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Too Busy, Too Bored, Too Burnt-Out:
Practical Theory-based Tools to Win
Back the Unmotivated LearnerKarin B. Gray, MD
Whitney L. Browning, MD
Sarah F. Denniston, MD
H. Barrett Fromme, MD, MHPE
Natalie G. McKnight, MD
Kira A. Molas-Torreblanca, DO
Katie E. Pestak, DO
Disclosures
We have no relevant financial relationships with the manufacturers of any commercial products and/or providers of commercial services discussed in this CME activity.
We do not intend to discuss an unapproved/investigative use of a commercial product/device in our presentation..
Goals and Objectives
• Practice Motivational Interviewing skills to re-engage the unmotivated
learner.
• Apply Self-Determination Theory to the unmotivated learner and their
environment.
• Examine tools and strategies known to engage Millennial learners.
Roadmap
• Introductions
• Motivational Interviewing (large group)
• Motivational Interviewing (pairs)
• Self-Determination Theory (large group)
• Self-Determination Theory (small groups)
• Millennial Learners (large group)
• Millennial Learners (small group)
• Report Back and Wrap Up
Motivational Interviewing
5 Key Principles of MI: Express Empathy
• Use reflective listening
– Use statements that demonstrate understanding of learner’s thoughts and feelings
– Accepting attitude
– Nonjudgmental
– Collaborative
• Reframing into potential change talk
– “It sounds to me like…”
5 Key Principles of MI:Develop Discrepancy
• Learner goals/values versus current behavior
Focus on discordance
Motivate change
• May achieve commitment to change
5 Key Principles of MI:Avoid Argument
• Avoid direct confrontation
• Arguments
– Counterproductive
– Leads to defensiveness
• Resistance change strategy
5 Key Principles of MI:Rolling With Resistance
• “Rolling” is not engaging or opposing
Reframing negative information
New, positive interpretation
• Perception can be shifted
5 Key Principles of MI:Support Self-Efficacy and Optimism
Precontemplation:
Not considering change, unwilling to change
Raise awareness Contemplation:
Aware but is ambivalent
Help to choose change
Determination:
Committed to change
Help identify change strategies
Action:
Taking steps toward change
Help implement change strategies
Maintenance:
Sustaining change
Develop new skills for maintaining
Recurrence/Relapse
Cope with consequences and determine next step
Stages of Change
Importance/Confidence/Readiness Ruler
• Probe lower
– Challenge patient to defend the positive
– Avoid probing upward early
• Probe upward later in the discussion
– “Which of the changes we discussed would need to occur to bring you up from 5 to 6?”
Spirit of Motivational Interviewing
• Collaboration (vs. Confrontation)
• Optimism
• Respect
• Evocation (Drawing Out vs Imposing Ideas)
• Autonomy (vs. Authority)
Using OARS
Open-ended Questions
Affirmations
Reflective Listening
Summary Statements
Using FRAMES
Feedback
Responsibility
Advice
Menu
Empathy
Self-Efficacy
Pair Share Activity
• Think about principles of MI
• Use OARS for Kelly’s heme/onc rotation
• Use FRAMES for Kelly’s current rotation
Self-Determination Theory
Self Determination Theory
• Framework of human motivation
• Prior: “Carrot and Stick”
• Developed by Edward Deci and Richard Ryan at the University of Rochester in the 1970’s
• Articulates intrinsic and extrinsic sources of motivation
• Yes, rewards can change our motivation – but for the better?
– Initial studies showed that students interested in an activity were transiently more engaged
when offered rewards, then less engaged from baseline when rewards removed
• Emphasized the quality, not the quantity of motivation
What Moves You?
• Extrinsic motivation: Doing something to
achieve a “separable outcome”
• Intrinsic motivation: “Doing an activity for its
inherent satisfactions rather than for some
separable consequences”
A Little More Theory
• SDT assumes humans are wired for intrinsic motivation
• Concerned with “the conditions which elicit and sustain, versus subdue
and diminish, this innate propensity”
– In the right setting, intrinsic motivation is natural
– Fairly easy to disrupt
Ryan RM, Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol. 2000 Jan;55(1):68-78
Basic Psychological Needs
• Cognitive Evaluation Theory: Three basic psychological needs will foster
intrinsic motivation
– Autonomy
– Competence
– Relatedness
Ryan RM, Deci EL. Self-determination Theory Basic Psychological Needs in Motivation, Development, and Wellness. New York: Guilford, 2017.
Cognitive Behavioral TheoryBasic Psychological Needs
Optimal Health and Motivation
Competence
Relatedness
Autonomy
3 Basic Psychological Needs
Animated by Camp Stomping Ground, accessed 7/18/2017 at https://youtu.be/3sRBBNkSXpY. An excerpt from the opening keynote at The Self-Determination Theory Conference 2013 by Richard Ryan. Used with permission.
Regulatory Styles
• Organismic Integration Theory: Identifies three regulatory styles
– Amotivation
– Extrinsic motivation
– Intrinsic motivation
Ryan RM, Deci EL. Self-determination Theory Basic Psychological Needs in Motivation, Development, and Wellness. New York: Guilford, 2017.
Organismic Integration Theory
AmotivationExtrinsic
MotivationIntrinsic
Motivation
Impersonal
Apathy, Lack of
intention
External
Reward or Punishment
SomewhatExternal
Compulsion, guilt
SomewhatInternal
Thoughtful valuing of
goals
Internal
Assimilation of values into self
Internal
Pure interest, challenge, joy,
curiosity
How do we move our learners from A to Z…or I (Internalization and Integration)??Cook DA, Artino AR. Motivation to learn: an overview of contemporary theories. Medical Education. 2016;50(10):997-1014. doi:10.1111/medu.13074.Ryan RM, Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol. 2000 Jan;55(1):68-78.
Self Determination Theory
AmotivationExtrinsic
MotivationIntrinsic
Motivation
ImpersonalApathy,
Lack of intention“CAN’T”
ExternalReward or
PunishmentPRIZE
IntrojectedCompulsion,
guilt“SHOULD”
IdentifiedThoughtful valuing of
goalsVALUE
IntegratedAssimilation
of values into self
“I AM”
InternalPure interest, challenge, joy,
curiosityJUST HAPPENS
RelatednessRespect, caring,
inclusivity, safety.
Competition, Criticism, Tradition
CompetenceChallenge, Positive
Feedback
Negative feedback, Impossible challenge
AutonomyChoice,
responsibility, acknowledging feelings, avoid
judgment
Rewards, imposed goals
See citation above
Why the Big Deal?
• Motivation matters to us!
• Quality of learning matters to us!
• Self-Determination Theory has been applied in multiple contexts –
all levels of education, business, parenting, health care. It works!
Getting to Intrinsic MotivationConditions that Facilitate Conditions that Undermine
Autonomy-Absence of Pressure-Goal Choice-Strategy Choice-Task Involvement-Promotion of Task Interest
Autonomy-Pressure toward Outcomes-Punishment Contingencies-Goal Imposition-Deadlines-Controlling Rewards-Ego-involvement-Surveillance
Competence-Optimal Challenge-Positive Feedback-Informational Rewards
Competence-Non-Optimal Challenges-Negative Feedback
Relatedness-Empathy-Warmth-Acknowledge Emotions
Relatedness- “Cold” Interactions- Lack of Positive Involvement
Ryan RM, Deci EL. Self-
determination Theory Basic
Psychological Needs in
Motivation, Development,
and Wellness. New York:
Guilford, 2017.
The Millennial Learner
How to motivate the unmotivated “star” of your show
Millennial learner (ML)• *Definition of ML: generation born between 1982 and
2002 (Howe & Strauss, 2000)
• Largest and most culturally diverse generational cohort
in U.S. history
• Preferences: collaborating, connecting, and creating
social change
• “tech savvy”
• “connecting and sharing information”*Pinder-Grover T, Groscurth, CR; PRINCIPLES FOR TEACHING THE MILLENNIAL GENERATION: INNOVATIVE PRACTICES OF U-M FACULTY, CRLT Occasional Paper No. 26, 2009
What the Literature Shows…
Strengths
Want to achieve
Team-oriented
Goal-oriented
Hard-working
Need transparency
Challenges
Anxious
Require frequent feedback
Learning needs to be personalized
Need sense of accomplishment
Need higher praise
Set expectations
Be a coach, not a teacher
Target learning on rounds
Focus on the patient
Build a community
A Framework
Millennials and Theory
Motivational Interviewing
-collaborative, nonjudgmental
-optimism through personalized learning
-evoke their perspectives
Self-Determination Theory
-Intrinsic motivation, comes from
within
-Autonomy, relatedness, competence
Your Turn
Thinking about your next time on service, what approaches can you take
to motivate millennial learners when motivation is at a winter low?
Millennial Theater:Small group break-out
• The Staging
• The Performance
• The Curtain Call
Report Back and Wrap Up
• Goals and Objectives
– Practice Motivational Interviewing skills to re-engage the unmotivated learner
– Apply Self-Determination Theory to the unmotivated learner and their
environment
– Examine tools and strategies known to engage Millennial learners
• Questions, Comments, What Worked for You?
References
• Bundy, C. Changing Behaviour: Using Motivational Interviewing Techniques. J R Soc Med. 2004; S44(97):43-47.
• Resnicow K, McMaster F. Motivational Interviewing: Moving from Why to How with Autonomy Support. Int J Behav Nutr Phys Act. 2012; 9:19.
• Miller WR, Rollnick S. (2013). Motivational Interviewing: Helping people change. New York, NY: Guilford Press.
• Chirkov V, Ryan RM, Kim Y, Kaplan U. Differentiating autonomy from individualism and independence: a self-determination theory perspective on internalization of cultural orientations and well-being. J Pers Soc Pscyhol. 2003 Jan;84(1):97-110.
• Miller, W. R., & Rollnick, S. (2002). Motivational Interviewing: Preparing people for change, (2nd ed.). New York, NY: Guilford Press.
• Sheldon L, Using Motivational Interviewing to Help your Students. The NEA Higher Education Journal, 2010, pp 153-159
References
• Lipman V. (2015, March 1) Study shows secret to managing millennials can be summed up in one word. Retrieved from:
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vTBJMR5JjCxJfQyfHQ-ZSkPlyYkKT9EcxJf_3KbREtsjqteLYPwUByqgNOjrYAu2IfOR5cBCICQhY7H3uwPRPRL5x4KaPl5SyBKeuUM-
4Uj_7UwIsjUYFXpF9_s4hckiBHAArOrxNAieIEUTfiaY_Eto8Ng9VKD2Zv3uGnhctX3CsTvYAddZpstZ3ykjdwUJSiAtjkgoN4Prjr_eydTx1kMte1ZfobAgOSurdfCmj3h0
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