Extraordinaire Precepting Chronicles 101: The Power of Positive Engagement to
Motivate the Poor Performer
Anita Cleven, PharmD, RPh
Huy Hoang, PharmD, RPh
Disclosure
In accordance with the ACPE’s and ACCME’s Standards for Commercial Support, anyone in a position to control the content of an educational activity is required to disclose their relevant financial relationships. In accordance with these Standards, ASHP is required to resolve potential conflicts of interest and disclose relevant financial relationships of presenters.
• In this session:
All planners, presenters, reviewers, and ASHP staff report no financial relationships relevant to this activity.
Opening Skit Questions
1. Is Huy motivated to beat this experience, whyor why not?
2. Is Dr. Cleven supportiveof Huy’s dreams?
?
2018 National Pharmacy Preceptors Conference Extraordinaire Precepting Chronicles 101:
The Power of Positive Engagement to Motivate the Poor Performer
©2018 American Society of Health-System Pharmacists Page 1 of 17
Objectives Identify the pillars of motivation according to Self‐
Determination Theory. Explain self‐efficacy/regulation and its impact on
motivation. Evaluate and determine the cause for a poor
performing unmotivated learner. Design and tailor a dialogue to motivate the poor
performer using positive engaging techniques.
Pre‐Test Questions
1. According to Self‐Determination Theory individuals must seek to satisfy what psychological needs?
Satisfaction, Competence, RelatednessCompetence, Autonomy, Belonging Competence, Autonomy, Relatedness Satisfaction, Belonging, Competence
Pre‐Test Questions
2. What type of motivation is the most desirable level of motivation?
Extrinsic Intrinsic Integrated regulation External regulation
2018 National Pharmacy Preceptors Conference Extraordinaire Precepting Chronicles 101:
The Power of Positive Engagement to Motivate the Poor Performer
©2018 American Society of Health-System Pharmacists Page 2 of 17
Pre‐Test Questions
3. Why is positive engagement important to a learner’s motivation?
Creates an environment of safety and facilitates connection with the learnerHelps support competenceHelps support autonomy All the above
Pre‐Test Questions
4. What is a positive engaging technique that you can utilize to enhance intrinsic motivation in the unmotivated poor performer?
Give rewards Provide feedbackGive emotional support Provide directives
Human Functioning
Reject growthDiminished responsibilityCrushedNon‐optimalPassiveIndolent
Reject growthDiminished responsibilityCrushedNon‐optimalPassiveIndolent
ThrivingInspiredAgenticActiveConstructiveNormative
ThrivingInspiredAgenticActiveConstructiveNormative
Optimal Human Condition Optimal Human Condition
2018 National Pharmacy Preceptors Conference Extraordinaire Precepting Chronicles 101:
The Power of Positive Engagement to Motivate the Poor Performer
©2018 American Society of Health-System Pharmacists Page 3 of 17
Motivation
Motivation
Amotivation
Move to act, it produces
Self‐Determination Theory (SDT)
Inherent Growth
Tendencies
Innate Psychological
Needs
Self‐motivation (Intrinsic and Extrinsic), Personality Integration
SDT and Innate Psychological Needs
motivation = anything that thwarts CAR
motivation = anything that enhances CAR
Competence Autonomy Relatedness
2018 National Pharmacy Preceptors Conference Extraordinaire Precepting Chronicles 101:
The Power of Positive Engagement to Motivate the Poor Performer
©2018 American Society of Health-System Pharmacists Page 4 of 17
SDT Continuum of Motivation
Amotivation
Extrinsic Motivation
External RegulationIntrojected RegulationIdentified RegulationIntegrated Regulation
Intrinsic Motivation
Extent to which basic psychological needs, CAR are metExtent to which basic psychological needs, CAR are met
The Self‐Determination Continuum of Motivation (Adapted from Ryan & Deci, 2000)
Amotivation
Unwillingness to perform, lacking intention to act Not feeling competent, expecting no desired
outcomeType of regulation Amotivation
Locus of causality ImpersonalReason for behaviors Passivity, avoidance,
oppositional Effects Insecurity, fear of failure,
resistance, apathy
SDT Continuum of Motivation
Amotivation
Extrinsic Motivation
External RegulationIntrojected RegulationIdentified RegulationIntegrated Regulation
Intrinsic Motivation
Extent to which basic psychological needs, CAR are metExtent to which basic psychological needs, CAR are met
The Self‐Determination Continuum of Motivation (Adapted from Ryan & Deci, 2000)
2018 National Pharmacy Preceptors Conference Extraordinaire Precepting Chronicles 101:
The Power of Positive Engagement to Motivate the Poor Performer
©2018 American Society of Health-System Pharmacists Page 5 of 17
Extrinsic Performance of an activity in order to attain some separable outcome
External Introjected Identified Integrated
Locus of causality
External Somewhat external
Somewhat internal
Internal
Reason for behaviors
Externalrewards and punishments
Self‐control, ego, internal rewards and punishments
Personal importance, conscious valuing
Congruence, awareness, synthesis w/self
SDT Continuum of Motivation
Amotivation
Extrinsic Motivation
External RegulationIntrojected RegulationIdentified RegulationIntegrated Regulation
Intrinsic Motivation
Extent to which basic psychological needs, CAR are metExtent to which basic psychological needs, CAR are met
The Self‐Determination Continuum of Motivation (Adapted from Ryan & Deci, 2000)
Intrinsic Motivation
Doing an activity for the inherent satisfaction of the activity itself
Autonomous motives, integrated, self‐determinationType of regulation Intrinsic
Locus of causality InternalReason for behaviors Interest and enjoyment
Effects Sense of volition, pleasure, energy, persistence
2018 National Pharmacy Preceptors Conference Extraordinaire Precepting Chronicles 101:
The Power of Positive Engagement to Motivate the Poor Performer
©2018 American Society of Health-System Pharmacists Page 6 of 17
Think‐Pair‐Share
Adam completes projects because he is fearful of what others think and is getting directives from his preceptor
Lisa completes all projects assigned to her because she grasps the value and understands its’ importance in the profession
Based on this synopsis, who is more likely to remain motivated throughout the experience and why?
Based on this synopsis, who is more likely to remain motivated throughout the experience and why?
Case 1: Anxious TJ
TJ appears to be tense and confides in you that he is highly anxious and is completing this experience because he “has to.” He is having trouble getting his assignments in on time and is not meeting many competencies of the experience. At midpoint he is not on track to pass.
Self‐Assessment: Identify the motivation behind the performance. . . Self‐Assessment: Identify the motivation behind the performance. . .
Case 2: Good ole’ Laura
Laura comes to your site after having not passed her previous APPE. She is upset and you come to find out that she is indifferent and disinterested in being at your site. She is lagging behind the other learners and has an attitude of “who cares?”
Self‐Assessment: Identify the motivation behind the performance. . . Self‐Assessment: Identify the motivation behind the performance. . .
2018 National Pharmacy Preceptors Conference Extraordinaire Precepting Chronicles 101:
The Power of Positive Engagement to Motivate the Poor Performer
©2018 American Society of Health-System Pharmacists Page 7 of 17
Techniques to positively engage the unmotivated poor performer
Positive FeedbackPositive Feedback
Identify and nurture needs and wants
Identify and nurture needs and wantsGive emotional supportGive emotional support
How to direct properlyHow to direct properly
Communicate value in uninteresting activities Communicate value in uninteresting activities
The Power of Positivity
Make learning relevant to goals Reinforce positive behaviors Respond with positivity Get to know the learner Get learner involved in the
process Stay optimistic and enthusiastic
Positive Learning Environment
Creates a climate of safety, trust and respect
“Brain performs significantly better when it is positive than when it is
negative, neutral or stressed.”
‐ Shawn Achor
“Brain performs significantly better when it is positive than when it is
negative, neutral or stressed.”
‐ Shawn Achor
Positive Feedback
You can help set the trajectory for learners’ motivation If used effectively, positive feedback has a positive
impact on learners’ behavior, engagement, competence, self‐regulation, and can increase intrinsic motivation
Influences the relationship you have with learners Important not to overuse (i.e. use too frequently and
without a specific purpose) as this can facilitate extrinsic motivation
Positive FeedbackPositive Feedback
2018 National Pharmacy Preceptors Conference Extraordinaire Precepting Chronicles 101:
The Power of Positive Engagement to Motivate the Poor Performer
©2018 American Society of Health-System Pharmacists Page 8 of 17
How to deliver positive feedback
Timely, constructive and supportive environment Non‐threatening, directed towards learning
issues not learner Ask learner what went well and opportunities for
improvement Provide points for improvement through use of
suggestions
Positive FeedbackPositive Feedback
Phrases to assist with positive feedback
“Wow, I love how you did that patient write‐up. It was thorough and included all pertinent information.”
“My suggestion is to utilize xyz to help ensure your findings.”
Positive words: surely, absolutely, assure, great, fantastic, gladly, certainly, terrific, not yet
Positive FeedbackPositive Feedback
What does your learner want?
Attempt to understand what the learner wants Be realistic Tailor experience
Identify and nurture needs and wants
Identify and nurture needs and wants
2018 National Pharmacy Preceptors Conference Extraordinaire Precepting Chronicles 101:
The Power of Positive Engagement to Motivate the Poor Performer
©2018 American Society of Health-System Pharmacists Page 9 of 17
Create a sense of belonging
Fosters a positive relationship
Give emotional support
Give emotional support
Warm
Positive
SharingLearners feel vulnerable
to express feelings, doubts and questions
Direct with can, may, couldinstead of must, need and should
Refrain from obligatory statements “You can learn this”
“Maybe you can do it this way”
“It is your choice”
“It would help to include xyz”
“If you study this it will increase your understanding of”
How to direct properlyHow to direct properly
Uninteresting Activities. . .
Communicate value of doing these activities• Provide rationale• Relevance to profession and practice• Relate to colleagues, friends and family
Communicate value in uninteresting activities Communicate value in uninteresting activities
2018 National Pharmacy Preceptors Conference Extraordinaire Precepting Chronicles 101:
The Power of Positive Engagement to Motivate the Poor Performer
©2018 American Society of Health-System Pharmacists Page 10 of 17
Reflection time
1. Which one of these positive engaging techniques have you tried?
2. Which one would you like to try?
Revisit Case 1: Anxious TJ
TJ appears to be tense and confides in you that he is highly anxious and is completing this experience because he “has to.” He is having trouble getting his assignments in on time and is not meeting many competencies of the experience. At midpoint he is not on track to pass.
How would you positively tailor your conversation to motivate TJ?
How would you positively tailor your conversation to motivate TJ?
Revisit Case 2: Good ole’ Laura
Laura comes to your site after having not passed her previous APPE. She is upset and you come to find out that she is indifferent and disinterested in being at your site. She is lagging behind the other learners and has an attitude of “who cares?”
How would you positively tailor your conversation to motivate Laura?
How would you positively tailor your conversation to motivate Laura?
2018 National Pharmacy Preceptors Conference Extraordinaire Precepting Chronicles 101:
The Power of Positive Engagement to Motivate the Poor Performer
©2018 American Society of Health-System Pharmacists Page 11 of 17
Polling Slide: Post‐Test Questions
1. According to Self‐Determination Theory individuals must seek to satisfy what psychological needs?
Satisfaction, Competence, RelatednessCompetence, Autonomy, Belonging Competence, Autonomy, Relatedness Satisfaction, Belonging, Competence
Polling Slide: Post‐Test Questions
2. What type of motivation is the most desirable level of motivation?
Extrinsic Intrinsic Integrated regulation External regulation
Polling Slide: Post‐Test Questions
3. Why is positive engagement important to a learner’s motivation?
Creates an environment of safety and facilitates connection with the learnerHelps support competenceHelps support autonomy All the above
2018 National Pharmacy Preceptors Conference Extraordinaire Precepting Chronicles 101:
The Power of Positive Engagement to Motivate the Poor Performer
©2018 American Society of Health-System Pharmacists Page 12 of 17
Polling Slide: Post‐Test Questions
4. What is a positive engaging technique that you can utilize to enhance intrinsic motivation in the unmotivated poor performer?
Give rewards Provide feedbackGive emotional support Provide directives
Key Takeaways
Key Takeaway #1: The greater the psychological needs of competence, autonomy, and relatedness are met, the greater the learners’ motivation level
Key Takeaway #2: Autonomy supportive teaching enhances intrinsic motivation (e.g. refrain from obligatory statements)
Key Takeaway #3: Positive engaging techniques (positive feedback, directing properly, value in uninteresting topics, emotional support, identify needs and wants) help foster motivation
References1. Ryan, R. M., & Deci, E. L. (2000). Self‐determination theory and the
facilitation of intrinsic motivation, social development, and well‐being. American Psychologist, 55, 68–78.
2. Kusurkar RA, Croiset G, Ten Cate TJ. Twelve tips to stimulate intrinsic motivation in students through autonomy‐supportive classroom teaching derived from self‐determination theory. Med Teach.2011;33(12):978–982.
3. Pankonin, Ashlie, and Rebekah Myers. “Home.” Center for Health Identity Behavior and Prevention Studies CHIBPS, 2018, wp.nyu.edu/steinhardt‐appsych_opus/teachers‐use‐of‐positive‐and‐negative‐feedback‐implications‐for‐student‐behavior/.
2018 National Pharmacy Preceptors Conference Extraordinaire Precepting Chronicles 101:
The Power of Positive Engagement to Motivate the Poor Performer
©2018 American Society of Health-System Pharmacists Page 13 of 17
References continued4. “The Power of Praise and Recognition.” Training Journal, 13 Nov.
2017, www.trainingjournal.com/articles/feature/power‐praise‐and‐recognition.
5. Sogunro, O. A. (2015). Motivating factors for adult learners in higher education. International Journal of Higher Education, 4(1), 22–37. doi:10.5430/ijhe.v4n1p22
6. Zimmerman, B. J. (2000). Self‐efficacy: An essential motive to learn. Contemporary Educational Psychology, 25, 82–91.
7. Orsini C, Evans P, Jerez O. How to encourage intrinsic motivation in the clinical teaching environment?: a systematic review from the self‐determination theory. J Educ Eval Health Prof. 2015;12:8. doi: 10.3352/jeehp.2015.12.8.
2018 National Pharmacy Preceptors Conference Extraordinaire Precepting Chronicles 101:
The Power of Positive Engagement to Motivate the Poor Performer
©2018 American Society of Health-System Pharmacists Page 14 of 17
RESOURCES
12 Tips to Stimulate Intrinsic Motivation 1. Identify and nurture what students need and
want 2. Give positive and constructive feedback
3. Have students’ internal states guide their behavior 4. Give emotional support
5. Encourage active participation 6. Acknowledge students’ expressions of negative effect
7. Encourage students to accept more responsibility for their learning 8. Communicate value in uninteresting activities
9. Provide structured guidance 10. Give choices
11. Provide optimal challenges 12. Direct with ‘can, may, could’ instead of ‘must, need, should’
Adopted from: R. A. Kusurkar, G. Croiset & Olle Th. J. Ten Cate (2011) Twelve tips to stimulate intrinsic motivation in students through autonomy-supportive classroom teaching derived from Self-Determination Theory, Medical Teacher, 33:12, 978-982, DOI: 10.3109/0142159X.2011.599896
Textbooks
1. Ryan, Richard M., and Edward L. Deci. Self-Determination Theory: Basic Psychological Needs in Motivation, Development, and Wellness. Guilford Press, 2017.
2. Deci, Edward L., and Richard Flaste. Why We Do What We Do the Dynamics of Personal Autonomy. G.P. Putnam, 1995.
3. Gagné Marylène. The Oxford Handbook of Work Engagement, Motivation, and Self-Determination Theory. Oxford University Press, 2015.
Articles
1. Pankonin, Ashlie, and Rebekah Myers. “Home.” Center for Health Identity Behavior and Prevention Studies CHIBPS, 2018, wp.nyu.edu/steinhardt-appsych_opus/teachers-use-of-positive-and-negative-feedback-implications-for-student-behavior/.
2. Sogunro, O. A. (2015). Motivating factors for adult learners in higher education. International Journal of Higher Education, 4(1), 22–37. doi:10.5430/ijhe.v4n1p22
3. Zimmerman, B. J. (2000). Self-efficacy: An essential motive to learn. Contemporary Educational Psychology, 25, 82–91.
2018 National Pharmacy Preceptors Conference Extraordinaire Precepting Chronicles 101:
The Power of Positive Engagement to Motivate the Poor Performer
©2018 American Society of Health-System Pharmacists Page 15 of 17
Preceptor Motivation Checklist Handout Self-Determination Theory-based criteria to assess motivation
Competence
I create an environment where learners can feel confident in his/her ability to manage________ I assign workload that my learner is capable of completing (e.g. assignments, projects, presentations, journal clubs, etc.) My learner is able to do his/her own work-up on a patient and review patient charts independently I set realistic expectations where my learner can meet the challenges of the experience My learner is confident in his/her ability to learn this material My learner is capable of learning new material for this course My learner is able to achieve my goals in this course My learner feels able to meet the challenge of performing well in this course Autonomy
I provide my learner with choices and options I am able to be open with my learner at our meetings I convey confidence in my ability to make changes I encourage my learner to ask questions I feel trust in my learner I answer my learner’s questions fully and carefully I make an effort to understand how my learner see things before suggesting a new way to do things I create an environment where my learner feels able to share his/her feelings with me Relatedness
I care about my learner as a person I make an effort to have the learner feel like he/she is a part of the pharmacy team I serve as a good role model for the learner I respect the learner I value the learner I am warm and inviting I feel connected to my learner I serve as valuable resource that my learner can look up to Adopted from: “Questionnaires.” An Approach to Human Motivation & Personality, selfdeterminationtheory.org/questionnaires/.
The more boxes that are checked, the greater likelihood your learners’ will feel intrinsically motivated. Do these results match your perception of your learners’ motivation at your site? If so, how?
2018 National Pharmacy Preceptors Conference Extraordinaire Precepting Chronicles 101:
The Power of Positive Engagement to Motivate the Poor Performer
©2018 American Society of Health-System Pharmacists Page 16 of 17
How would you handle the following situations?
CASE 1: Sarah is from out of state and tells you she does not have a strong social support system. She is engaged and has a strong desire to learn and grow. She tells you that doing a pediatric residency with you has been her lifelong dream and she is absolutely grateful for this opportunity. As an effective preceptor, how would you support Sarah?
Sarah appears to be motivated, however does not have strong social support. Her sense of relatedness may be thwarted. This may ultimately impact her motivation. A suggestion for you to consider: connect her with some other residents, and or other social networks.
Show your support by checking-in with her. <Fill in with additional suggestions>
CASE 2: Robert is completely disengaged and struggling to meet the demands of the experience. You are frustrated with him because he “just doesn’t care.” What would you do?
A suggestion for you to consider: seek to understand what is happening by utilizing positive dialogue (e.g. abstain from accusatory language).
Based on his response tailor your approach to help meet his career goals. <Fill in with additional suggestions>
2018 National Pharmacy Preceptors Conference Extraordinaire Precepting Chronicles 101:
The Power of Positive Engagement to Motivate the Poor Performer
©2018 American Society of Health-System Pharmacists Page 17 of 17