Why Controlling Teaching Persists in Medical Education: A Self-Determination Theory Perspective

Adam Neufeld

doi:10.5334/pme.2417

Why Controlling Teaching Persists in Medical Education: A Self-Determination Theory Perspective

Perspectives on Medical Education

Volume 15 (2026): Issue 1

By: Adam Neufeld

Open Access

|Sep 2026

Ryan RM, Duineveld JJ, Di Domenico SI, Ryan WS, Steward BA, Bradshaw EL. We Know This Much Is (Meta-Analytically) True: A Meta-Review of Meta-Analytic Findings Evaluating Self-Determination Theory. Psychol Bull. 2022;148(11–12):919–945. DOI: 10.1037/bul0000385
Open DOI Search in Google Scholar Back to article
Kusurkar RA, Croiset G, Mann KV, Custers E, ten Cate O. Have Motivation Theories Guided the Development and Reform of Medical Education Curricula? A Review of the Literature. Acad Med. 2012;87(6):735–743. DOI: 10.1097/ACM.0b013e318253cc0e
Open DOI Search in Google Scholar Back to article
Orsini C, Binnie VI, Wilson SL. Determinants and outcomes of motivation in health professions education: a systematic review based on self-determination theory. J Educ Eval Health Prof. 2016;13:19. DOI: 10.3352/jeehp.2016.13.19
Open DOI Search in Google Scholar Back to article
Neufeld A. Putting Self-Determination Theory Into Practice: A Practical Tool for Supporting Medical Learners’ Motivation. Clin Teach. 2025;22(4). DOI: 10.1111/tct.70140
Open DOI Search in Google Scholar Back to article
Baldwin CD, Craig MS, Garfunkel LC, Harris JP, Shone LP, Biondi E, Cellini MM, Varade WS. Autonomy-supportive medical education: let the force be within you! Acad Med. 2012 Nov;87(11):1468–1469. DOI: 10.1097/ACM.0b013e31826cdc3f. PMID: 23111259.
Open DOI Search in Google Scholar Back to article
Biondi EA, Varade WS, Garfunkel LC, et al. Discordance between resident and faculty perceptions of resident autonomy: Can self-determination theory help interpret differences and guide strategies for bridging the divide? Acad Med. 2015;90(4). DOI: 10.1097/ACM.0000000000000522
Open DOI Search in Google Scholar Back to article
Crockett C, Joshi C, Rosenbaum M, Suneja M. Learning to drive: Resident physicians’ perceptions of how attending physicians promote and undermine autonomy. BMC Med Educ. 2019;19(1). DOI: 10.1186/s12909-019-1732-6
Open DOI Search in Google Scholar Back to article
Su YL, Reeve J. A Meta-analysis of the Effectiveness of Intervention Programs Designed to Support Autonomy. Educ Psychol Rev. 2011;23(1). DOI: 10.1007/s10648-010-9142-7
Open DOI Search in Google Scholar Back to article
Neufeld A. Moving the Field Forward: Using Self-Determination Theory to Transform the Learning Environment in Medical Education. Teach Learn Med. 2024;36(5):654–659. DOI: 10.1080/10401334.2023.2235331
Open DOI Search in Google Scholar Back to article
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. Published online 2011. DOI: 10.3109/0142159X.2011.599896
Open DOI Search in Google Scholar Back to article
Hoffman BD. Using self-determination theory to improve residency training: learning to make omelets without breaking eggs. Acad Med. 2015 Apr;90(4):408–410. DOI: 10.1097/ACM.0000000000000523. PMID: 25340367.
Open DOI Search in Google Scholar Back to article
Neufeld A. Autonomy-Supportive Teaching in Medicine: From Motivational Theory to Educational Practice. MedEdPublish. 2021;10(1). DOI: 10.15694/mep.2021.000117.1
Open DOI Search in Google Scholar Back to article
Sawatsky AP, O’Brien BC, Hafferty FW. Autonomy and developing physicians: Reimagining supervision using self-determination theory. Med Educ. 2022;56(1):31–38. DOI: 10.1111/medu.14580
Open DOI Search in Google Scholar Back to article
Bartholomew KJ, Ntoumanis N, Ryan RM, Bosch JA, Thogersen-Ntoumani C. Self-Determination Theory and Diminished Functioning: The Role of Interpersonal Control and Psychological Need Thwarting. Personal Soc Psychol Bull. 2011;37(11):1459–1473. DOI: 10.1177/0146167211413125
Open DOI Search in Google Scholar Back to article
Amoura C, Berjot S, Gillet N, Caruana S, Cohen J, Finez L. Autonomy-supportive and controlling styles of teaching: Opposite or distinct teaching styles? Swiss J Psychol. 2015;74(3). DOI: 10.1024/1421-0185/a000156
Open DOI Search in Google Scholar Back to article
Haerens L, Vansteenkiste M, De Meester A, et al. Different combinations of perceived autonomy support and control: identifying the most optimal motivating style. Phys Educ Sport Pedagog. 2018;23(1). DOI: 10.1080/17408989.2017.1346070
Open DOI Search in Google Scholar Back to article
Pelletier LG, Séguin-Lévesque C, Legault L. Pressure from above and pressure from below as determinants of teachers’ motivation and teaching behaviors. J Educ Psychol. 2002;94(1). DOI: 10.1037/0022-0663.94.1.186
Open DOI Search in Google Scholar Back to article
Steindl C, Jonas E, Sittenthaler S, Traut-Mattausch E, Greenberg J. Understanding Psychological Reactance. Z Psychol. 2015;223(4). DOI: 10.1027/2151-2604/a000222
Open DOI Search in Google Scholar Back to article
Deci EL, Ryan RM. Intrinsic Motivation and Self-Determination in Human Behavior. Vol 53; 1985. DOI: 10.1007/978-1-4899-2271-7
Open DOI Search in Google Scholar Back to article
Reeve J, Deci EL, Ryan RM. Self-determination theory: A dialectical framework for understanding sociocultural influences on student motivation. In: Research on Sociocultural Influence on Motivation and Learning: Big Theories Revisited, Volume 4; 2004.
Search in Google Scholar Back to article
Assor A, Kaplan H, Kanat-Maymon Y, Roth G. Directly controlling teacher behaviors as predictors of poor motivation and engagement in girls and boys: The role of anger and anxiety. Learn Instr. 2005;15(5). DOI: 10.1016/j.learninstruc.2005.07.008
Open DOI Search in Google Scholar Back to article
Reeve J. Autonomy-Supportive Teaching: What It Is, How to Do It. In: Building Autonomous Learners. 2016. DOI: 10.1007/978-981-287-630-0_7
Open DOI Search in Google Scholar Back to article
Reeve J. Why teachers adopt a controlling motivating style toward students and how they can become more autonomy supportive. Educ Psychol. 2009;44(3). DOI: 10.1080/00461520903028990
Open DOI Search in Google Scholar Back to article
Reeve J, Vansteenkiste M, Assor A, et al. The beliefs that underlie autonomy-supportive and controlling teaching: A multinational investigation. Motiv Emot. Published online 2014. DOI: 10.1007/s11031-013-9367-0
Open DOI Search in Google Scholar Back to article
Orsini C, Imafuku R, Jennings B, Neufeld A, Tricio J, Kusurkar R. What influences clinical educators’ motivation to teach? A BEME systematic review and framework synthesis based on self-determination theory: BEME review No. 90. Med Teach. Published online 2024. DOI: 10.1080/0142159X.2024.2412166
Open DOI Search in Google Scholar Back to article
Reeve J, Jang HR, Jang H. Personality-based antecedents of teachers’ autonomy-supportive and controlling motivating styles. Learn Individ Differ. 2018;62. DOI: 10.1016/j.lindif.2018.01.001
Open DOI Search in Google Scholar Back to article
Lazarus RS, Folkman S. Stress, Appraisal, and Coping. 1984.
Search in Google Scholar Back to article
Neufeld A, Rigby CS. Autonomy vs. Independence: Implications for Resident & Faculty Engagement, Performance, and Well-being. HCA Healthc J Med. 2024;5(2):103–110. DOI: 10.36518/2689-0216.1780
Open DOI Search in Google Scholar Back to article
van der Goot W, Van Yperen N, Albers C, Jaarsma D, Duvivier R. Effects of (de)motivating supervision styles on junior doctors’ intrinsic motivation through basic psychological need frustration and satisfaction: an experimental vignette study. Adv Heal Sci Educ Theory Pr. 2024;30(2):401–426. DOI: 10.1007/s10459-024-10344-0
Open DOI Search in Google Scholar Back to article
Reeve J, Cheon SH. Teachers become more autonomy supportive after they believe it is easy to do. Psychol Sport Exerc. Published online 2016. DOI: 10.1016/j.psychsport.2015.08.001
Open DOI Search in Google Scholar Back to article
Cheon SH, Reeve J, Vansteenkiste M. When teachers learn how to provide classroom structure in an autonomy-supportive way: Benefits to teachers and their students. Teach Teach Educ. Published online 2020. DOI: 10.1016/j.tate.2019.103004
Open DOI Search in Google Scholar Back to article
Hafferty FW, Franks R. The hidden curriculum, ethics teaching, and the structure of medical education. Acad Med. 1994;69(11). DOI: 10.1097/00001888-199411000-00001
Open DOI Search in Google Scholar Back to article
Wear D, Skillicorn J. Hidden in plain sight: The formal, informal, and hidden curricula of a psychiatry clerkship. Acad Med. 2009;84(4). DOI: 10.1097/ACM.0b013e31819a80b7
Open DOI Search in Google Scholar Back to article
Mann K, Gordon J, MacLeod A. Reflection and reflective practice in health professions education: A systematic review. Adv Heal Sci Educ. 2009;14(4). DOI: 10.1007/s10459-007-9090-2
Open DOI Search in Google Scholar Back to article
Edmondson AC. The Fearless Organization: Creating Psychological Safety in the Workplace for Learning, Innovation, and Growth. Vol 1.; 2018.
Search in Google Scholar Back to article
Malin G, Palmer A. Pressure to Perform: Canadian Student Perspectives of Pimping Through a Self-Determination Theory Lens. Teach Learn Med. Published online 2025. DOI: 10.1080/10401334.2025.2578464
Open DOI Search in Google Scholar Back to article
Boggiano AK, Flink C, Shields A, Seelbach A, Barrett M. Use of techniques promoting students’ self-determination: Effects on students’ analytic problem-solving skills. Motiv Emot. 1993;17(4):319–336. DOI: 10.1007/BF00992323
Open DOI Search in Google Scholar Back to article
Hafferty FW, Castellani B. The increasing complexities of professionalism. Acad Med. 2010;85(2). DOI: 10.1097/ACM.0b013e3181c85b43
Open DOI Search in Google Scholar Back to article
Watling CJ, Ginsburg S. Assessment, feedback and the alchemy of learning. Med Educ. 2019;53(1). DOI: 10.1111/medu.13645
Open DOI Search in Google Scholar Back to article
Phaneuf JC, Sehlbach C, Gauvin-Morin A, Slimani O, Walsh C, Heeneman S. When using entrustable professional activities thwarts basic psychological needs: A case study of residents’ experience. Med Teach. Published online 2026. DOI: 10.1080/0142159X.2026.2649217
Open DOI Search in Google Scholar Back to article
Gianakos AL, Freischlag JA, Mercurio AM, et al. Bullying, Discrimination, Harassment, Sexual Harassment, and the Fear of Retaliation During Surgical Residency Training: A Systematic Review. World J Surg. 2022;46(7). DOI: 10.1007/s00268-021-06432-6
Open DOI Search in Google Scholar Back to article
Riaz Q, Waterval D, Sehlbach C, Paulus A. Culture, power and practice: Critical discourse analysis of workplace-based assessments in hierarchical postgraduate medical education. Med Educ. Published online 2026:1–9. DOI: 10.1111/medu.70251
Open DOI Search in Google Scholar Back to article
Cheon SH, Reeve J, Yu TH, Jang HR. The teacher benefits from giving autonomy support during physical education instruction. J Sport Exerc Psychol. 2014;36(4). DOI: 10.1123/jsep.2013-0231
Open DOI Search in Google Scholar Back to article
McClintock AH, Fainstad T. Growth, Engagement, and Belonging in the Clinical Learning Environment: the Role of Psychological Safety and the Work Ahead. J Gen Intern Med. 2022;37(9). DOI: 10.1007/s11606-022-07493-6
Open DOI Search in Google Scholar Back to article