Table 3 Integration of survey and interview findings, informed by Self-Determination Theory

AUTONOMY

Self & Time

Managing self & time against uncertain outcomes. Similar to Bureaucracy, Financial, an extrinsic de-motivator. Students have not internalised a desire to do research. Research, and its unforeseen outcomes, is not a good fit with the immediate demands of study and lack of time for research.

Previous Research Experience

We had such a short period of time to work on a project, it’s hard to, hard to I guess pick a topic that’s interesting and at the same time feasible (105 Yr2)

Students initiate and regulate their research behaviors with a high degree of volition and a sense of choice.¹⁹

Total sample r_s = -0.27 All Stages

r_s = -0.16 Pre-clinical

r_s = -0.22 Clinical

r_s = -0.17 Pre-CR

I was just trying just to find my ground in terms of second year, had a big year, and then you come to the end of the holidays and you just want a break and then you find out that there’s a research opportunity there…. so it wasn’t the best timing (103 Yr 5)

r_s = -0.22 Post-CR

Career

Career advantage is an extrinsic motivator but can be demotivating if not accompanied by a sense of a higher purpose, such as Clinical Relevance, the pursuit of scientific knowledge, or identification with research careers. Otherwise doing research feels inauthentic and forced.

Career Advantage

I find that in medicine, especially, there’s such heavy weight on people doing research, even though it doesn’t really reflect their clinical competence.….So I’m a little frustrated at that because I’d rather be doing research because I want to do it, rather than be doing it so my resume looks padded out (104 Yr 5)

r_s = -0.38 (range = -0.24 – -0.49)

All Years, All Stages

Group differences: Mean(SD)

1.8(0.7) Pre-CR, 1.6(0.7)* Post-CR

1.8(0.7) Pre-Clinical, 1.6(0.7)* Clinical

Suited to Academic Career

The benefits are I think, that I’m hoping, that it will help me to get into specialty training easier. I was thinking of doing ophthalmology when I started and they only take in a couple of people every year, so I thought it would give me a good, good leg up into being a bit more competitive (101 Yr 2)

r_s = 0.39 Yr4, r_s = 0.41 Yr5

r_s = 0.20 pre-CR, r_s = 0.36 post-CR

Difficult with Clinical Career

r_s = 0.30 Yr1, r_s = 0.16 Yr2, r_s = 0.24 Yr5

r_s = 0.22 Pre-Clinical,

r_s = 0.20 Clinical

r_s = 0.20 pre-CR, r_s = 0.23 post-CR

Bureaucracy

The bureaucracy and bother of doing research. Processes that hinder or assist the conduct of research, such as ethics. An extrinsic de-motivator which can be overcome if intrinsically motivated to do research, and if not seen to be due to lack of competence.

Bureaucracy

It ended up taking us nearly six months to get ethics approval, if not longer. And it was just a retrospective study and we were asking, you know, no names were going to be mentioned or anything like that…. It was really disheartening every time you’d send something in and you’d get rejected and it would be for some technicality that you didn’t even think existed (104 Yr5)

r_s = 0.35 Yr4, r_s = 0.23 Yr5

r_s = 0.21 clinical, r_s = 0.25 post-CR

Group differences: Mean(SD)

2.8(0.9) Pre-Clinical, 2.5(0.9)* Clinical

2.8(0.9) Pre-CR, 2.4(1.0)* Post-CR

Research During

(r_s = -0.43 Yr5, where experience was positive during degree)

That’s it, like if there’s like a streamlined information [portal] of what research is going on and who needs help or what research you can take on and how to get in those positions. It kind of like feels, like I don’t know how to be involved even if I wanted to (111 Yr 4)

Financial

Financial barriers and rewards. An extrinsic motivator, it can act as an immediate facilitator, but not deeply motivating in the longer term, especially for students who have internalised a desire to do research.

Lower Salary

I hate to say it, but it’s the finances. Research can be quite time intensive. Even with the summer res scholarship it doesn’t provide you with much income in return for the work that you’re doing (119 Yr 1)

r_s = 0.21 Yr2 (range = -0.09 – 0.21)

I guess money’s a good thing, but I’m not trying to say money’s not my only thing that’s motivating me, but for other people, that kind of thing might be a push (122 Yr 1)

COMPETENCE

Confidence

At first, it seems research is only offered or suited to high performing students and is beyond one’s abilities. With experience there is increasing confidence in doing research, particularly when research support and supervision is provided, to reach a sense of achievement and mastery. A key example of increasing internalisation.

Previous Research Experience

I think coming straight out of school into the course and then in the first years you might get an email about some research opportunity. I guess because you have to apply and it’s a competitive process, I kind of thought, oh well, I won’t get it anyway or I haven’t got any experience yet, I’ll just have to wait until I get the experience. (108 Yr 5)

The need to be effective in interactions with research, the desire to exercise capacities, seek optimal challenges, and extend skills.¹⁹

Total sample r_s = -0.27, All Stages

r_s = -0.16 pre-clinical, r_s = -0.22 clinical

r_s = -0.17 pre-CR, r_s = -0.22 post-CR

(r_s = 0.27, All Years, All Stages)

Research During

(r_s = -0.43 Yr5, where experience was positive during degree)

I mean, it’s something I have accomplished myself so I can look at it and say, yeah I’ve accomplished this….I’ve shown, I’ve proven that I could do it. (101 Yr 2)

RELATEDNESS

Clinical relevance

Students enter medical school wanting to be clinicians; they are peripherally aware of research but cannot see its relevance until exposed to the realities of clinical practice. For those doing additional research, the sense of having added to scientific knowledge through their discoveries is highly motivating. Conversely, the notion of not being driven by practical relevance or discovery, but by venal aims such as career advancement, is demotivating.

Keeping Up to Date

But when we started our clinical years, we realised that sort of practice in the hospital isn’t sort of as cut and dried as the first few years of medicine. That sometimes clinical decisions are based on things that we don’t fully understand, so we have to base it on the best evidence out. So we started to realise, or I started to realise that research, what contributes to that and that’s helpful to further understand the decision we’re making, whether they’re the right ones (113 Yr3)

(range = -0.26 – -0.32), All Years, All Stages)

The need to establish close and secure attachments with others; feeling emotionally linked to and interpersonally involved in warm, caring relationships; connection with a ideals or goals held by a group; a sense of purpose.^19,21

Another motivator is because people legitimately do want to be good doctors and they think that research is important for that. ….they feel they want to ask a clinical question and they truly do want to know the answer (107 Yr 5)

Research as a Social Activity

Students are intrinsically motivated by social relationships; the image of research as lonely work, and poor quality relationships in research teams can be highly demotivating. However, good relationships and teamwork foster motivation and confidence.

Research During

When the school is selecting for medical students, they select I suppose friendly communicative kind of personalities, so maybe that’s why some of them are not so, they wouldn’t be so drawn to research which is maybe a more lonely kind of occupation (113 Yr 3)

(r_s = - 0.43 Yr5, where experience was positive during degree)

The good part of it is everyone can contribute and different people have different ideas and different ways to look at things (117 Yr4)

Personal Relevance

Increasing awareness of Clinical Relevance and of the researcher identity can be hastened by connection with a person to whom the student can relate, for example, a role model, mentor, or supervisor. These include researchers who teach or do clinical work, who counter the attitude that research is only suited to academically oriented students and that it cannot be combined with clinical work.

Only suited to academic career

I think I mostly heard about it from my grandfather because he was a virologist and he did work on influenza for 20 years, and so he would tell us stories about his research and it was just really, really fascinating to hear about someone discovering something that had never been seen by anyone else before.(101 Yr 2)

r_s = 0.28 (range = 0.20– 0.41)

lowest agreement in Yr5(r_s = 0.41)

Difficult to combine with clinical career

r_s = 0.30 Yr1, r_s = 0.16 Yr2, r_s = 0.24 Yr5

r_s = 0.22 Pre-Clinical, r_s = 0.20 Clinical

Even before I’d decided I wanted to do medicine, I was interested in medical research, and I have a few family friends who are doctors and one of them said that a really good way of getting into medical research is also doing medicine and it was something I was considering, so that was actually one of the reasons I chose to do medicine (112 Yr 3)

r_s = 0.20 pre-CR, r_s = 0.23 post-CR

Research During

(r_s = - 0.43 Yr5, where experience was positive during degree)