Testing Self-determination theory in residency: a multi-site path model of leadership, motivation, and burnout
DOI:
https://doi.org/10.36834/pjn9fa52Abstract
Background: Resident burnout persists in graduate medical education (GME), yet many wellness initiatives emphasize individual coping rather than the supervisory practices and learning environments that shape residents’ daily work. Self-determination theory (SDT) suggests that autonomy-supportive leadership (ASL)—behaviours such as acknowledging perspectives, providing meaningful rationales, offering guidance, and conveying respect—may support residents’ psychological needs and foster more self-determined motivation.
Objective: To examine an SDT-informed pathway linking residents’ perceptions of ASL with psychological need satisfaction, motivational quality, and well-being/ill-being.
Method: In Spring 2023, residents and fellows across 15 teaching hospitals within a U.S. healthcare system completed an anonymous online survey assessing ASL, basic psychological need satisfaction, motivational quality, and indicators of well-being and ill-being. Pearson correlations and path analysis with 10,000 bootstrap samples were used to examine relationships among study variables.
Results: A total of 278 trainees responded (16.8%). ASL was positively associated with need satisfaction and motivational quality and negatively associated with ill-being. The hypothesized path model showed good fit (χ² (3) = 2.04, p = .56, CFI = 1.00, RMSEA < .001, SRMR = .013). ASL predicted greater need satisfaction, which predicted higher motivational quality. Both were associated with greater well-being and lower ill-being. The model explained 46% of the variance in well-being and 35% in ill-being.
Conclusions: Autonomy-supportive leadership was associated with more adaptive motivational functioning and better resident well-being, suggesting a potentially modifiable target for faculty development and learning climate improvement. These findings provide integrated, context-specific support for SDT processes in residency training.
References
1. Naji L, Singh B, Shah A, et al. Global prevalence of burnout among postgraduate medical trainees: a systematic review and meta-regression. C open. 2021;9(1):E189-E200. https://doi.org/10.9778/cmajo.20200068
2. Berg S. 5 things health care organizations learned about burnout this year. AMA Recovery Plan for Physicians. 2023. Available from https://www.ama-assn.org/practice-management/physician-health/5-things-health-care-organizations-learned-about-burnout-year [Accessed on Mar 28, 2024].
3. Shalaby R, Oluwasina F, Eboreime E, et al. Burnout among residents: prevalence and predictors of depersonalization, emotional exhaustion and professional unfulfillment among resident doctors in Canada. Int J Environ Res Public Health. 2023;20(4). https://doi.org/10.3390/ijerph20043677
4. Prentice S, Dorstyn D, Benson J, Elliott T. Burnout levels and patterns in postgraduate medical trainees: a systematic review and meta-analysis. Acad Med. Preprint posted online 2020. https://doi.org/10.1097/ACM.0000000000003379
5. Ghahramani S, Lankarani KB, Yousefi M, et al. A systematic review and meta-analysis of burnout among healthcare workers during COVID-19. Front Psychiatry. 2021;12. https://doi.org/10.3389/fpsyt.2021.758849
6. Oliinyk P, Chaplyk V, Timchenko Y. Professional Burnout in Healthcare workers: signs, causes, prevention and treatment. Proc Shevchenko Sci Soc Med Sci. 2022;66(1). https://doi.org/10.25040/ntsh2022.01.08
7. Ryan R, Deci E. Self-determination theory and the facilitation of intrinsic motivation. Am Psychol. 2000;55(1):68-78. https://doi.org/10.1037/0003-066X.55.1.68
8. Ryan RM, Deci EL. Self-Determination Theory: basic psychological needs in motivation, development, and wellness. Guilford Publishing; 2017. https://doi.org/10.1521/978.14625/28806
9. Bartholomew KJ, Ntoumanis N, Ryan RM, Bosch JA, Thogersen-Ntoumani C. Self-determination theory and diminished functioning: the role of interpersonal control and psychological need thwarting. Personal Soc Psychol Bull. 2011;37(11):1459-1473. https://doi.org/10.1177/0146167211413125
10. Vansteenkiste M, Ryan RM. On psychological growth and vulnerability: Basic psychological need satisfaction and need frustration as a unifying principle. J Psychother Integr. Published online 2013. https://doi.org/10.1037/a0032359
11. Orsini C, Binnie VI, Wilson SL. Determinants and outcomes of motivation in health professions education: a systematic review based on self-determination theory. J Educ Eval Health Prof. 2016;13:19. https://doi.org/10.3352/jeehp.2016.13.19
12. Kusurkar RA, Croiset G, Galindo-Garré F, Ten Cate O. Motivational profiles of medical students: association with study effort, academic performance and exhaustion. BMC Med Educ. Published online 2013. https://doi.org/10.1186/1472-6920-13-87
13. Nix GA, Ryan RM, Manly JB, Deci EL. Revitalization through self-regulation: the effects of autonomous and controlled motivation on happiness and vitality. J Exp Soc Psychol. Published online 1999. https://doi.org/10.1006/jesp.1999.1382
14. Williams GC, Deci EL. Internalization of biopsychosocial values by medical students: A test of self-determination theory. J Pers Soc Psychol. 1996;70(4):767-779. http://dx.doi.org/10.1037/0022-3514.70.4.767
15. Bailey TH, Phillips LJ. The influence of motivation and adaptation on students’ subjective well-being, meaning in life and academic performance. High Educ Res Dev. 2016;35(2). https://doi.org/10.1080/07294360.2015.1087474
16. Hansen SE, Defenbaugh N, Mathieu SS, Garufi LC, Dostal JA. A mixed-methods exploration of the developmental trajectory of autonomous motivation in graduate medical learners. Med Sci Educ. 2021;31(6):2017-2031. https://doi.org/10.1007/s40670-021-01396-7
17. Brafford A, Ellis B, Guldner G, et al. A multi-wave study of factors associated with resident engagement, depression, burnout, and stay intent. HCA Healthc J Med. 2024;5(3). https://doi.org/10.36518/2689-0216.1837
18. van der Goot W, Van Yperen N, Albers C, Jaarsma D, Duvivier R. Effects of (de)motivating supervision styles on junior doctors’ intrinsic motivation through basic psychological need frustration and satisfaction: an experimental vignette study. Adv Heal Sci Educ Theory Pr. 2024;30(2):401-426. https://doi.org/10.1007/s10459-024-10344-0
19. Hoffman BD. Using self-determination theory to improve residency training. Acad Med. Published online 2015. https://doi.org/10.1097/acm.0000000000000523
20. Sawatsky AP, O’Brien BC, Hafferty FW. Autonomy and developing physicians: reimagining supervision using self-determination theory. Med Educ. 2022;56(1):31-38. https://doi.org/10.1111/medu.14580
21. Kusurkar RA, Croiset G. Autonomy support for autonomous motivation in medical education. Med Educ Online. Published online 2015. https://doi.org/10.3402/meo.v20.27951
22. Orsini C, Evans P, Jerez O. How to encourage intrinsic motivation in the clinical teaching environment?: a systematic review from the self-determination theory. J Educ Eval Health Prof. 2015;12. https://doi.org/10.3352/jeehp.2015.12.8
23. Orsini CA, Binnie VI, Tricio JA. Motivational profiles and their relationships with basic psychological needs, academic performance, study strategies, self-esteem, and vitality in dental students in Chile. J Educ Eval Health Prof. Published online 2018. https://doi.org/10.3352/jeehp.2018.15.11
24. Biondi EA, Varade WS, Garfunkel LC, et al. Discordance between resident and faculty perceptions of resident autonomy: Can self-determination theory help interpret differences and guide strategies for bridging the divide? Acad Med. 2015;90(4). https://doi.org/10.1097/ACM.0000000000000522
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Adam Neufeld, Gregory Guldner, Cody R DeHaan, C Scott Rigby, Richard M Ryan, Jason T Siegel
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Submission of an original manuscript to the Canadian Medical Education Journal will be taken to mean that it represents original work not previously published, that it is not being considered elsewhere for publication. If accepted for publication, it will be published online and it will not be published elsewhere in the same form, for commercial purposes, in any language, without the consent of the publisher.
Authors who publish in the Canadian Medical Education Journal agree to release their articles under the Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 Canada Licence. This licence allows anyone to copy and distribute the article for non-commercial purposes provided that appropriate attribution is given. For details of the rights an author grants users of their work, please see the licence summary and the full licence.
How to Cite
