In this issue, Gupta and colleagues present interesting results on whether medical
students who have written a scientific paper have a higher chance of being selected
for a residency spot in paediatrics [1]. Before addressing the findings of their study
and contemplating on extrinsic versus intrinsic motivation for conducting research,
we would like to take a step back and elaborate on the overall importance of scientific
training in medicine.
According to the CanMEDS, the core competencies of a scholar consist of two distinct
elements: being able to use and being able to conduct research. This distinction between
using and conducting research has also been adopted in the 2009 blueprint for medical
education in the Netherlands [2].
Using research applies to all physicians, as every physician should be able to understand
and use research to integrate scientific knowledge in clinical practice and form grounded
diagnosis [3, 4]. Involving scientific knowledge in clinical decisions requires physicians
to keep up-to-date with the newest developments in medicine. Also, they should be
able to critically appraise scientific literature and discuss research findings both
with colleagues, and with patients who have better access to information from the
internet than in the past [5, 6]. Moreover, using research can also be seen as a contribution
to the process of life-long learning, continuously translating new knowledge into
patient care [7].
In addition to all physicians utilizing research, medical education also intends to
cultivate some physicians who will conduct research. These physician-scientists are
needed to make progress in the continuously evolving field of medicine and to form
a bridge between science and practice, by translating research outcomes into clinical
settings. Furthermore, physician-scientists have the ability to identify relevant
clinical questions and problems. By being actively engaged in clinical practice, these
physician-scientists encounter daily clinical questions and problems, which can serve
as inspiration for scientific research. Moreover, physician-scientists can contribute
to developing new knowledge by formulating research questions, thinking about proper
study designs, contributing to data collection and interpretation of results, and
writing scientific papers. They can also develop clinical guidelines, and are role
models by implementing this new knowledge into clinical practice [8, 9]. In this process
of translational research, back and forth from ‘bench to bedside’, physician-scientists
are key. However, in the last decade concerns have been raised about the declining
number of physician-scientists in many countries [3, 10, 11].
In order to train all physicians to reach the required level of a scholar, and also
to counteract the decline of the physician-scientist workforce, scientific training
must play an important role in medical education. This can be established in two ways.
The first is by engaging students with talents and ambition into extracurricular research
programs. Examples of these extracurricular research programs are MD/PhD programs
and scholarly concentration programs, the latter becoming a common method within the
field of medical education [12, 13]. The second is by integrating research into medical
curricula in a way that it reaches all medical students [7]. We believe that acquainting
students with both using and conducting research should already be clear goals in
the early phases of medical education. Actually conducting research can help students
to understand and use research, while at the same time this offers an opportunity
to shed light on a possible research-oriented career. Also, it helps to recognize
talented students and helps them develop into the next generation of physician-scientists.
Healey and his colleagues have developed a framework to illustrate the research-teaching
nexus and explain four ways in which students in higher education can experience research
in the curriculum. According to this framework, students can be viewed as audience
or as active participants, while the emphasis can be on the research process or on
research content. It has been argued that viewing students as participants, combined
with an emphasis on the research content, is a form of active learning [14]. Active
learning, or ‘learning by doing’, is seen as the most optimal way to engage students
in this kind of activity [15–17]. This can be established, for instance, by offering
students the opportunity to conduct or participate in an authentic research project
during their medical training. In this respect, the hands-on experience of publishing
a scientific paper may well be seen as an excellent example of active learning, and
thus would be a powerful means to cultivate scientific minds.
In this issue, Gupta and colleagues show thought-provoking research findings, which
indicate that pre-residency publication is not associated with achieving a higher
rank in first-choice match for paediatric residency in Canada [1]. From this, they
conclude that extrinsic motivation should not be the main driving factor for doing
research and publishing a paper, as apparently a published paper does not help to
get a higher ranking. They also argue that educators should be honest about this to
students and adapt the information communicated towards them. Of course, the question
can be raised whether these findings tell us something about the intrinsic value of
writing a publication in medical training? Perhaps they tell us more about the selection
procedure in this specific paediatric setting in Canada, and the weight given to publications
by selection committees, which can vary between specialties and even countries. Imagine
what could happen if medical students were to read Gupta’s paper and indeed no longer
have the ambition to do research and publish a paper? Or, the other way around, what
if students who are interested in doing research no longer apply for a residency in
paediatrics? What might be the consequences for the scientific image of paediatrics
and other specialties alike?
Nevertheless, as educators we are happy to see that extrinsic motivation for doing
research should be less important for medical students, making room for developing
sincere intrinsic motivation. In line with this, we would like to cordially invite
educators to emphasize the importance of research for the future of clinical practice
and patients, thereby fostering the intrinsic motivation of these students. Studies
based on the Self-Determination Theory have shown that intrinsic motivation is related
to better academic performance and general wellbeing [18, 19]. Hence, educators should
aim to stimulate students’ intrinsic motivation. However, we can imagine that students
tend to start participating in research because of extrinsic motivators, such as the
belief that conducting research will secure a competitive residency spot or broaden
their future career options [3, 20–22]. This notion of the importance of research
seems logical, as many educators emphasize the need to do something extra to students
from the beginning of medical training.
But is conducting research because of these extrinsic incentives always bad? Could
it be that students are extrinsically motivated when they start conducting research,
but become intrinsically motivated along the way? Perhaps students become more and
more familiar with the ins and outs of research, and discover how much fun it is to
do. By engaging in research, students could also discover their own talents and research
competencies, which contributes to their intrinsic motivation for research. For instance,
experiencing research could enhance students’ research self-efficacy over time, and
according to Bandura’s Social Cognitive Theory enhanced self-efficacy influences intrinsic
motivation [23]. This is in line with one component of the Self-Determination Theory,
which states that perceived competence of a person is related to his or her intrinsic
motivation. Moreover, students can shift in the continuum of the different types of
motivation, as also described by the Self-Determination Theory [18, 19]. Thus, it
seems fair to assume that a process of transitioning extrinsic motivation into intrinsic
motivation over time is possible. Before students are discouraged from doing research
because it probably has no value in gaining a residency spot or a first match outcome,
we believe it is of great importance to investigate whether this extrinsic motivation
to do research can indeed turn into feelings of intrinsic motivation while being actively
engaged in research.
In conclusion, we would like to emphasize the great importance of directing a sufficient
number of medical students towards a research-oriented career. This could help to
avoid a further decline in physician-scientists and thereby contribute to the next
generation of physician-scientists that is so urgently needed in our world of medicine.
It would be unfortunate for every specialty, including paediatrics, if students were
to engage less and less in research before entering residency. Therefore, dealing
with the intrinsic and extrinsic feelings of students towards research in such a way
that could trigger their intrinsic motivation for research could be of great value.