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Motivation 101: Can You Learn To Love Med School? (Part 1)

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by Alec Palmerton, MD in Uncategorized
USMLE Motivation

Tell me if this sounds familiar. You’ve gotten home from a long day in class or the hospital. You tell yourself, “I’m tired. I need a 30-minute break before I start studying.”

30 minutes pass. Then an hour. Before long, it’s been two hours, and while your guilt continues to grow, you still haven’t started that UWorld block.

Then the self-hate starts. “What is wrong with me?” you may have asked yourself. “I know I SHOULD be studying…why am I sitting here?”

In extreme cases, we may even feel a sense of futility. “What’s the point of studying?” You may look back on the past year or two and regret how you’ve been learning, and feel like there is no way to recover.

“I’m already so far behind, what’s the point?”

What makes it even worse is that other students appear super motivated. I don’t mean those super stressed-out kids who are always on the verge of their next emotional breakdown. I mean the ones who always seem to know what they’re doing. You know who I’m talking about. Calm, in control. They’re the first in the library and the last to leave. They’re not only good at school, but they’ve done research since day 1. They seem to take everything in stride and bounce back stronger.

(Note, this is Part 1 of a 3-Part Series. Read Part 2 and Part 3.)

Are You Going Through the Motions?

Do you feel like you’re in perma-procrastination mode? Do your 5 minute YouTube breaks turn into hours-long ordeals? Did you promise yourself you’d only watch 20 minutes of your favorite show…three episodes ago?

If so, then you may be having a problem with motivation. Motivation is vital in everything we do. We can have the best teacher, the best study plan, and the best resources in front of us. Without the motivation to use them, they are meaningless.

Let’s put it another way. Our score on the USMLEs is the cumulative result of the months and years before we take them. Motivation is the fuel for that outcome.

Even more importantly, the best predictor of how we live in the future is how we’re living today.

If we dread getting out of bed, what kind of life will we be living when we’re doctors?

However, when we lack motivation, we feel guilty. If we’re not motivated, it’s somehow our fault.

“What’s wrong with me?” we ask ourselves. “I know I should be studying.”

This guilt comes from the mistaken belief that motivation is a fixed quantity. We are either born motivated or lazy. However, decades of research in psychology have demonstrated this belief is false. Motivation is a skill that we can learn. Just as we can learn to suture or to tie a knot, we can learn and hone our ability to stay motivated.

To improve our motivation, we first need to understand its ingredients.

Can You Teach Yourself How to Love What You’re Doing?

Researchers break down motivation into two broad types: intrinsic and extrinsic. Let’s start with extrinsic motivation.

Extrinsic motivation is what we know all too well in med school. Extrinsic motivation is being motivated by the rewards that action might bring. Here are some examples:

  • Studying to get a good grade
  • Doing research to stand out in residency applications
  • Doing Qbank questions because we want a higher USMLE score

Intrinsic motivation means doing an activity because the task itself is the reward. Examples are:

  • Studying because we love learning
  • Doing research because we want to solve the problems
  • Doing QBank questions because we enjoy testing our knowledge

Self-Determination Theory: How to Build Intrinsic Motivation

If these examples of intrinsic motivation seem like a pipe dream, they’re not! A major reason behind my academic success has been intrinsic motivation. I’ve taught myself to love learning. This is NOT something innate (as you will see). Instead, it is something you can learn.

To learn how to build intrinsic motivation, let’s discuss Self-Determination Theory (SDT). Decades of psychologic research supports it. It also promises to unravel the age-old med student challenge: how do I learn to love what I’m doing?

SDT posits that three core human needs form the basis of motivation. They are autonomy, meaning, and competence. Improve each of these, and you can learn to love what you’re doing for the sake of doing it.

In this post, we will explore autonomy and meaning, and see how we can use them to boost our intrinsic motivation. In the following posts, we will discuss competence, and practical ways you can become more motivated today.

1. Autonomy

Our need for some control over our own lives is an innate part of the human spirit. We see this desire clearly come into being in a two-year-old child. During the “terrible twos,” we witness children coming into their own personalities (sometimes literally kicking and screaming while they do so).

Toddlers often rage at the lack of control they have in their lives. And when you think about it from their perspective, who can blame them? Everything is decided for them — from when they go to bed, to what food they eat, to what clothes they wear.

It is a wise parent who starts giving their toddler some choices such as “Would you like to wear the red shirt or the green shirt today?” or “Would you like grape juice or apple juice to drink?” Even when the choices are limited, having a sense of control can be profoundly calming on young children.

Medicine Challenges Our Sense of Autonomy

As a medical student, I often felt a distinct lack of control over my life. In many ways, I was like a toddler with all my choices taken away from me. I had to be at this place at this time, stay there this long, and then complete this task by this specific time.

Medical school feels more like high school than high school. When I was a resident, some medical students even had to ask if they could go to the bathroom.

Many medical students add to these restrictions by coming up with elaborate study schedules that take away any sense of freedom or spontaneity.

This lack of choice drains our motivation. One way we can build it back up is by giving ourselves some alternatives. You can choose how you study, how you will learn the material, and where you study. You can choose which task you will do first on your clinical to-do list.

Autonomy Builds an Internal Locus of Control

Columbia researchers wrote in 2010, “Each choice – no matter how small – informs the perception of control and self-efficacy.” These decisions and their outcomes comprise what psychologists call our “internal locus of control.”

Here’s an interesting illustration of how our internal locus of control works. Researchers divided fifth graders into two groups. Each group received the same math problem. When the students finished, one group was praised for their intelligence. (“Wow, you must be so smart for solving that problem!”). The other group was praised for the effort they put into solving the problems. (“Wow, you must have worked so hard at that problem!”).

Next, the children had the option of choosing another math problem. The kids praised for their intelligence chose the easier problem. They also gave up more easily. The ones lauded for effort selected more difficult questions, and persevered longer.

My interpretation? The more control we feel over our surroundings, the more motivated we will feel. Autonomy plays a strong role in developing this sense of control.

How We Can Improve Our Locus of Control

It’s not just fifth graders who can be trained to see results as a product of their own control. Have you ever told yourself:

  • “I’m bad at IV’s,”
  • “I am not good at dissections,” or
  • “I suck at standardized tests.”

Stop labeling yourself. Instead, think:

Aim to see the results around you as the product of your own actions. You can take control. And, by doing so, you will be more motivated.

2. Meaning (Purpose)

Viktor E. Frankl writes in Man’s Search for Meaning, “Those who have a ‘why’ to live, can bear with almost any ‘how.’”

Meaning is the second part of Self-Determination Theory. Combined with autonomy/choice, purpose can take your motivation to the next level.

Take a minute and ask yourself two questions:

  • What kind of doctor did you write about becoming in your medical school essay? (e.g., helping the scared, underserved, etc.)
  • What kind of doctor do you actually feel yourself becoming?

If your answers were the same to both questions, then congratulations. You may be the first.

Not becoming the doctor you thought you would? That sick, twisted knot in your stomach is the feeling of your purpose not matching your actions.

Forgetting Your Purpose Can Destroy Motivation

There’s no quicker way to kill motivation than to lose sight of your greater purpose.

Let’s look at why that is happening. When I got into medical school, I was thrilled. My med school essay was about how I loved to learn and apply new knowledge. I dreamed of learning about the body. I wanted to teach others how to integrate and apply their knowledge. It didn’t matter what specialty I chose, I told myself.

However, when I got to medical school, I could feel that idealism slipping away. Before arriving, I hadn’t given much thought to what specialty I wanted to do. I figured I’d have time. Many of my classmates, however, seemed to know exactly what they wanted to do. And it didn’t take a rocket-scientist to see that many “dream” specialties had lots of free time and/or salary. Or that they required high Boards scores.

Slowly, my motivation switched from, “I want to help people,” to “I want to score high on Boards, so I don’t close any doors.”

I forgot my purpose and focused on extrinsic motivation. I started to become more stressed out. It was harder to motivate myself.

Eventually, I was so stressed that I couldn’t continue on the path of aiming solely for high grades. Instead, I told myself, “if the only thing you accomplish in med school is to still love learning at the end, it would have been a huge success.”

I stopped worrying about my test scores. I let go of worrying about what specialties paid the best. Instead, I focused on why I went into medicine:

To apply knowledge of the human body in the service of helping others.

Focusing on Purpose Improved My Motivation (and My Scores)

Once I stopped worrying about my grades, a funny thing happened. I started enjoying going to class again. And my scores even improved.

(True story: I’m not super religious. However, on the day of my Step 1, I didn’t pray for a high score. I actually prayed for the score that would allow me to fulfill God’s plan for me.)

That’s not to say that money and free-time are bad. Or that you shouldn’t choose a competitive field. They’re not bad, and there are plenty of fantastic reasons to do any specialty, competitive or not.

However, extrinsic motivators like free-time and money are weak sources of motivation. Plus, their pursuit tends to cause high levels of stress and low levels of happiness.

USMLE Motivation

Remembering our purpose can improve our intrinsic motivation

Re-Discovering Our Purpose Can Ease Burnout

Meaning can also be an effective treatment for an extreme lack of motivation: burnout.

In one study, the Mayo Clinic had a group of physicians set aside one day a week to do something meaningful to them. Some volunteered, some did research, others did clinical work. The “meaningful work” group experienced a 50 percent lower burnout rate than in peers who didn’t set aside time for such purposeful work.

I wonder: how much of your time is spent doing the things that you find most meaningful?

Purpose: Practical Steps to Improve Motivation

So what can we do to infuse our actions with meaning? We must clarify our greater purpose, and remind ourselves daily.

First, ask yourself, why are you in medicine? Really, do it. Take 5 minutes, and ask yourself why you wanted to come into medicine in the first place.

Maybe it was because you wanted to take care of people who couldn’t take care of themselves. Or perhaps you were motivated to be a champion of the underserved. Or maybe you wanted to be a researcher. Whatever it is, it’s easy to lose sight of.

Second, combine it with the first part of Self-Determination Theory: autonomy. In other words, see the things around you as a meaningful choice, rather than something that you have to do.

Dread Studying? Make it a Meaningful Choice to Improve Your Intrinsic Motivation

Turning obligations into meaningful choices is especially powerful when we think about things we don’t want to do. Things like studying, listening to lecture, or doing our Anki flashcards. When doing these things, ask yourself, “why am I doing this?”

Another way to do this is to ask yourself what choices you can make that can advance your purpose. For me, I came to medical school because I loved learning. Not only learning but applying what I knew to a more significant cause. But I found myself starting to hate learning because I felt like a receptacle for facts, rather than someone who was making sense of what I was being taught.

So I turned to Self-Determination Theory. “What choices could I make (autonomy), to fulfill my purpose?” One idea I generated was to make lectures more meaningful. I used to sit in lecture and take copious notes. For things I didn’t understand, I would just memorize them, like many of my classmates.

However, to create more meaning for myself, I wrote down questions to things I didn’t understand. “Why are GI viruses naked?” “Why do DNA viruses cause cancer?”

Anything I didn’t understand, I’d write down. Instead of memorizing these as facts, I used these questions to start discussions with my professors after class.

I learned some pretty incredible things. Most importantly, studying went from a dreaded chore to a reminder of my life’s purpose.

It can be very motivating to have choices. However, the most motivating kinds of options are those that infuse your actions with meaning and purpose.

Concluding Thoughts

Med school motivation is often in short supply. Remember that extrinsic factors – studying for high grades, etc. – can lead to more stress, and paradoxically worse outcomes. To re-build your sense of motivation, remember to give yourself choices. And to gain even more motivation, remind yourself of your sense of purpose.

Want to learn more about how to love medicine, rather than dreading it? This is Part 1 of a 3-Part Series. Read Part 2 and Part 3.

What do you think? Are you struggling with motivation? What has worked for you? Let us know in the comments!

Photo by Jamie Street

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Want FREE Cardiology Flashcards?

Cardiology is key for impressive USMLE scores. Master cardiology from a Harvard-trained anesthesiologist who scored USMLE 270 with these 130+ high-yield flash cards. You’ll be begging for cardio questions - even if vitals make you queasy.