title: Motivation as an independent and a dependent variable in medical education: a review of the literature.
abstract: BACKGROUND
  Motivation in learning behaviour and education is well-researched in general education, but less in medical education.
  
  
  OBJECTIVE
  To answer two research questions, 'How has the literature studied motivation as either an independent or dependent variable? How is motivation useful in predicting and understanding processes and outcomes in medical education?' in the light of the Self-determination Theory (SDT) of motivation.
  
  
  METHODS
  A literature search performed using the PubMed, PsycINFO and ERIC databases resulted in 460 articles. The inclusion criteria were empirical research, specific measurement of motivation and qualitative research studies which had well-designed methodology. Only studies related to medical students/school were included.
  
  
  RESULTS
  Findings of 56 articles were included in the review. Motivation as an independent variable appears to affect learning and study behaviour, academic performance, choice of medicine and specialty within medicine and intention to continue medical study. Motivation as a dependent variable appears to be affected by age, gender, ethnicity, socioeconomic status, personality, year of medical curriculum and teacher and peer support, all of which cannot be manipulated by medical educators. Motivation is also affected by factors that can be influenced, among which are, autonomy, competence and relatedness, which have been described as the basic psychological needs important for intrinsic motivation according to SDT.
  
  
  CONCLUSIONS
  Motivation is an independent variable in medical education influencing important outcomes and is also a dependent variable influenced by autonomy, competence and relatedness. This review finds some evidence in support of the validity of SDT in medical education.
authors.affiliation: Center for Research and Development of Education, University Medical Center Utrecht, The Netherlands. R.Kusurkar@umcutrecht.nl
authors.forename: R A
authors.initials: RA
authors.lastname: Kusurkar
authors.forename: Th J
authors.initials: TJ
authors.lastname: Ten Cate
authors.forename: M
authors.initials: M
authors.lastname: van Asperen
authors.forename: G
authors.initials: G
authors.lastname: Croiset
mesh_terms: D000367:Age Factors; D001519:Behavior; D002321:Career Choice; D004501:Education, Medical; D006801:Humans; D007858:Learning; D009042:Motivation; D026684:Personal Autonomy; D010551:Personality; D012737:Sex Factors; D012959:Socioeconomic Factors