The PAPERs Podcast

Episode Host: Jason R. Frank.

Episode 75 transcript. Enjoy PapersPodcast as a versatile learning resource the way you prefer- read, translate, and explore!

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Episode article

Orsini, C., Imafuku, R., Jennings, B., Neufeld, A., Tricio, J., & Kusurkar, R. A. (2024). What influences clinical educators’ motivation to teach? A BEME systematic review and framework synthesis based on self-determination theory: BEME Review No. 90. Medical Teacher, 1–9.

Episode notes

The notes for this weeks episode.

Background 

We work during challenging days for healthcare professionals. Pandemics, cutbacks, more patients, chronic diseases, new technologies, more patients, metrics, quality standards, medicolegal issues, and more patients. Is it any wonder that teachers in HPE report high levels of burnout, educational exhaustion, and inability to take on more? But countries need more…more learners, more teaching, and new teaching methods. So why do teachers teach?

But countries need more…more learners, more teaching, and new teaching methods. So why do teachers teach? 

There is literature describing the challenges of teachers in the health professions. The frictions include more learners, greater expectations, final and productivity pressures, low compensation, little acknowledgement, and incredible time pressure. The literature suggests more motivated teachers lead to better teaching, better teacher wellbeing, better teacher retention, and more learner-centred teaching. But what is the state of research about what motivates teachers in health professions? 

Purpose 

Enter Orsini et al, an authorship team from around the world (East Anglia to Gifu Japan, Calgary to Santiago and Amsterdam). Their paper is “What influences clinical educators’ motivation to teach? A BEME systematic review and framework synthesis based on self-determination theory: BEME Review No. 90:” in Medical Teacher, and it’s available online ahead of print in Oct 2024. 

The authors “aimed to systematically search and synthesise research evidence from the clinical education literature on factors influencing educators’ motivation to teach, using a framework synthesis method, based on Self Determination Theory.”  

Methods

The authors conducted their review following the STORIES and PRISMA guidelines. They searched multiple databases using terms like “motivation,” “educators,” and HPE (excluding “teaching”). Papers were excluded if they didn’t focus on undergraduate or postgraduate training, weren’t written in English, or didn’t present primary research (e.g., editorials). To ensure thoroughness, journal websites, reference lists, and grey literature were also reviewed.

Each study was evaluated using the MERSQI and JBI instruments. The data extraction process was systematic and included a calibration exercise to ensure consistency.

For analysis, the authors used narrative framework synthesis guided by Self-Determination Theory (SDT), which aligns closely with the study’s focus on motivation. SDT categorizes motivation into three types:

• Autonomous motivation (internally driven satisfaction).
• Controlled motivation (external, transactional factors).
• Amotivation (lack of motivation).

Building on previous research, the study examined factors influencing teacher motivation across three domains: systemic factors (“above”), individual attributes (“within”), and learner-related influences (“below”). These dimensions formed the theoretical framework for the study.

Result/Findings

The authors identified 7700 records, of which 29 finally met all the eligibility criteria. Publications were from 1998-2022, nearly all from the Global North. About half the studies involved physicians. Most studies involved surveys, interviews or focus groups. All papers were considered of “adequate” quality.  

These studies revealed key drivers of motivation: 

• Systemic Factors: Workload, compensation, and leadership styles.
• Individual Factors: A sense of purpose and intrinsic satisfaction.
• Learner-Related Factors: Engagement and challenges posed by learners. 

A standout feature of the paper is a detailed framework mapping these factors against SDT’s motivation categories, offering practical insights for educators and administrators. We’ve developed a simplified version below, but please visit the original paper to access the original, more detailed one: What influences clinical educators’ motivation to teach? (article in Medical Teacher)

Motivation Source	Autonomous Motivation	Controlled Motivation	Amotivation
Systemic (Environment)	– Support from leadership – Opportunitt to have input on teaching content	– Compensation – Job demands – Institutional recognition	– Lack of support – Unsupportive culture – High workload – Weak teaching evaluation systems
Personal (Educators)	– Sense of Purpose (institution, profession, learners) – Contribution to learners – Enjoyment of teaching – Professional growth and mastery	– Recruitment opportunities – Reduce own workload – Status and pride
Learner-Related Factors	– Motivated and engaged learners – Positive feedback	– Learner recognition and appreciation	– Difficult or unprepared learners

Conclusions 

The authors concluded that their findings should inform efforts to enhance teacher motivation, education quality, and teacher retention. They finished with 12 recommendations: 

1. Involve educators in course design for placements and on an overarching level in undergraduate/postgraduate education and/or curriculum development.  
2. Line managers/supervisors should adopt a transformational as opposed to a transactional leadership style.  
3. Plan manageable workload and protected teaching time.  
4. Use comprehensive teaching evaluation plans to inform educator practice.  
5. Build adequate and contextual recognition structures.  
6. Organise support from and communication with the educational programme.
7. Nurture clinical educators’ interests in their teaching role.  
8. Emphasise enjoyment and altruistic reasons to teach.  
9. Set up mentoring schemes and longitudinal placements to develop long-term relationships with learners.
10. Provide faculty development opportunities for teaching and clinical skills.
11. Build communities of practice/learning amongst clinical educators.
12. Raise learners’ awareness on their responsibility towards clinical educators’ optimal motivation. 

PaperClips 

• This paper covers a critically important topic in our contemporary HPE enterprise: teacher engagement. The findings should be useful to anyone who agonizes over how to motivate, recruit, and retain good teachers. 
• The methods used were systematic, but the exclusion criteria likely keep the voices of teachers in the Global South out of the review.

Articles and websites mentioned in this episode

Article: “Using framework analysis methods for qualitative research: AMEE Guide No. 164”.

Website: OpenGrey (www.opengrey.eu), is a comprehensive database specializing in “grey literature” produced in Europe. Grey literature includes non-commercial publications like research reports, doctoral dissertations, technical documents, white papers, and conference proceedings. OpenGrey contains over 700,000 bibliographic references across science, technology, biomedicine, economics, and social sciences.

It’s a resource for researchers and educators, offering tools to export bibliographic records and locate documents. While it doesn’t store full-text documents directly, it connects users to sources and institutions where the documents can be accessed.

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Transcript of Episode 75

This transcript is made by an autogenerated text tool and some manual editing by the Papers Podcast team. Read more under “Acknowledgment”.

Jason Frank, Lara Varpio, Linda Snell, Jonathan Sherbino.

Start

[music]

Linda Snell: Welcome to the Papers Podcast. Linda here, as usual i have with me the dynamic quartet. I was going to say dynamic duo and plus one, but it’s a dynamic quartet. And that includes Jon.

Jonathan Sherbino: Let’s hope we’re not doing math today. Hi, everybody.

Linda Snell: And Lara.

Lara Varpio: Hi, everyone.

Linda Snell: And Jason. Hi.

Jason Frank: Hi, everybody.

Linda Snell: Just before we start.

Linda Snell: I’d like to comment on a comment that was made by one of our listeners, Adin Nelson, who’s a pediatrician from Cornell. Adin says, wants to add a point to our discussion of the challenges in the paper of episode 52, which was the one about joy in Medical Education. Adin thinks that by selecting highly rated educators, we create a murky chicken and egg situation.

Linda Snell: Does teaching bring joy or does joy make you a teacher who’s more likely to be highly rated by your learners? He’s not saying a better teacher, just more highly rated. He would argue the latter, that human beings mirror each other’s emotsökions, and that will be reflected in their ratings.

Linda Snell: That enthusiasm breeds enthusiasm. If it looks like you’re having fun, your group will have fun. And he thinks that this may have skewed the results of the papers. Well, Adin, we did say that there were challenges and concerns with the methodology. Although we did not specifically mention this one. And we did say that more studies should address methodological concerns, probably including this one.

Linda Snell: So the bottom line is, I agree with you. And thanks very much for picking up something that we didn’t make absolutely explicit. Please keep listening, and please keep giving us your thoughtful comments and feedback. So now, let’s go to Jason, who has an… Interesting paper for us today. Go for it, Jason.

Jason Frank: Thanks very much. I want to start with a couple of anecdotes. The first is I had a nice resident who shall not be named come up to me at the hospital and say, hey, I heard your podcast. You guys are like, like med ed intellectual giants. I said, well, thank you so much. And then she added in your own minds. I thought that was awesome.

Jonathan Sherbino: That story I didn’t believe until the punchline at all.

Jason Frank: And then she walked away. I also want to mention that Jon flew to Ottawa where I live last weekend and we went and saw a concert. Jon pulled his best Courtney Cox. He’s up there dancing with Bruce Springsteen. It was awesome. Well done, Jon.

Lara Varpio: You saw the boss?

Jason Frank: Not just see the boss. He was right in front of us.

Jonathan Sherbino: It was so good. I will Courtney Cox my way anytime to get closer to that god of rock and roll.

Lara Varpio: I’m so jealous!

Jason Frank: And then the best part was Jon and I left the concert, got in a car and went and played hockey. How Canadian was that? I was like, yeah. Well, I played hockey. I’m not sure what Jon was doing.

Jonathan Sherbino: Well, I had more than one beer. So I would agree with that assessment when I was playing hockey at midnight.

Linda Snell: Beer sort of loosens up your muscles so you don’t have to do a warmup.

Jonathan Sherbino: It loosens up your inability to back check. I’ll tell you that.

Jason Frank: All right. So let’s talk teaching today. I have entitled this episode Hot for Teacher. You’ll hear why in a second. So. We work in challenging days as healthcare professionals. I think you would all agree. I’m going to ask you in a minute about those challenges.

Jason Frank: Obviously, we work in a world with pandemics and cutbacks, more patients, chronic diseases, new technologies, more patients, metrics, quality standards, medical legal issues, and more patients. And there might be a theme here. Is it any wonder why teachers in our environment report high levels of burnout, educational exhaustion, and inability to take on more?

Jason Frank: I certainly live in a medical school where we’re constantly asking the teachers to do something more or do something different, and we get pushback. At the same time, countries around the world need more learners, more teachers, and new teaching methods. So why do teachers teach?

Jason Frank: And normally at this point, I would ask something like, hey, Jon, Lara, Linda, why do you teach? What’s your joy of teaching? But we’re not going there. First, we’re doing the problem. I want to ask each of you, what are you hearing from your fellow teachers? About challenges to be a good teacher. And we’re going to go Linda, Jon Lara.

Linda Snell: So absolutely, I agree. It’s more, more, more. But to me, it’s that combination of more, more, more with less, It’s those more teachers, more students, more work, more patients, whatever, but less resources.

Linda Snell: So you’re dealing with that extra load, the EMR, the doubling the class size, the demands from administration with, oh, by the way, you don’t get anything to help you with this. So to me, although we’ll get there eventually, teaching is actually a bit of a relief from this.

Jason Frank: Jon?

Jonathan Sherbino: The challenge I think that I hear, and I want to be cautious, this is my take in my anecdote, so I don’t want to speak too broadly, is that as health professionals, we’re holding the system together more and more with our own grit and our own time.

Jonathan Sherbino: And the space and the capacity for teaching is not accounted for in those metrics. So in Ontario, the province where I practice in Canada, there’s a report card that’s put out quarterly ranking emergency departments. I’m an emergency physician. And I’m ranked as a busy inner city tertiary academic teaching center against a community hospital.

Jonathan Sherbino: And the government decides that’s an apples to apples comparison. So my friend who’s the chief of that community hospital that’s not even 15 kilometers from me is number one in the province. And I’m not sure where we rank, but it ain’t one.

Jonathan Sherbino: But the metrics that they’re accounting for is simply patient oriented metrics, which to one worldview makes sense. But I have the extra capacity of more than 4,000 learners that come through my hospital every year. That’s not in the scorecard. So there’s a little bit of that. Now, here’s the other side.

Jonathan Sherbino: And I want to be really wary of this, not my old man sitting on my porch yelling at the kids to get off the lawn. But there is a different kind of transactional relationship that I’m starting to experience with learners, which is deliver my education now. Where is my education? Rather than I am.

Jonathan Sherbino: In a role of collaboration beside you, challenged with the same issues around patient care, and will take on that mentoring or take on that apprentice type of model. And I think that’s probably a little bit of me just saying, you know, kids these days, and when I was a kid, and teachers probably said the same thing, but there does seem to be a bit of a misalignment of incentives.

Jonathan Sherbino: It may be the learners pushing back and saying, hey, we’re doing a lot. For the health systems as well. And so where’s that return on investment for our case, which is the education, but they’re directing it at the individual rather than the system.

Jonathan Sherbino: And so there’s this antagonistic viewpoint. Both of us are saying the system’s breaking, we’re trying to hold it together. And I can’t believe that you need me to teach, or I can’t believe that you’re not teaching me. And so the conflict doesn’t happen at the system level, it comes down to the individual level.

Lara Varpio: So what I’ll add to that is challenges that I hear, I think one of the things that happened around 2020, and it’s still happening now, but when the pandemic hit and when here in the U. S. There were the George Floyd movements and the Black Lives Matters, around that time there were several different events, many different happenings that happened at the same time.

Lara Varpio: And society has fundamentally shifted. Society is fundamentally different now than it was in 2019. And I think we’re not really, we’re only now starting to understand the depth and breadth of those impacts, of those happenings on who we are in Medical Education, health professions education, and as clinician educators.

Lara Varpio: And what that means, from my perspective, the things that I’m hearing, is about how educators are struggling to figure out who they are in this new space, in this new social set of structures. We’re learners, as you pointed out, Jon, have different orientations, different expectations.

Lara Varpio: We’re patients do, where the systems that we work in have added pressures about advocacy and equity that are desperately important. But they didn’t take anything off the list of things we’re supposed to do as well. So I think what’s happening right now, I think when I hear from educators who are struggling, it’s that right now the world has changed.

Lara Varpio: And the job has changed. And we’re not clear on what that means for individuals in individual contexts and how to manage. How do I pull this off? Especially when they’re not necessarily trained for the variety of roles and expectations that we have of them.

Jason Frank: Wow, those are really good, powerful points. They resonate with me. The two that particularly resonate with my current lived experience is people or friends of mine or colleagues from multiple medical schools saying, I’m being asked to do more with less. This governments aren’t taking it into account.

Jason Frank: They’re counting on doctors to and others to teach without additional funding. And I agree that something has changed that people feel more burned out. There’s a second theme though. And that is I have friends who are always consistently nominated for teaching awards who seem to love going to work and teaching and their metrics are good.

Jason Frank: So what the heck are they doing that they put it all together, right? So what’s the literature say about this topic? It says there’s lots of frictions in our environment to borrow that business term, more learners, greater expectations.

Jason Frank: Financial productivity, net pressures, low compensation for this kind of education work, little acknowledgement and incredible time pressure. So we’ve kind of touched on all of those. The literature also says that if you, the more motivated you are to teach, it leads to better outcomes. So better teaching by whatever measure, better teacher wellbeing, better teacher retention, and more learner-centered teaching.

Jason Frank: So that’s really interesting. If we can somehow tip a system or help people be motivated to teach, some good things happen as well. So that’s what this paper is about. So enter Orsini et al. This is an authorship team around the world. I love saying where they’re all from. So from East Anglia to Gifu, Japan. Linda, who goes to Japan all the time, have you been to Gifu?

Linda Snell: I have been to Gifu. Wonderful place. It’s probably got one of the best med ed units in the country. And Rintaro, who is one of the authors, actually comes over to Montreal every couple of years to visit us. He is a very rapidly emerging educator who’s doing a lot of good work.

Jason Frank: There you go.

Jonathan Sherbino: I want Japanese educators to come visit me. Please come to the Hammer. I guess it’s not as enthralling as a metropolitan city like Montreal.

Jason Frank: Other authors from Calgary to Santiago to Amsterdam. So there you go. Pick a city. Their paper is, here’s the title, What Influences Clinical Educators’Motivation to Teach a BEME Systematic Review and Framework Synthesis Based on Self-Determination Theory. They get marks for one of the longest titles we’ve done this year. This is a BEME review. This is BEME review number 90.

Jason Frank: And of course, it’s in Medical Teacher. It was online ahead of print in October 2024. And I picked it out. I just thought this topic was in the air. So what’s their purpose? They, quote, aimed to systematically search and synthesize research evidence from the clinical education literature on factors influencing educators’ motivation to teach using a framework synthesis method and based on self-determination theory.

Jason Frank: It’s kind of the title recapped. All right. So let me tell you a bit about methods. I am going to ask you about methods. We do a lot of reviews. There’s a lot of reviews in MedEd. And I don’t want to spend too much time on this or really want to spend time on the implications of their findings.

Jason Frank: All right. So they stated they conducted this review using the STORIES and PRISMA guidelines. Everybody knows the PRISMA guidelines. Does everybody know the STORIES guidelines? I’m getting thumbs up from everybody. So Linda has it. So it’s published in BMC Medicine. And this is my take on it. Feel free to jump in, Jon and Lara.

Jason Frank: Stories is kind of like an adaptation of PRISMA applied to MedEd Using not just quantitative methods. Jon, was that what you’d say with stories? Okay, fair enough, getting nods. Okay, multiple databases were searched and they searched for, quote, motivation and educators and HPE. They didn’t search for “teaching”, which I thought was really striking to me.

Jason Frank: Like, why not use the keyword about your topic? Papers were excluded if they didn’t address undergraduate and postgraduate. So basically, they limited to undergraduate and postgraduate. They weren’t published in English. So they basically excluded the rest of the world or not primary research. So they wouldn’t accept an editorial.

Jason Frank: They did look for journal websites, reference lists, gray lit searches, and they supplemented the strategy that way. They did an appraisal step. They appraised using MERSQI for quantitative studies and JBI instruments for the qual. Data was systematically extracted. They had a calibration exercise. So I’m going to pause there. That’s just their… Sort of systematic search.

Jason Frank: Jon, do you have any comments on the strategy?

Jonathan Sherbino: I thought it’s an exemplary type of systematic review.

Jonathan Sherbino: I don’t have any critiques of it. There’s a couple of points I just want to pull out. They’re new to me. I thought they’re kind of interesting. The first is they searched the gray literature and they didn’t do it by just jumping to Google Scholar, which is kind of my default.

Jonathan Sherbino: Although there’s evolving AI that might offer you new ways to look at gray literature. They went to a site called OpenGray. EU which I think must be some kind of search engine. I don’t think it’s necessarily a repository. And they have a whole database of white papers, PhD dissertations, conference proceedings, et cetera, et cetera.

Jonathan Sherbino: And they use their own internal mesh headings, or I guess they’re really more like titles or categorizations. There’s only 20, but three of them. So we were talking. You know, like seven, can’t even do math as I’m trying to do multiple things in my head. So, so.

Lara Varpio: The record to show that you can’t do math on the fly either. Like.

Jonathan Sherbino: I can do math on the fly, but I was actually looking over…

Lara Varpio: Evidence suggests that no, you can’t. Three of, 3 of 15 is 5.

Jonathan Sherbino: Concerning things in my, of the court of my vision. Anyway, so. Of those 20 categories, three of them are hilarious. One is the military, another is missiles, and the third is ordinance. And so you have that as part of your mesh terms. There’s no education. So it’s an interesting choice of a great literature search. I thought it was funny.

Jason Frank: That’s awesome. Ordinance.

Jonathan Sherbino: The second part is I had no idea what the JBI was. And so that led me down a rabbit hole. We’re using rabbit holes as a metaphor a lot, but I had to do a deep dive to figure out what… What that was. And it actually stands for the Joanna Briggs Institute, who is the first matron of the Royal Adelaide Hospital sometime in the mid 19th century.

Jonathan Sherbino: And so that hospital is a major academic health center that has a big influence in Medical Education. I think it’s kind of cool to have a reference back to the OG, the person who made that culture possible. Which led me to the thing is, what’s the JBI?

Jonathan Sherbino: And so then I found a paper by Majid, M-A-J-I-D. It’s in Qualitative Health Research 2018. We’ll put a link to that in the show notes. And it has a whole bunch of quality research appraisal tools. And so Lara and I will usually argue something about SRQR or CO-REG.

Jonathan Sherbino: We’ve talked before about CASP. We’ve seen that a couple of times on episodes, but they have a whole bunch of other ones that I’ve never heard of. Varpio, do you know what POPE is?

Lara Varpio: No, but it sounds rude.

Jonathan Sherbino: You don’t got no POPE? Can you pay, Poe?

Lara Varpio: I’m not talking to you about this on the record.

Jonathan Sherbino: Anyway, it’s a true thing. I’m probably besmirching the reputation of those authors who have done fine work. It has total legitimacy. And so this paper will give you a whole kind of compared contrast of all these different quality tools. No critique here, just to point out something that was new to me and maybe interesting to the audience.

Jason Frank: So what I heard out of all of that was that was an amazing choice of paper, Jason. Thank you, Jon. That’s awesome. Okay. Anybody else got any comments on their search strategy?

Linda Snell: Yeah, I have a couple.

Linda Snell: First of all, I do agree with Jon that it was in general a good search strategy. I’m a little concerned about their choice not to use the word search term teach or teaching. And the reason is that I happen to know a paper by Yvonne Steinert called Why Physicians Teach Giving It Back to… Paying it forward. It’s in Medical Education 2015, and we can post this as well.

Linda Snell: And it’s actually about motivation to teach. And it comes up with some results that, in some sense, actually reflect what these authors found. So it would support it. And I think it brings up a problem with how how search terms and choice of search terms can actually influence your results. Lara, would you agree?

Lara Varpio: Yeah, your search terms are key.

Lara Varpio: And it is concerning if we know that there are papers that didn’t get captured. So that gives us a little cause for pause. But Jason, you said you didn’t want to spend too much time on methods. We’ve already done a fair bit. So I’m just going to add one little point. Because the manuscript said that their corpus was 29 manuscripts, right?

Lara Varpio: The 29 papers was included in their corpus. So first of all, that feels a little small, but my bigger concern is this. So if, and this is a thought for anyone who’s interested in doing this kind of synthesis and that relies on evaluation of the manuscripts for inclusion.

Lara Varpio: So we have to evaluate the quality of the work they’re in, in order to decide if you should keep it in your corpus for the review. And my thing is this, if you ever find that you’re in a situation where every single manuscript you found. Is of sufficient quality, hits the criteria for inclusion, for me, that’s a moment of pause.

Lara Varpio: And that’s a moment of pause because my experience, and it’s just my experience, we take it as an N of 1. But if you have 100% acceptance rate of the quality of the studies you identified, then you probably are not using either the right evaluation tool, or there’s a piece of that evaluation tool you’re not understanding correctly.

Lara Varpio: Because there’s a, in a body of literature, if you give 30 papers in any corpus, pretty much guaranteed one of them is not going to be meeting the kind of rigor and quality standards that you want. So anytime you have 100%, my suggestion to our listeners, just have a pause and ask, am I using the right tool? Am I using the right tool correctly?

Jason Frank: That’s awesome. I thought that as well. There’s, there’s, they sort of have a throwaway line, like all the papers were adequate quality without getting into the detail.

Jason Frank: Hey, Lara, while I still have you, can you just make a one sentence comment on framework synthesis? They use the phrase all through the paper. And so what’s your take on that?

Lara Varpio: Framework analysis, you asked for a quick sentence. Jason, I’ll give you a very quick sentence. Framework analysis is an umbrella term. There are many different ways of engaging and doing framework analysis, framework methods. The idea of that work is that it’s the short answer in my brain is a rack and stack approach to qualitative data analysis, what you’re trying to do.

Lara Varpio: And you can do it deductively, inductively. You can do both. There’s, I guess, many different ways. But the idea is when you have really large qualitative data sets, you often use framework analysis because it’s A… Very structured approach to analysis.

Lara Varpio: And what you’re trying to do is create coding structures that you can apply rather, you know, depending on the approach, but usually kind of rigidly across a broad data set to say this paper had the code ABC, not D and E, but G. And but this paper had different ones. So you’re really creating, you will end up with a matrix of coded data.

Lara Varpio: But there’s many different ways of doing it. There is an AMEE Guide that exists about framework analysis that Klingberg is the first author. I was lucky enough to work on that with her and Renee Stalmeijer. So the AMEE Guide might be a resource for anybody who’s interested in using it.

Jason Frank: All right. So they used self-determination theory as well. So this is like one of their lenses for doing the analysis. It was chosen because it speaks to motivation and personality. It has three categories of motivation. Now here, these terms are important because this is used in this paper to analyze the data.

Jason Frank: Autonomous motivation, which is kind of like, I think of it as like internal, it’s inside you. Controlled motivation, which I think is kind of transactional. Like you get something, you’re like at rewards. And amotivation, which is a funny category of motivation, but basically it says anything that demotivates you for a given issue.

Jason Frank: Previous work identified factors that impact teacher motivation in the system. And so they borrowed three other terms. So there’s a three by three table forming as we talk. The system above you is anything the system structure does to impact teaching. Intrinsic is like what’s inside you, like what motivates you yourself. And below is their term for things that bubble up from learners that motivate you.

Jason Frank: All of these concepts are incorporated in the study’s theoretical framework. And so let me tell you the results. And this is where I think the value of this paper is. It’s in this beautiful table. Table one. So Lara already identified that there were 7,700 records initially identified, of which they kept 29. Like, wow, that’s incredible.

Jason Frank: Somehow they got down to my IQ level, 29. That finally met all the eligibility criteria. Publications were from 1998 to 2022, and nearly all of them are from the global north. Now, that’s not unusual in med ed searches, but you can’t help but thinking that they’re eligibility. Criteria limiting things to English and so on must have impacted that list. About half the studies involved physicians.

Jason Frank: Most studies were surveys, interviews, or focus groups trying to get data from teachers. Okay, and we said before, all studies were considered adequate, quote-unquote, in terms of quality. So there’s this beautiful table one. It’s a three-by-three table, and it incorporates SDT and the previous research on factors in motivating teaching.

Jason Frank: So there’s factors from above, that’s the system issues. There’s factors within, and then there’s factors from below, that’s the learners. And then across the top is factors influencing autonomous motivation, which they value in this paper, controlled motivation, which is that transactional, and a motivation, things that turn you off.

Jason Frank: And there’s no surprises in the table, but what’s so amazing is it’s all in one place. So for all of you listening to this podcast. Who are in an environment where teachers are disengaged and you’re trying to get them back in the game, this table tells you all the answers.

Jason Frank: It talks about how the system, in terms of the leadership of the people who organize a med ed system, have a huge impact on how teachers behave. So that’s the autonomy support. Opportunities to influence the design of the curriculum and the teacher’s role. Versus more transactional things would be things like job requirements like you have to teach or what rewards I get and so on.

Jason Frank: There’s some fascinating ones around learners and fascinating ones about what we bring to the table. So I’m just going to ask Linda Lara Jon, what’s something that struck you from this table? It’s okay if you overlap. I’m just wondering what you thought was valuable or very interesting.

Linda Snell: So when I look at it in my own head, I go back to those old sayings about internal locus of control and external locus of control, which I think is the first two categories that they’ve talked about.

Linda Snell: I picked lack of trainee continuity as something that struck me because it’s a negative and it’s in a motivation or negative motivation. And I think the opposite is also true. Trainee continuity probably is something that does motivate and probably goes into the factors from above.

Linda Snell: You know, trainees, faculty members, supervisors often have less time on service. And in my setting, that’s a pitch to something that’s good for wellness of faculty. So you’re not doing a month at a time, for instance, on a ward, you might do two weeks or one week. There’s also decreased presence of the learner, which is also in some part due to, trying to improve wellness.

Linda Snell: You know, you don’t have to be there every day. You have to be at a teaching session. You can take a personal day, whatever it is. So, or you’re taking the day off. Post-call. So both of those things, in theory, are good for wellness, but it seems like they’re bad for motivation to teach.

Linda Snell: You know, continuity is so important because you get to know the learner, you get to know their strengths, you get to know where you need to focus. So this is something that I think really makes sense to me, and it’s something where I think we can intervene, recognizing that there’s that tension between things like wellness, and things like motivation, and how are we going to deal with that?

Lara Varpio: So the highlights result, in my mind, exactly what we’d expect to find, to create a context where an educator has autonomy, can provide input about the training program, has appropriate compensation and recognition, and they’ll feel motivated to teach, have a lack of support from the institution, a weak teaching evaluation system, heavy productivity demands, and they won’t be motivated to teach. This feels really clear.

Lara Varpio: Internal drivers, like a sense of purpose and supporting learners to integrate it to the profession and connecting with the connecting with learners, professional growth. If the individuals have those drivers, then they’re motivated to teach.

Lara Varpio: So for me, the paper is a succinct summary of the body of literature they found. And I kind of see this paper as a line in the sand. We’ve done enough work on this topic and have a rather fulsome perspective on what motivates educators. According, using this particular theory, right?

Lara Varpio: Self-determination theory. I don’t see this necessarily as a call for more research in this space, but I do see it as a call for harnessing the knowledge that we have available and to do something about educator motivation and evaluating the effectiveness of different efforts to increase motivation.

Lara Varpio: The paper’s table one, Factors Influencing, it’s called Factors Influencing Clinician Educators’Motivation to Teach, is a beautiful takeaway. This is the summary. That’s the thing you’re going to put in your corkboard of life, post it there. Got it.

Lara Varpio: Now that we understand the phenomenon, and I think this paper is suggesting that we do, what are you going to do? How are you going to implement these findings? So that for me is the bottom line of these results. There’s one thing, though, I want to ask you all about, because did you notice at the front end of the paper, there was this interesting sentence where they talked about how the findings…

Lara Varpio: Would be particularly relevant for distributed health professions training models. And then later again, in the discussion section, it says that the discussion, the sentence says something like, quote, these findings support the distributed health professions education training model. But there was one sentence in the front and one sentence in the back.

Lara Varpio: And I read this thing a couple of times trying to figure out what connected. And I’m just wondering if I missed it. Did you see something? What does this have to do with distributed learning? I’m not really sure. Jon, maybe you read, you probably read all the appendices and the notes that they took privately. You went into their house. You zoomed into their private life. Nobody likes it when you do it. It’s creepy.

Jason Frank: Talk to their mother.

Lara Varpio: Right? Don’t be that guy. But maybe you saw something there that I didn’t.

Jonathan Sherbino: Interestingly, I did try to get to the supplemental data and it was not available. I went to the publisher website. I went through my university access. I tried to pay for it. I did a bunch of stuff. I wanted to see what they had. And I think it’s a…

Jonathan Sherbino: … publisher problem, but they keep saying, refer to this supplementary, this, and I wanted to see the original data or the table that usually says, here’s all the data from each study, not available. So I did try to be creepy in an academic way, Lara, not my regular way, unsuccessfully.

Lara Varpio: Let’s go back to that. You were willing to pay for it. Why don’t you just pay me some money and I’ll make a table of stuff and we can just do that there.

Jonathan Sherbino: But I’m only paying if there’s numbers in the table.

Lara Varpio: I’ll put all the numbers. And some emojis. There’ll be extras.

Lara Varpio: It’ll be fun.

Jonathan Sherbino: So here’s my thoughts on the findings. There’s lots of good stuff here. I would direct people that want to understand here’s how to align your teaching environment to be successful. But I’m going to focus my answers on some demotivators, what they call a motivational factors.

Jonathan Sherbino: And that’s not me trying to be pessimistic, but my, my sense is that teachers are under threat as the health system. Becomes more fragmented. You heard my start, my comment at the start. I think learners feel that they’re holding up the system. Teachers feel like they’re holding up the system.

Jonathan Sherbino: And when the teacher learner dyad meets, we’re like, we don’t have time for this. And everybody’s frustrated or challenged with each other. So if you have a great system, you can see some of the ideas, but I want to focus on two things. First, they have a nine cell table, so a three by three, and they have a big blank spot around intrinsic motivation. That’s demotivating.

Jonathan Sherbino: And so it’s interesting to me that they have a blank spot. It might be a function of they were so selective, they only got down to 29 papers. If they had scrolled up to 60 papers, that blank spot would have fed in. And I think one of the blank spots they fail to meet is the decision around work-life balance.

Jonathan Sherbino: So here’s a true case for me from two days ago. I made a decision to go do a mentoring session one-on-one with a trainee who I think has a ton of potential. And I mistimed when that session ended. And I got home just after my little one got to bed. And so I didn’t get to kiss her goodnight and see her go to bed. I made a decision for that.

Jonathan Sherbino: I’m not sure if I’m always going to make that decision because I’m being asked by the system to make these choices. And so I don’t seek work-life balance here. And I think that’s under appreciated. And any teacher will immediately be able to tell a very similar anecdote from the last week about how they made a choice for the benefit of their work as an educator against their own personal and other private…

Jonathan Sherbino: … priorities. The second part I want to call out because this is one of the soapboxes I love to get up on. Most recently, I was reeling against some of the vice deans in my faculty on this matter, which is student evaluations of teaching.

Jonathan Sherbino: And they talk about a weak teaching evaluation system under the factors above. So I look at that as systemic, extrinsic factor that’s demotivating. Can I just remind all of you, y’all know, can I just remind all of the listeners, y’all know, maybe not the evidence, but you know the experience. That student evaluations of teaching has been a debunked phenomenon for too long.

Jonathan Sherbino: And we should just say here that the system is broken. We need to rethink it because it’s just misogynist, racist, ableist, homophobic. It’s all the isms. And it’s routinely shown to have no discrimination around teaching evaluation and teaching ability. It just has discrimination, the bad kind. And so that’s the…

Jonathan Sherbino: Part i want a red line it’s here but it’s lost and i just want to remind us that we need to have systems that are motivating not demotivating for teachers preach so that’s that’s i’ll get off my i’m not getting off this is the one soapbox i’m going to stay on let’s do this i’m always a little frustrated we bring them down in previous lives a bunch of the meta analyses of this data and so maybe we should bring that back together on another ranty episode we should do a ranty episode that’d be my rant no that’s dangerous.

Jason Frank: Unlike all our other episodes, you mean?

Lara Varpio: What we told.

Jason Frank: All right. Let me wrap this up. So again, delicious paper. The authors concluded that their findings should inform efforts to advance teacher motivation, educational quality, and teacher retention. They finished with 12 recommendations. I’ll summarize all 12 recommendations to do the right thing, which is what we were just ranting about.

Jason Frank: This is the value of this paper. This is my pitch to everybody before we have a little vote. If you look at table one, if you just printed or… Saved table one, and then use that as a checklist for your own teaching environment, you’ll find things that are gaps.

Linda Snell: Yeah. I think it’s helpful. I think it’s helpful to look at table one in conjunction with looking at the recommendations.

Jason Frank: Because yeah, they just basically tell us what to do next with them. All right. So I think this is a useful paper. My takeaways from this one was This paper covers a critically important topic. It gives you almost a checklist to look at your own environment.

Jason Frank: Like I just said, the methods used were systemic, but they show examples of how you can exclude good papers by having very tight. Inclusion exclusion criteria. So I thought that was kind of a, I think it was a miss that we had mostly global north yet again. Hey, but kudos to the authors. They did a ton of work.

Jason Frank: Okay. So we’re doing something different today. In the past, we had a vote for methods and a vote for impact. We’re going to have a single vote and it’s what’s the value of this paper to you? That’s, that’s the new line. Like, is this. Is this paper something you’re going to use to teach?

Jason Frank: Is this paper something that you think is going to change practice or change research or stimulate? Like all those things. So that’s what we’re doing. One to five. And we’re going to go. We’re going to start with Lara because she’s so excited about this new scale. Lara, Linda, Jon, what’s the value of this paper for you?

Lara Varpio: I love this new approach. I think this is a great idea. I didn’t like voting before. The value of this. Why are you crossing your fingers, Jon?

Jonathan Sherbino: I had this secret belief that with our new scale, you might play by the rules. I’m just being optimistic. We need to see what happens. But please, you be you.

Lara Varpio: It’s all good. I’ll be me. Don’t worry. And your delusion will soon be called asunder. But anyway, this paper is a value for me because it is a succinct, nice, tight summary of our understanding of what motivates educators.

Lara Varpio: Like I said, it’s a line in the sand. We’re done. This is sufficient for me. So that’s the value for me. So. On a scale of one to five in terms of that particular value, I’m going to give this paper a four thumbs up emojis.

Jason Frank: Fantastic.

Lara Varpio: Thank you.

Jason Frank: Linda?

Linda Snell: And I’m going to give it a four. I don’t know about the thumbs up and the emojis and all of that, but it’s a four and not a five because I am concerned that they miss papers. But having said that, it’s one-stop shopping for somebody who is looking at how to motivate teachers.

Jonathan Sherbino: I’m going to give it a four.

Jonathan Sherbino: The part, I guess, here’s my synthesis of all the parts I really liked. It’s very systematic. I like the framework analysis so that they organize the findings, not just here is a linear or here’s a random assortment, but it’s organized in a way that the theory holds it together and you can see it from that lens.

Jonathan Sherbino: So that organization takes a lot of data and makes it much more manageable. I think table one is a really helpful table.

Jonathan Sherbino: I have small degrees of critique in that the contextualization, and I think of a classic contextualization in my world where MD education at the continuing professional development lens is self-funded. Nursing professional education at the continuing professional development lens is funded by the system.

Jonathan Sherbino: And so you have different approaches. And so When you push it all together, you see some things, but you’ll lose a bit of the nuance. And it’s just a minor little thing, but there’s maybe some nuance lost by the fact that they’re down to 29 papers from more than 7,500.

Jonathan Sherbino: There’s a bit of nuance lost because they’ve done it in a systematic way and not in a realist way, looking at more contextual elements, but it’s still a great organization of the literature. I don’t need to read another systematic review of… Teacher motivation for, for quite some time until the literature really moves the conversation forward.

Jason Frank: Awesome. So I’m going to give this a five for all the reasons that my colleagues just said.

Jason Frank: They’re just being, you know, like grumpy. What’s the word? Grumble bunnies. This is an excellent paper because the value of this, I just took on a job where I’m going to help change the teacher ecosystem. I’m just going to distribute table one to everybody and highlight things. And you know, this is, this is highly valuable paper. I recommend it to everybody. So there you have it.

Jason Frank: That’s Orsini et al. We would love to hear from anybody who has any comments. Come hit us up through our Gmail. Come hit us up through the website. We would love to hear from you or hit us on socials. We always appreciate your comments, your insights, why Jon is wrong about something. We always appreciate that. And we’d love to hear from you. So thanks for joining us today.

Lara Varpio: Talk to you later.

Jonathan Sherbino: Thanks for listening.

Jason Frank: Take care, everybody.

Jason Frank: You’ve been listening to the Vapers Podcast. We hope we made you just slightly smarter. Podcast is a production of the Unit For Teaching And Learning at the Karolinska Institute. The executive producer today was my friend, Teresa Sörö.

Jason Frank: The technical producer today was Samuel Lundberg. You can learn more about the Papers Podcast and contact us at www.thepaperspodcast.com. Thank you for listening, everybody. Thank you for all you do. Take care.

Linda Snell: Bye-bye.

Acknowledgment

This transcript was generated using machine transcription technology, followed by manual editing for accuracy and clarity. While we strive for precision, there may be minor discrepancies between the spoken content and the text. We appreciate your understanding and encourage you to refer to the original podcast for the most accurate context.