can aid the process of motivation.
NVMO, ERB number 482.
越来越多的患者需要复杂的护理，尤其是老年人。由于各种原因，这变得越来越困难。家庭医生基本上有责任提供这种护理，因此家庭医学住院医师培训计划应该使住院医师为这项任务做好准备。我们从自我决定理论（SDT）中了解到，动机在学习中起着关键作用，为了提高动机，满足自主性、能力和关联性这 3 项基本心理需求至关重要。由于住院医师往往缺乏动机，住院医师培训计划面临着一个重要的挑战，即激励他们学习和参与复杂的老年护理。然而，如何做到这一点还不够了解。
我们在比利时和荷兰的四所大学进行了一项定性多机构案例研究。在 2015 年 6 月至 2019 年 5 月期间，我们通过半结构化访谈、文件分析和教育时刻的观察，对信息进行了三角分析。在 SDT 概念的指导下，由多学科团队使用 ATLAS.ti 版本 8 对分析进行了迭代。在此过程中，我们对住院医师学习复杂老年护理的动机有了更深入的了解。
我们仔细审查了 1369 页文件和 4 部电影，观察了 34 个教育时刻，并进行了 41 次半结构化访谈。虽然我们发现了 SDT 提出的所有 3 项基本心理需求，但每一项似乎都有其自身的挑战。首先，指导住院医师和鼓励他们独立学习之间的紧张关系使自主性需求变得复杂。其次，复杂护理的不可预测性导致能力感降低。然而，指南和模型可以帮助住院医师捕捉和理解其复杂性。第三，家庭医学实践、患者以及通过满足或挫败关联性需求的教育实践，被确定为动机的关键调节因素。通过树立正确的榜样，鼓励住院医师讨论真实的困境并将他们的医疗保健方法从治疗转变为护理，教育者可以激发他们的动机。
我们的研究表明，感知自主性的程度、教育计划的指导、使用真实的困境以及小组促进者的参与都可以帮助激励过程。
NVMO，ERB 编号 482。
