Análisis de la motivación en estudiantes de medicina: perspectivas para la formación de futuros profesionales de la salud

Abstract

Introduction: Understanding the evolution of motivation among medical students is essential for improving educational outcomes and professional development. Objective: To analyze motivational trajectories in medical students using the Academic Motivation Scale (AMS) and Self-Determination Theory (SDT), identifying key factors in their academic progression. Methods: This mixed-methods study assessed motivational patterns in 1,331 medical students (first through sixth years) employing: (1) a 28-item AMS, (2) interannual comparative analyses, (3) a network model based on SDT, and (4) thematic analysis of open-ended responses to explore influencing factors. Results: Findings revealed a distinct inverted J-shaped trajectory: motivation peaked during early years (first and second year), sharply declined through intermediate clinical training, and partially recovered in the final year - consistent with previous findings about intrinsic motivation attenuation and resurgence during academic-to-clinical transitions. Network analysis positioned intrinsic motivation as a central node, dynamically interacting with contextual factors like clinical immersion (linked to autonomy and competence). Male students showed lower probability of high motivation (OR = 0.734) compared to females, while mental health diagnoses showed no significant association, potentially reflecting institutional resilience supports. Affective commitment (altruistic passion) emerged as a key motivator, whereas deficient learning environments and excessive demands were primary demotivators. Conclusions: The study highlights three practical implications: (1) early curricular reforms (e.g., active learning) may sustain motivation, (2) advanced clinical immersion can reactivate intrinsic motivation, and (3) urgent systemic safeguards are needed (e.g., transparent mistreatment reporting mechanisms). These findings advocate for SDT-aligned interventions balancing autonomy-supportive pedagogy, psychological safety, and equitable support to optimize medical training motivation.