Internal medicine clerks' motivation in an online course: a mixed-methods study.

Purpose: At LUMC, a Small Private Online Course (SPOC) was developed complementary to the clinical learning environment of the internal medicine clerkship. The developers used the self-determination theory in the design of the SPOC's assignments aiming to improve learners' intrinsic motivation. This study investigates the impact of the SPOC and its specific assignments on student motivation.

Methods: The study uses a mixed-methods approach. The authors describe a quantitative analysis of students' responses on an intrinsic motivation inventory (IMI), and a qualitative thematic analysis of semi-structured group interviews, respectively.

Results: Seventy-eight students (response rate 42%) filled out the IMI. Their scores were (7-point Likert scale): interest/enjoyment 3.76, competence 4.02, choice 3.53, value/usefulness 4.20, relatedness 3.85. Thematic analysis of the interviews (14 students) revealed seven themes: collaboration with peers, usefulness, SPOC-related factors, workload, motivation, and performance.

Conclusions: Motivation could be optimized creating useful, authentic cases that train skills that are directly transferrable to clinical practice. Challenging, interesting and student-generated assignments positively influenced students' autonomy and motivation. Lack of awareness of online performance negatively affected the feeling of competence. Perceptions of online collaboration were suboptimal. The study can be helpful for other teachers to enhance motivation while developing online courses.