The Power of Positive Engagement - American Society of ...

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 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


2. What type of motivation is the most desirable level of motivation?

Extrinsic Intrinsic Integrated regulation External regulation





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


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




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




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


Amotivation









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


Amotivation







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




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. . .




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





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


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


What does your learner want?

Attempt to understand what the learner wants Be realistic Tailor experience






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




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?




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


2. What type of motivation is the most desirable level of motivation?

Extrinsic Intrinsic Integrated regulation External regulation


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





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/.




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.




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.




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?




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>




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