Motivating Learners in a Digital World

Podcast Transcript

Dr. Jamie Stoller:

Hello, and welcome to MedEd Thread, a Cleveland Clinic Education Institute podcast that explores the latest innovations in medical education and amplifies the tremendous work of our educators across the enterprise.

Dr. Cecile Foshee:

Hi. Welcome to today's episode of MedEd Thread. I am your host, Dr. Cecile Foshee, director of the Office of Interprofessional Learning and director of the Master of Education in Health Professions education here at Cleveland Clinic in Cleveland, Ohio. Today, I'm very pleased to have Dr. Michael Nelson here to join us. Dr. Nelson is the media director of the Center for Youth and College Education at Cleveland Clinic. Dr. Nelson, welcome to the podcast.

Dr. Michael Nelson:

Thank you. It's great to be here.

Dr. Cecile Foshee:

So, why don't you start telling us a little bit about yourself?

Dr. Michael Nelson:

Sure. My journey to medical education is not a typical journey to medical education. I started out as a high school language arts teacher, and I taught high school language arts for five years. I loved it, but while I was there, I got my master's in curriculum instruction and I really got into curriculum and curriculum design. But another thing I really got into was technology at that time. And when I was teaching, I found that I was always trying different technology approaches. I was using iPods, Google Drive, and all kinds of stuff like that to just be really innovative with my technology integration.

I probably would have stayed a teacher using a ton of technology all the time. I intended to eventually become a professor, you know, when it came to be retirement time, but when I met my now wife, she was just about to start medical school at Case Western. When we decided to get married, when we got engaged, I picked up. I left my teaching job. I moved to Cleveland with her when she started residency at the Cleveland Clinic. And during that time, I enrolled in a PhD program in educational technology at the Ohio State University. I got very interested in technology integration, how we prepare teachers to use technology, and all things like that.

Fast forward, I did teacher education for a little bit and we had the opportunity to move back here to Cleveland, saw this staff position with an educational technology focus at the Cleveland Clinic, and I was like, man, that is, like, the perfect fit. My wife can be a physician at the clinic. I can work in this educational technology staff position. Took it, and then while I was here, I had this opportunity to become the medical director at the Center for Youth and College Education.

So now I'm back full circle working with high school and college students again, but also working in medical education as well.

Dr. Cecile Foshee:

That's wonderful. What a great path. We have a lot of common in, in, in those ways, yes. Tell me, what are some things that educators need to remember when it comes to motivating learners?

Dr. Michael Nelson:

Sure. So, I think the couple things we need to keep in mind is not, one thing is that not all motivation is the same. At the total base level, there are two types of motivation. There's intrinsic motivation, and that's motivation that you have, you want to do something because you like it, because you enjoy it. It's something you would like to pursue. On the other hand, there is extrinsic motivation, and this is motivation where you are doing something because of some kind of outside force.

Now, in many cases, like, extrinsic motivation is pitched as the bad kind of motivation, and intrinsic motivation is pitched as the good kind of motivation. And that's true to an extent, but there are a lot of different types of extrinsic motivation. So, I'm going to give you an example. If I had a passion for something in medicine, right, I had a passion for medicine, I pursue a medical career, I'm intrinsically motivated because I want to help people and I want to treat people, right?

But, if I was someone who, instead of going into medicine, I took a job working at a factory that makes aglets, and those, those are those little plastic things that you get into your shoelaces, right, most people don't have a passion for aglets. They're not going to, like, get all excited about, like, being an aglet person and going on and, like, talking about, "This is my passion, aglets," right? But over time, as they're working, they may suddenly find that instead of just doing this for the money or just doing this because their boss says so, they may find that they take pride in what they do. They may find that they enjoy the leadership aspects of that job. They may enjoy working with other people, and they may feel like they're good at it, too. And it's a really motivating thing to be good at something, and also to be important, to feel like you matter, to feel like you're a part of a team, right?

So that's kind of the gist of extrinsic motivation. You have the base model where you are motivated because someone is forcing you to do something. You're being coerced. But on the higher end, if you view something as related to your identity, you can still do things that you aren't internally motivated to do. You can really work hard at them and enjoy them because it's related to something that you do see as a part of your identity. It's kind of almost intrinsic motivation.

And the concept behind that aglet example are the basic concepts behind s- what's called self-determination theory. And with self-determination theory, you basically try to move people from that super-internalized extrinsic motivation towards closer and closer to intrinsic motivation. And the way you do that is by accommodating the basic needs. That's what they're called in the theory. It's competence, relatedness, and autonomy. So, you want to foster feelings that someone is competent, that they feel like they can be successful at doing something, that they're good at something. It's a very motivating thing to be good at something. If anyone's ever tried to pick up a musical instrument, you know that it's not very fun when you first start and you're not competent. But if you could push through and become competent, then you get hooked and you keep doing it and doing it. We see this all over life, right? So that's competence.

Relatedness, we want to feel like we're a part of something. We want to feel connected to other people, connected to a team. And then autonomy is, we want to feel like we have some control in life, that we are able to make a difference and it's our decisions that are driving what we do. So, competence, relatedness, autonomy. And if we foster those things, people become more motivated and they're more likely to internalize that motivation as well. So, when working with students, it's a good example to foster those kinds of things, you know, give them opportunities to feel like they are succeeding, opportunities to feel like they're a part of something, opportunities to feel like they have some level of control.

Because if you just show up to work or school or whatever and you're just told what to do and you don't know what you're doing and you have no control over what you're doing, you're not motivated. It's very amotivational. Also, when someone is making a decision, there's another theory called expectancy value theory, that basically takes one of those things, competence, and we're gonna see competence, and, you know, your expectancy for success and self-efficacy, these feelings that you can succeed at things, they're in, like, all the motivation theories in some shape or form, very, very important for people to feel like they're good and feel like they can do well.

So, off that tangent, the theory I was just talking about, expectancy value theory, the two components are expectancy for success, so whether you feel like you can be successful, and value beliefs. Your value beliefs include whether you're interested in something, so this is just do you like it. If I like doing this, I'm gonna be more motivated to do it. If I like a specialty in medicine or a career, I'm more likely to want to do it. Interest, utility value, so do I think something is useful to me? That's, like, useful in many ways. It can be useful to help you improve your life, like give you a career, make money. For, like, educators, it can be useful to help students learn.

Importance is the third value belief, and for importance or attainment value, does this thing I'm deciding to do mesh with how I view myself? So, if I view myself as a nurse practitioner, does this thing that I'm deciding whether or not to do line up with that identity I have for myself? Is it gonna align with who I am? And then the last thing, of course, is cost in expectancy value theory. Is it really time-consuming and difficult to do this thing?

In my dissertation, I studied teachers and I found that for teachers to use technology when they teach, it was really important for them to, I mean, one thing that was important was for them to like technology. The teachers were more likely to use the technology to improve their instruction when they liked it. Also, when they thought it was useful for student learning, so that utility value was really, really important. And again, as I said before, competence. Very important. So, their self-efficacy. Did they feel like they could actually succeed if they used technology? Those things were all very, very important.

Dr. Cecile Foshee:

So, you talked about that factory worker in the beginning, and then there's a lot of similarities that I'm seeing between these theories and these perspectives that you're talking about. But it really comes down to having the opportunity to feel like you matter, to feel like you're able to do something, when you talked about, you know, giving that examples like maybe it's not the most interesting to do the aglets, but, you know, maybe at some point you really grow to realize that you can be the best that you can be. So, can you then talk about, a little bit about that? You know, outside of these theories, how do you create those moments for your learners so that you can instill some of these things in them?

Dr. Michael Nelson:

Sure. So, if we really want them to feel, in terms of, like, feeling like they matter and feeling like they make a difference, I would say gradually introduce them to more complex tasks and let them actually work at it. So rather than just throwing them in, we would like to create a scenario where they can actually be successful.

So, a great example of this. Say you are, you know, training surgeons, and the surgical residents are learning very complex procedures. If you want them to develop their competence and to feel like they are good and feel like they can make decisions, it might be a good idea to take them to, like, the simulation center, for example, to work on a difficult procedure. That way, they are allowed to fail. There's low risk. They can ask questions, and they can also feel like they are somewhat in charge, to a degree. They can have that self-direction.

Dr. Cecile Foshee:

That's great, so really give them the opportunity to practice on making that task probably attainable, and then growing on that.

Dr. Michael Nelson:

Exactly. Yeah, so giving them that opportunity to be successful and, you know, to fail in a safe environment where there aren't high stakes.

Dr. Cecile Foshee:

That's great. So, you talked about, you know, um, working with teachers in your dissertation. What are the most take-home points that you, you got out of that? Like, what would be the message that you would give to, to our listeners from that work?

Dr. Michael Nelson:

I think it's really important to help educators and learners feel like if they work at it, it's gonna work out for them. And for learners, one of the things that you can do to really help them do that is goal setting. So, you set small goals over time that they can achieve, and you help them achieve the goals. You give them opportunities to succeed. That's not saying make everything easy, because we don't want to make everything easy. We want things to gradually become more difficult. But we want them to feel like if they try hard, that effort is going to pay off, because we like, again, we like to feel like we're in control. We want that sense of autonomy. We want to feel like we're in control. We want to feel competent. So, give them that sense that they're achieving their goals. If they work, it's going to work out for them, and that they are actually achieving. They are progressing. We want to foster a sense where people feel like they are growing, they are aware of their competence and their increase in competence.

Dr. Cecile Foshee:

That's great. I know in the beginning, you also talked about intrinsic versus extrinsic, and extrinsic, that really being a bad thing. I really like that you, you emphasized that, because we have this tendency of thinking, you know, one thing is better than the other. So, in the goal orientation, it's the same thing, right? So, you're talking about this performance versus mastery kind of approach. People tend to think that mastery's better, so I like that you are, you know, really focusing on just attaining the goals. So maybe you can speak a little bit about that, you know, so that people don't think of one better than the other.

Dr. Michael Nelson:

Sure. To an extent, we do want to ideally foster as much mastery as possible. We want to make learners want to learn, learn for the sake of learning. That's the ideal thing. But also, just learning for the sake of doing well and performing, not necessarily a bad thing. For example, there are situations where what learners have to learn is just incredible boring and mundane. And you're not gonna get people motivated about some things internally, like you're never gonna love motivating these body parts or these pathways for hormones, or whatever.

So, but in those situations, you can make it a little more interesting. You can do things like add gamification elements, you know? There are a lot of games online where instead of just grilling people with quiz questions, you can make it a trivia game. You don't want to do that all the time, because focusing all the time on performance and comparing to others, not really a good thing. You can undermine intrinsic motivation if you do that all the time, if you make everything external. And you also want to make sure that, you know, when you're doing this gamification and you are having this comparison, you aren't making the people at the bottom the same people at the bottom every time, because if you see yourself at the bottom and you're always performing, it's very amotivational.

Like, one of my professors at Ohio State, he's a renowned motivation professor, and the first thing he did at our TA orientation for educators is he walked up to the board and he drew the normal curve, that, like, bell curve. And he said, "How many of you had teachers who drew this after you took a test and told you, 'Here's how many students got A's, B's, C's, and D's'?" I mean, I think everyone's had a teacher at some point who's done that. Never do that. Never. It's fine for the students at the top, but they don't really need to be motivated further. They're motivated. For the students that are at the bottom, they see they're there at the very bottom. They're not competitive with the other students. It's very amotivational for them. You're helping people who don't need help, and you're making things worse for the people who do need help.

So that social comparison is something we should be very wary of. And like I said, competition can be okay in doses. We should use competition. It's very motivating in some ways. But if it's comparison, comparison, comparison all the time, it's amotivational.

Dr. Cecile Foshee:

That's a great point that you bring up, and it's probably something that happens quite a bit in our environment, so I'm glad that you have, you know, really honed in on that. Are there other things that people should be aware of not doing that would demotivate people?

Dr. Michael Nelson:

Giving bad feedback. So, if you give good feedback and you tell people what they can improve on and how they can get better, that's motivational, because that's giving me targets. That's saying, okay, I can do this and this and this. But if your feedback to learners in any specialty, if you're just always saying, "Oh, you did a really good job because you're smart," "You did a great job," that can make people feel good and that can be okay, but our feedback should really be focused on something that can be improved, that can grow. If your feedback is always based on static things, if you're just telling them they're intelligent, that's why they're working, well, then what happens if they run into a roadblock, right? If we foster this sense where everything is happening because they are innately intelligent, then when they fail, it's also because they're innately unintelligent. And we don't want to have that. We want to foster more of a growth mindset, where they feel like they can grow and they feel like they can improve. So that's another big thing, I think, that is something to avoid.

Dr. Cecile Foshee:

So, y- you know, earlier you also talked about gamification and games. Maybe our listeners would benefit from understanding the difference between those two, because people tend to get infatuated with the idea of gamification without truly understanding what that means.

Dr. Michael Nelson:

Yeah, so this is something, and you'll see, there are academic papers that, where people argue about this, where the line is drawn, but a game is created for the sake of the game, right? You can learn playing the game, but the game is the point. You know, I'm playing a video game. It has educational value. Some of the games that I played when I was a kid, you know, had educational value, but the whole point was that the games were fun. They were created to be games.

Gamification is when you add gaming elements to non-games. So, if I create a trivia quiz with online polling and points and things like that, but the main activity is a quiz, I'm gamifying that activity. Or if I have a leaderboard on the learning management system that assigns points for hitting different indicators or doing key cases, I'm adding a game element, that leaderboard. I'm adding that to something that is not a game. And it can be motivating to add these game elements to things, especially when, like I said, they're boring things that aren't enjoyable anyway. If you're already motivated to do something and you are achieving, as an instructor, it's not necessarily the best idea to gamify something that the learners are already motivated to do, because external rewards are a complicated thing in educational psychology. They can be motivating, but if people start doing things because of the external rewards instead of the value of what they're doing, that can be a problem.

Dr. Cecile Foshee:

That's true. Excellent point. I really like that you're talking about the difference between those two, and one with the goal being of learning while you're having fun, and the other one is the goal is to have fun while you may be, you know, doing a little bit of learning as well. So, it's ultimately the purpose that, that makes a difference.

Dr. Michael Nelson:

Absolutely.

Dr. Cecile Foshee:

Very nice. Very nice. Is, is there any other technologies that would be helpful for motivating learners?

Dr. Michael Nelson:

Yeah, I think there are a number of different technologies that would be useful. Instructors should consider, if they are going to lecture during didactic sections, maybe flood that instruction instead. You know, you can record a video and assign the video at home, that learners can watch that. And that way, you can be with the learners and provide them with direct feedback and make a more student-centered learning process. You can provide them with exploration activities, also online in a learning management system. So, we have MyLearning here at the Cleveland Clinic. You can create a MyLearning resource page and encourage your learners to use it. And if they're interested in something, they can explore further on their own and do different activities. You can also foster community with things like MyLearning. You know, you can use online polls and surveys to do check-ins with students, like very quick, snap check-ins just to provide feedback and to have them reflect also on their own learning.

Dr. Cecile Foshee:

Lots of opportunities. That's great. Thank you for bringing that up. Is there anything else that you feel is important for our listeners to know that maybe I didn't ask?

Dr. Michael Nelson:

I think the most important thing is to think about your learners as people, and to realize that they have the same desires and interests and drives as you. Because sometimes it's easy to think about all the tasks we want them to achieve. We have to think about, what is pushing them to achieve these tasks, and what can we do to make it more motivational for them to achieve the tasks? How can we make it a more enjoyable experience?

Dr. Cecile Foshee:

That's excellent. You have a little bit of empathy for them and put yourself in their shoes. You know, what is their perspective? Sometimes we forget that, don't we?

Dr. Michael Nelson:

Exactly.

Dr. Cecile Foshee:

Great. Well, thank you so much, Dr. Nelson. This has been a great podcast. To our listeners, thank you very much, and we will see you on our next podcast, and have a wonderful day.

Dr. Jamie Stoller:

This concludes this episode of MedEd Thread, a Cleveland Clinic Education Institute podcast. Be sure to subscribe to hear new episodes via iTunes, Google Play, SoundCloud, Stitcher, Spotify, or wherever you get your podcasts. Until next time, thanks for listening to MedEd Thread, and please join us again soon.