Medical PhD programmes aim to train future generations of clinician-scientists i.e., medical doctors who combine patient care with research. Enrolment in medical PhD programmes has increased tremendously in the past decades [1,2,3,4,5]. Simultaneously, there are concerns about PhD candidates well-being [6,7,8,9,10], a complex combination of the presence of positive (e.g. satisfaction, self-efficacy, work engagement) and/or absence of negative (e.g. anxiety, stress, burnout) mental states [11]. Several studies found that 3050% of PhD candidates self-report significant levels of stress, burnout and other mental health problems [12,13,14,15,16]. Negative aspects are related to delaying doctoral study and intentions to quit [17,18,19,20,21,22,23]. Subsequently, programme attrition, with rates between 2560%, is a major concern in the medical doctoral domain, as well as in other doctoral domains [10, 19, 24]. This issue is particularly critical as it may potentially contribute to the decline in and shortage of clinician-scientists [25, 26].

Motivation is strongly linked to well-being and, hence, persistence and study completion and success [6, 27,28,29,30,31]. Therefore, insight into factors affecting motivation of medical doctors (MDs) pursuing a PhD could provide guidance on how to optimize medical doctoral programmes learning environments and supports in maintaining and fostering motivation during the programme. In this study, motivation is regarded as a multidimensional construct consisting of different types of motivation based on Self-Determination Theory (SDT) [27,28,29,30]. SDT distinguishes autonomous and controlled motivation. Autonomous motivation (AM) derives from a PhD candidate attributing personal value to learning, due to genuine interest and pleasure in the research itself. Controlled motivation (CM) includes persuasion of learning or work as a means to an end that is separate from the activity itself, for example to obtain a reward such as a future training or job position. Autonomous motivation is associated with positive outcomes in education, such as intention to persist and subjective well-being, whereas controlled motivation is reported to be associated with negative outcomes, such as anxiety and lower positive affect [6, 28, 31,32,33].

A PhD in the medical field is more common than in any other domain [19]. Furthermore, the research environment of medical PhDs differs substantially from environments in other fields. Medical PhD candidates are (future) medical doctors, who commonly combine patient care with their PhD trajectory, mainly supervised by PhD-holding clinicians, and often return to clinical care after their PhD trajectory [34]. Furthermore, as they are employed at a clinical department, the healthcare culture and hierarchy will affect the research environment. In addition, some programme directors consider a PhD highly important or necessary to get a specialty training position [35]. To this end, a subset of MDs obtains a PhD degree to gain admission to their desired specialty [36]. This admission-related aspect of pursuing a PhD might be more prevalent in medicine in contrast to domains and, by definition, is controlled motivation.

Recently, we quantitively explored autonomous and controlled motivation and its relation to work engagement, (expected) delay, drop-out intentions, and clinician-scientist career ambitions in over 1300 Dutch medical PhD candidatesFootnote 1. Our national survey study showed that autonomous motivation was positively related to PhD candidates work engagement and clinician-scientists career ambitions. In addition, higher autonomous motivation resulted in less drop-out intentions, contrary to controlled motivation which was related to lower work engagement and research ambitions, and higher drop-out intentions. However, insight into factors affecting autonomous and controlled motivation during the PhD journey was lacking and deeper understanding called for a qualitative approach. In this follow-up study we aim to answer the question of which factors affect autonomous and controlled motivation during the PhD journey. By that, we aim to contribute to the conscious use of strategies to increase autonomous motivation and, hence, well-being, successful completion of the PhD programme, and, eventually, a sustainable clinician-scientist workforce.

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The bumpy ride to a medical PhD degree: a qualitative study on factors influencing motivation - BMC Medical Education - BMC Medical Education