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HOW to be an autonomy-supportive medical teacher: Five practical recommendations

Medical teachers should regularly reflect on their teaching approach as it will determine their students’ motivation. Autonomy-supportive teaching enhances intrinsic motivation which means doing something because it is interesting and enjoyable, whereas a controlling style of teaching enhances extrinsic motivation which means doing something because of outside pressures. Intrinsic motivation is associated with deep learning and better academic performance in comparison to extrinsic motivation [1]. In this article, five practical recommendations are introduced to make the teaching approach more autonomy-supportive.


Introduction
Medical teachers should regularly reflect on their teaching approach as it will determine their students' motivation. Autonomy-supportive teaching enhances intrinsic motivation which means doing something because it is interesting and enjoyable, whereas a controlling style of teaching enhances extrinsic motivation which means doing something because of outside pressures. Intrinsic motivation is associated with deep learning and better academic performance in comparison to extrinsic motivation [1]. In this article, five practical recommendations are introduced to make the teaching approach more autonomy-supportive.

Background
Self-determination theory (SDT) is a motivational theory that focuses on intrinsic motivation. The theory assumes that all humans have an intrinsic desire to explore and react to their environment [2]. Because SDT assumes that everyone is naturally motivated, the theory focuses on the factors that stimulate or inhibit intrinsic motivation [3]. SDT stated that intrinsic motivation is enhanced by the fulfillment of three innate and basic psychological needs: the need for autonomy, the need for competence, and the need for relatedness [1]. Autonomy-supportive teaching aims to satisfy these needs and enhance intrinsic motivation among students by making them feel autonomous and competent and also supported by their teachers, fostering relatedness [4]. According to Reeve [5], autonomy-supportive teaching includes: a) fostering the students 'perspective, b) welcoming their thoughts, feelings, and behaviors, and c) supporting their motivational development and capacity for autonomous self-regulation. On the other hand, a controlling style of teaching includes (a) adoption of the teacher's perspective, b) intruding into students' thoughts, feelings, or actions, and c) pushing students to think, feel, or behave in certain ways.

The five practical recommendations
The literature review reveals many proposed "tips" and "acts" that nurture autonomy-supportive teaching [4][5][6]. However, the implementation of those is not without challenges. For instance, problem-based learning (PBL) stimulates intrinsic motivation as students have the chance to choose sources of information which enhances their feelings of autonomy. It stimulates relatedness because students must work in groups to solve problems [6]. On the other hand, PBL is resource-intensive and requires well-trained facilitators. Also, it necessitates allocating extra time in the curriculum. Based on the above we introduce the following five simple and practical recommendations that enhance autonomy-supportive teaching. They can be used by most medical teachers apart from their teaching experiences. Additionally, they are amenable to implementation in various learning environments.

Use interesting learning methods
If the learning method is interesting for students, this may enhance their intrinsic motivation.
For Example, using simulation-based learning rather than lectures to teach certain topics like principles of laparoscopic surgery may be more interesting for students. Students will work on a virtual reality laparoscope and box trainer. This will lead to curiosity [7]. Curiosity is associated with the motivation for competence [8]. Working on the box trainer necessitates teamwork which supports the feeling of relatedness.

Explain the importance of the topic
Always give a rationale to explain why a certain topic, especially if it is not interesting, is truly important for students. For example, some anatomy and pathology topics are uninteresting but essential for both surgical study and future practice. Through understanding the importance of a certain subject for their medical career, students will autonomously choose to study it, enhancing their self-determined motivation [4].

Offer your students choices
Encourage giving students choices concerning learning methods and dates of assessment whenever possible. Giving students the chance to choose learning methods, exercises, and tasks leads to autonomy and enhances intrinsic motivation due to feelings of being responsible for their learning [4]. The author recommends offering students enough time to revise and discuss the timetable of the course before its beginning and give their opinions. Changes are considered if they are applicable after discussion with the course coordinator and tutors.

Use autonomy-supportive language
Always try to use autonomy-supportive language like: 'if you want to study this topic well, it will help you to understand the next one and avoid controlling language like: 'you must study this well to pass the exam'. Controlling communications hinder students' autonomous selfregulation whereas autonomy-supportive communications functionally support students' autonomous self-regulation [5].

Do not intrude on students' activities; rather, invite them to think about their practice
If the teacher uses intrusion and pressure during a learning activity this may lead students to neglect their internal natural patterns and instead, adopt the teacher's way of thinking, feeling, or behaving [5]. For example, during a simulation-based training session for suturing the teacher may take a needle holder out of a student's hand and show them how to hold it without asking them to think about their method and compare it to what they have learned.

Ethical approval
Not applicable.

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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author contribution
The entire article has been conducted by the corresponding author.

Please state any conflicts of interest
The author have no conflict of interest.

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Guarantor
The guarantor is the corresponding author. Name: Osama Mahmoud Bendari Yakout.