Effect of changes to the formal curriculum on medical students’ motivation towards learning: a prospective cohort study

ABSTRACT BACKGROUND: One of the factors known to influence performance in the learning process is student motivation. In turn, students’ motivation can be regulated by a large number of variables relating to the individual (such as sex, age and socioeconomic status) or to aspects of the academic life. OBJECTIVE: The primary aim of this study was to evaluate the influence of curriculum changes involving reduction in content overload and increased early exposure to clinical settings, on motivation towards learning among Year 1 medical students. Secondarily, the aim was to ascertain whether this influence on motivation remained stable until the undergraduate program ended (Year 6). DESIGN AND SETTING: Prospective study on two student cohorts at a Brazilian state-owned university. METHODS: Two consecutive student cohorts were assessed: one with a traditional curriculum (n = 87) and the other with a reformed curriculum (n = 63), at the same medical school. Participants in both cohorts gave responses on four scales in Years 1 and 6: the Academic Motivation Scale, containing subscales for autonomous and controlled motivation, and lack of motivation towards learning; Beck’s Anxiety and Depression Inventories; Spielberger’s State-Trait Anxiety Inventory; and the Social Adjustment Scale. In Year 6, 68% of the initial sample (66 students with the traditional curriculum and 36 with the reformed curriculum) was reassessed. RESULTS: No differences between Year 1 cohorts were found regarding demographic and social background, social adjustment, depression or anxiety. Students with the reformed curriculum scored significantly higher regarding autonomous and controlled motivation than those with the traditional curriculum. Comparison between Year 6 and Year 1 showed increases in controlled motivation only for the traditional curriculum cohort. CONCLUSION: Curriculum changes were associated with increased motivation towards learning in Year 1, which persisted until Year 6.

摘要

背景：已知影响学习过程表现的因素之一为学生学习动机。学生的学习动机可受诸多与个体相关的变量（如性别、年龄、社会经济地位）或学术生活相关因素的调控。

研究目的：本研究首要目的为评估课程改革（即减少内容过载、增加早期临床接触）对一年级医学生学习动机的影响；次要目的为确认该动机影响是否能持续至本科培养结束（六年级）。

研究设计与研究场所：此项前瞻性研究在巴西一所公立大学开展，纳入两届学生队列。

研究方法：对同一医学院的两届连续入学学生队列进行评估：传统课程组（n=87）与改革后课程组（n=63）。两届受试者在一年级和六年级均完成四项量表测评：学习动机量表（Academic Motivation Scale），包含自主性动机、控制性动机及无学习动机三个子量表；贝克焦虑与抑郁量表（Beck’s Anxiety and Depression Inventories）；施皮尔伯格状态-特质焦虑量表（Spielberger’s State-Trait Anxiety Inventory）；以及社会适应量表（Social Adjustment Scale）。六年级时，对初始样本的68%（传统课程组66人、改革后课程组36人）进行了复测。

研究结果：一年级两届学生在人口学与社会背景、社会适应、抑郁或焦虑水平上均无显著差异。改革后课程组学生的自主性动机与控制性动机得分显著高于传统课程组。对比六年级与一年级数据，仅传统课程组的控制性动机出现显著提升。

研究结论：课程改革与一年级医学生学习动机提升相关，且该效应持续至本科六年级。