Table 2 Summary of themes and sub-themes and analysis according to SDT

1. Interaction with the lecturer

Interaction with the lecturer as a process of enhancing the feeling of competence, identification with being a doctor and facilitating the learning cycle

Interaction with the lecturer

1.1 Endorsement of

competence through feedback

Interaction with the lecturer and its feedback endorse the feeling of competence

1.2 Monitoring of the

learning cycle through feedback

The learning process is monitored through the interaction (feedback) with the lecturer

1.3 The lecturer is a role model

Through reduced contact (only possible via email or web-based lessons), the function of the lecturer as a role model was decreased. Hereby the identification with being a doctor was also decreased and the internalization of studying to become a doctor was also reduced. The result is a shift towards external regulated behavior. The lack of feedback and monitoring of the learning cycle (due to web-based lessons) resulted in a decreased feeling of competence with an accompanied decrease of ability beliefs- all nourishing amotivation.

The ability beliefs of a student are influenced at most by the teacher and its competence support.

The lecturer (role model) functions as a key figure for medical students. The need for interpersonal affiliation develops when good relationships with these key figures develop. Students need stable relationship with these key figures, they are nurturing for internalization and hence autonomy supportive in terms of motivation, increasing relatedness and decreasing amotivation. Due to the pandemic these relationships were reduced and therefore relatedness to those key figures vanished and amotivation increased.

Sample statements for theme 1.

“In the teaching units the educators always gave us feedback and that helped me to organize the learning at home and supported me to identify the learning contents which I should focus more on.” (S2)

“I felt like a part of a whole and mostly I wanted to become like our educators.” (S3)

“At the beginning of each class, we usually display the learning goals, and we check regularly if they have been achieved. Some students need more time- sometimes you see it in their faces. I give them a break and then I make a wanted repetition.” (SE1)

“I ask the students to ask questions at any time and I try to get them all on the same track.” (SE2)

“When I take them to the ward to see a patient and when they are allowed to wear their white coat, you see a glimpse in their eyes. I feel a great responsibility, they seem to absorb all that I do.” (JE2)

2. Disruption of face-to-face teaching units

The lack of face-to-face teachings endorsed the feeling of helplessness and incompetence through a decreased interaction with the lecturer and peers

2.1 Increase of gaps in knowledge

Through the lack of face-to-face teachings gaps in knowledge cannot be clarified and the sense of incompetence grows; the connections of the learning contents are not easily seen, resulting in feelings of incompetence and overload

2.2 Decrease of class´ structure

Learning content and its load is less structured and the students feel incompetence and overload

2.3 Less confirmation of the learning cycle

Confirmation of the learned the confirmation of the learning process is reduced and the sense of incompetence increases; increasing feeling of deprivation

In SDT, amotivation is defined as utmost state of motivational deficit. Amotivation is often defined and characterized by feelings of alienation and helplessness. The growing feeling of incompetence induced by the disruption of face-to-face teachings increased the feeling of helplessness and resulted in amotivation. Ability beliefs vanish and nurture amotivation.

Characteristics of the task (online lessons) were not stimulating and hence no high-quality experience in terms of knowledge gain took place. The result is enhanced amotivation.

Students are impacted by adequate transmittance of information to accelerate the learning cycle- this results in competence support. The lack of face-to-face teachings impaired this acceleration, hence decreased the feeling of competence and resulted in amotivation.

Sample statements for theme 2.

“I was so overwhelmed by the learning goals. Usually, I never looked at them but during the lockdown I felt that they are like a mountain I could never climb alone.” (S2)

“It took me days to repeat and repeat things and I was not aware that I simply did not understand it properly” (S2)

“The educators always gave us the feeling they will guide us through the learning process. Webex did not convey that. We could not really have a true interaction. I felt lost somehow and sometimes panicked even”. (S6)

“When I held my classes online, I lost the connection to my students. I knew some of them from prior classes and they knew me. The Interaction was not the same anymore. Usually, I considered myself as their navigational system through the semester. During the lockdown, I saw my students often being desperate but still not participating.” (SE1)

“After the semester, I can tell you about how many students will have which kind of test results. I know them and I see how their learning progresses. During the lockdown I could not make any statement concerning any student.” (SE3)

“It was frustrating often. I tried to talk to the students to see what else I could explain in order to help them with their learning, but it seemed as if they themselves desperately locked up” (JE1)

3. Disruption of patient contact

Patient interaction as a process facilitating the identification with the job (wanting to help patients) and hereby enhancing the feeling of competence and wish to learn

3.1 Interaction with patients enhances the wish to help

3.2 interaction with patients endorses the identification with being a doctor

Interaction with patients enhances the feeling of competence; the importance of the studies was lost in the students´ sight

Patient interaction functions as a catalysator in the identification process (being a doctor) and internalizing the task. The locus of causality for studying is seen from within, the more identification with being a doctor settles in. The subtype of amotivation, value placed on the task, decreases while identification decreases. The value of the task (being a doctor, hence studying) devalues. Values by implication, influence the perceived desirability of a task and hereby influence the organization of personal goals. All the mentioned was affected by the disrupted patient contact.

Patients contact furthermore fosters the feeling of autonomy (I will be a doctor) which would facilitate the adoption of studying as an internal behavior. Here again the disruption led to a decrease of this internalization process.

Sample statements for theme 3.

“When I went to bedside teaching, it was always so motivating. I knew why I study medicine and I knew why I want to learn in order to be able to help”. (S3)

“Any time I had contact with a patient, my wish grew to be completely in charge for my own patients after medschool”. (S4)

“One does not need lots of effort to have a good bedside teaching. The students always are so motivated when they are in their future roles”. (SE1)

“It is sometimes very adorable how students slip into their future roles. They love wearing the white coat and “playing” doctor” (SE3)

“When we have seminars on a topic and then the next day go to ward to apply the gathered knowledge, the students are always so happy and eager” (JE1)

4. Disruption of daily university structure

Structure of university as an influencing factor of the daily life and individuals´ (students) feelings

4.1 Decreased feeling of security by disruption of university structure

The structure given by the university (mandatory classes etc.) provides a feeling of security; the structure given by the university is something reliable and was absent during lockdown, resulting in increased feelings of helplessness

4.2 Decreased daily routine

The university structures the daily routine and the sudden absence results in insecurity

4.3 Decreased sense of freedom

Being a student and attending university creates a sense of freedom

4.4 Increased devaluation of university

classroom teaching and studying seemed more and more irrelevant

The role of the environment per se matters in terms of supporting the basic psychological needs. The structure of university endorses the sense of effort beliefs in relation to their time management (go to university, study afterwards and it will work out well). This feeling of reliability vanished by the closure and resulted in a feeling of alienation and helplessness- hence amotivation increased. The loss of structure increased the levels of perceived stress– resulting in a learned helplessness. The task (studying medicine- in terms of going to university) becomes a less integral part of students´ life and hereby its importance decreases- resulting in amotivation for studying medicine. The activity (studying medicine) becomes less self-expressed. Students´ autonomy vanished as due to the closure of university their own learning strategies were not fulfilled. Students did not feel to act out of free choice (I go to the library when I want, I don’t attend a non-mandatory lecture etc.). Hence the locus of causality moved to extrinsic regulation.

Sample statements for theme 4.

“Prior to the lockdown it was easy. We had our schedule, and all other activities were planned around that.” (S1)

“All of our daily routine was based on the structure given by the universities- it is different for us who go to medschool than other students- suddenly all was gone.” (S2)

“It was such a good feeling to be a student, going to university- it felt so intellectual. After a while I lost the sense of studying- it was an awkward feeling.” (S2)

“When they start to go to medical school, they are still like pupils and their daily structure does not change actually. The Deans´office let them know when to attend which class. Although they feel free, they still are in schedule boundaries” (SE1)

“Suddenly they lost their gathering place and they told me, without that place, why attend online classes” (SE1)

“Some of the students told me they are feeling depressed. Mainly because university was their mainstay in life which defined so many things for them”. (JE2)

5. Social (peer) isolation through closure of universities

Closure of universities led to social isolation, enhancing insecurities and the feeling of incompetence

Social (peer) isolation through closure of universities

5.1 Increased feelings of alienation

Students were suddenly “all alone” and with reduced contact to their peers; feelings of deprivation increased; lack of contact with peers and lack of learning groups decreased the actual meaning of studying

5.2 Decreased role identification

The meaning of being a medical student was not seen

5.3 Decreased peer stress to endorse learning

Social pressure as a positive factor to endorse learning

5.4 Decreased perceived perspectives

Lack of perspectives; the importance of the task was not seen anymore (the why to study)

The broader social context in which the student is situated influence academic attitudes and behaviors and therefore amotivation. Relationships with others are a basis to fulfill individuals psychological needs. Either through needs that are satisfied or during an interaction where bilaterally needs are satisfied. These relationships (in this context mainly with peers) were disrupted by pandemic circumstances. Effort believes are stronger in communities and learning groups a.e enhance the feeling that the needed strategies are to master the task (studying medicine). Interaction with peers enhances the importance and hence the value of studying- here amotivation stemmed from devaluing the task due to deficits in interaction and lonely coping. The interaction with peers automatically centered university as an integral part of students´ lives- this vanished centering led to increased amotivation.

The closure of universities led to frustration of students, mainly because of the lack of practice of practical skills- automatically their environment conveyed negative information about university (as listed in the evaluations). This led to devaluing university and hence studying medicine and hereby amotivation grew. The feeling of (knowledge) competence vanished as confirmation by peers was not possible as usual (a.e learning groups). The students did not have the chance to experience a supporting network and the feeling of competence, relatedness and autonomy decreased.

Sample statements for theme 5.

“During the orientation phase (first week of university), most of the learning groups are formed. We go through the learning phases together, we talk about our fears, we set goals and try to achieve them together- we even have lunch and coffee together. During the pandemic all was gone and we could not even meet in private. Online meetings were no substitute. It was a bad feeling.” (S1)

“I often talked to my peers about what we would like to become- in sense of which specialty. We evaluated our learning and helped each other. Suddenly all this interaction was gone” (S5)

“It is being with friends but also a friendly competition is motivating” (S6)

“The feeling: we are in this together was gone”. (S7)

“They are like small formations on the campus, and they share a lot of things to facilitate the stressful learning phases. I imagine it to be very hard for them to be all alone at once”. (SE2)

“I remember from my student time, that my learning groups were like family. They stressed also because if we did not learn like we set our goals, we would be the “looser”. (JE2)