Trainee‐environment interactions that stimulate motivation: A rich pictures study

Abstract

Context Staying motivated when working and learning in complex workplaces can be challenging. When complex environments exceed trainees’ aptitude, this may reduce feelings of competence, which can hamper motivation. Motivation theories explain how intrapersonal and interpersonal aspects influence motivation. Clinical environments include additional aspects that may not fit into these theories. We used a systems approach to explore how the clinical environment influences trainees’ motivation and how they are intertwined. Methods We employed the rich pictures drawing method as a visual tool to capture the complexities of the clinical environment. A total of 15 trainees drew a rich picture representing a motivating situation in the workplace and were interviewed afterwards. Data collection and analysis were performed iteratively, following a constructivist grounded theory approach, using open, focused and selective coding strategies as well as memo writing. Both drawings and the interviews were used to reach our results. Results Trainees drew situations pertaining to tasks they enjoyed doing and that mattered for their learning or patient care. Four dimensions of the environment were identified that supported trainees’ motivation. First, social interactions, including interpersonal relationships, supported motivation through close collaboration between health care professionals and trainees. Second, organisational features, including processes and procedures, supported motivation when learning opportunities were provided or trainees were able to influence their work schedule. Third, technical possibilities, including tools and artefacts, supported motivation when tools were used to provide trainees with feedback or trainees used specific instruments in their training. Finally, physical space supported motivation when the actual setting improved the atmosphere or trainees were able to modify the environment to help them focus. Conclusions Different clinical environment dimensions can support motivation and be modified to create optimal motivating situations. To understand motivational dynamics and support trainees to navigate through postgraduate medical education, we need to take all clinical environment dimensions into account.

‘I found myself a despicable being!’: Medical students face disturbing moral dilemmas

“…The Rich Picture method instigates participants to think differently about their experiences and express ideas that are difficult to put into words uncovering taken‐for‐granted perceptions and assumptions 46 . In medical education research, the Rich Pictures have been used to explore complex situations, such as emotional reactions and motivation of trainees, 49 medical expert judgements 48 and learning in the clinical environment 50 . Considering the emotional aspects of moral dilemmas and their expected complexity, we hypothesised that Rich Pictures would add to traditional interviews by allowing participants to deepen their reflections and bring the emotional and subconscious aspects of their experiences.…”

The ‘Rich Pictures’ Method: Its Use and Value, and the Implications for HRD Research and Practice

“…Interviews generally last between 30 and 45 minutes but can last longer (e.g., van Duin et al, 2021; Velthuis et al, 2021). For instance, van der Goot et al’s (2020) study of medical students’ workplace motivation gave participants 30 minutes to draw an RP and followed this with a 45-minute semi-structured interview which included probe questions specific to the content of the RP. Helmich et al (2017) also followed RPs with a semi-structured interview but were more prescriptive and standardized the interview schedule so that all participants were asked the same questions (could you please explain what is in the picture; what led you to choose this scenario; what makes a situation complex for you; what makes it exciting or overwhelming).…”

“…As they explained their RP to the researcher, they added an additional depiction of a boat set above waves to illustrate the sense of their new experience being up (positive) and down (negative/stressful). It may not be possible for all RPs to be completed in a single sitting, although most researchers suggest that around 20-30 minutes is sufficient and a short break can also be incorporated if necessary (Armson, 2011;LaDonna et al, 2018;van der Goot et al, 2020). On the other hand, if the RP is going to be left for a longer period and returned to later, it can be useful to give it a title (e.g., A rich picture of …), and a date.…”

“…It may not be possible for all RPs to be completed in a single sitting, although most researchers suggest that around 20–30 minutes is sufficient and a short break can also be incorporated if necessary (Armson, 2011; LaDonna et al, 2018; van der Goot et al, 2020). On the other hand, if the RP is going to be left for a longer period and returned to later, it can be useful to give it a title (e.g., A rich picture of …), and a date.…”

“…Post-data collection analysis can take a number of forms and across the research looked at in this article includes template analysis (Ribeiro et al, 2021), grounded theory (van der Goot et al, 2020) and content analysis (e.g., Bell & Morse, 2016; Bood et al, 2021; Cristancho et al, 2015). Guidance specific to content analysis of RP data is also provided by Bell and Morse (2013a) who adapted Carney’s (1994) analytical framework.…”