The Effect of Assessments on Student Motivation for Learning and Its Outcomes in Health Professions Education: A Review and Realist Synthesis

Rashmi A. Kusurkar, R.A. Kusurkar is professor and research programme leader, Research in Education, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam, professor and research programme leader, LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, VU University Amsterdam, and professor and research programme leader, Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands; ORCID: http://orcid.org/0000-0002-9382-0379.
Cesar Orsini, C. Orsini is associate professor in medical education, Norwich Medical School, University of East Anglia, Norwich, United Kingdom, and Researcher in Health Professions Education, Faculty of Dentistry, Universidad de Los Andes, Santiago, Chile; ORCID: http://orcid.org/0000-0002-5226-3625.
Sunia Somra, S. Somra was research assistant, Research in Education, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands, at the time of this study.
Anthony R. Artino, A.R. Artino Jr. is professor and associate dean for evaluation and educational research, School of Medicine & Health Sciences, George Washington University, Washington, DC; ORCID: http://orcid.org/0000-0003-2661-7853.
Hester E. Daelmans, H.E.M. Daelmans is director of the master of medicine programme, Faculty of Medicine Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
Linda J. Schoonmade, L.J. Schoonmade is information specialist at the medical library, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; ORCID: https://orcid.org/0000-0002-2407-5977.
Cees van der Vleuten, C. van der Vleuten is professor, School of Health Professions Education, University of Maastricht, Maastricht, the Netherlands; ORCID: http://orcid.org/0000-0001-6802-3119.

Document Type

Journal Article

Publication Date

5-4-2023

Journal

Academic medicine : journal of the Association of American Medical Colleges

DOI

10.1097/ACM.0000000000005263

Abstract

PURPOSE: In health professions education (HPE) the effect of assessments on student motivation for learning and its consequences have been largely neglected. This is problematic because assessments can hamper motivation and psychological well-being. The research questions guiding this review were: How do assessments affect student motivation for learning in HPE? What outcomes does this lead to in which contexts? METHOD: In October 2020, the authors searched PubMed, Embase, APA PsycInfo, ERIC, CINAHL, and Web of Science Core Collection for "assessments" AND "motivation" AND "health professions education/students." Empirical papers or literature reviews investigating the effect of assessments on student motivation for learning in HPE using quantitative, qualitative, or mixed methods from January 1, 2010-October 29, 2020, were included. The authors chose the realist synthesis method for data analysis to study the intended and unintended consequences of this complex topic. Assessments were identified as stimulating autonomous or controlled motivation using sensitizing concepts from self-determination theory and data on context-mechanism-outcome were extracted. RESULTS: Twenty-four of 15,291 articles were ultimately included. Assessments stimulating controlled motivation seemed to have negative outcomes. An example of an assessment that stimulates controlled motivation is one that focuses on factual knowledge (context), which encourages studying only for the assessment (mechanism) and results in surface learning (outcome). Assessments stimulating autonomous motivation seemed to have positive outcomes. An example of an assessment that stimulates autonomous motivation is one that is fun (context), which through active learning (mechanism) leads to higher effort and better connection with the material (outcome). CONCLUSIONS: These findings indicate that students strategically learned what was expected to appear in assessments at the expense of what was needed in practice. Therefore, health professions educators should rethink their assessment philosophy and practices and introduce assessments that are relevant to professional practice and stimulate genuine interest in the content.

Department

Health, Human Function, and Rehabilitation Sciences

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