Education Theory Made Practical – Volume 2, Part 4: Self-Determination Theory

( Here are links to the previous chapters in this series <Zone of Proximal Development; Transformative Learning Theory; Spaced Repetition Theory> We need your help. Before we publish all of these chapters as an ebook, we want the health professions community to weigh in on the confusing, missing, and disputed sections of each chapter.  Please include your comments at the bottom of the post. We will acknowledge your contribution in the forthcoming ebook.)


Authors: Scott Leuchten and Asit Misra

Editor: Sara M. Krzyzaniak

What is your Educational Theory?
Name of Theory:

Self-Determination Theory

Main Authors or Originators:

Edward L. Deci & Richard M. Ryan

Other important authors or works:

Six sub-theories related to Self-Determination theory:

1)   Cognitive Evaluation Theory

Deci, E. L., & Ryan, R. M. (1985). Intrinsic motivation and self-determination in human behavior. New York: Plenum.

2)   Organismic Integration Theory

Miller KA, Deci EL, Ryan RM. Intrinsic motivation and self-determination in human behavior. Contemp Sociol. 1988;17(2):253.

3)   Causality Orientations Theory

Deci EL, Ryan RM. The general causality orientations scale: Self-determination in personality. J Res Pers. 1985;19(2):109-134.

4)   Basic Psychological Needs Theory

Ryan R, Deci E. Self-determination theory: An organismic dialectical perspective. Handb Self-Determination Res. 2002:3-33.

5)   Goal Content Theory

Kasser T, Ryan RM. Further examining the American dream: Differential correlates of intrinsic and extrinsic goals. Personal Soc Psychol Bull. 1996;22(3):280-287.

6)   Relationships Motivation Theory

Deci EL, Ryan RM. Autonomy and need satisfaction in close relationships: Relationships motivation theory. In: Human Motivation and Interpersonal Relationships: Theory, Research, and Applications. 2014, p. 53–73.


Part 1: The Hook
A second year Emergency Medicine resident has started receiving low shift evaluations and has been at the center of two poor patient interactions requiring the intervention of the medical director. Both patient interactions revolved around the resident losing his patience. At the clinical competency committee meeting, it is found that the resident’s most recent in-service score has fallen from the year prior and evaluations have shown some regression on milestones. This is in stark contrast to his first year when he was noted to be progressing well and had positive patient interactions.

On his self-evaluation, which was submitted late, the resident mentions that he feels like he is not getting anywhere and feels lost in most of his clinical shifts. He reports that he does not feel like his faculty are supporting him.

The residency leadership and the resident’s advisor meet to discuss an action plan to help support the resident.


Part 2: The Meat
Overview of this theory

Self-Determination Theory (SDT) describes two basic types of motivation for human activity: intrinsic and extrinsic. Intrinsic motivation comes from within and represents the satisfaction in doing the action in itself. Extrinsic motivation comes from receiving an external reward or avoiding a penalty.

SDT is grounded in three basic assumptions: the first is that an individual has the ability to control internal and external forces; the second is that humans have an innate desire to grow; the third is that the first two elements do not come automatically, but rather are dependent on a person’s social environment.1  That is, individuals have control of themselves and their development; however they must be supported by their network and surroundings.

SDT also describes three essential psychological needs that must be satisfied in order to achieve wellness and success: competence, autonomy, and relatedness. Competence refers to an individual’s need to be in control of their environment. Autonomy describes the need act in harmony within ourselves and to be causal agents. Relatedness describes our need to “interact with, be connected to, and experience caring for other people”.2 When these three needs are met, a person can achieve well-being and with well-being comes growth.

The ultimate goal of SDT is to cultivate a person’s intrinsic motivation, as this motivation will lead to high-quality learning and creativity. Extrinsic motivators, such as rewards, should be used cautiously as multiple studies have shown that promoting extrinsic motivation can actually decrease an individual’s intrinsic motivation by lowering their autonomy.3–9

Background about this theory

SDT was developed from ideas and studies around what motivates individuals and has developed into a framework that guides research on motivation.

Two important sub-theories that comprise SDT are Cognitive Evaluation Theory (CET) and Organismic Integration Theory (OIT).10 According to CET, intrinsic motivation is influenced by external factors (e.g. communications and positive feedback) that may strengthen the perception of autonomy and competence. Alternately, external factors such a monetary reward, may ultimately undermine intrinsic motivation. OIT describes various types of external motivation that exist, particularly internalization and integration.

Additional sub-theories include Causality Orientations Theory, Basic Psychological Needs Theory, Goal Contents Theory, Relationships Motivation Theory.10–13

Modern takes or advances in this theory

Further work within the field of SDT has led to additional theories around wellness, effective functioning, and personal growth. These developments have provided applications in many different disciplines including education, healthcare, sports, exercise. Specifically, a large body of work now exists examining how to create environments that support autonomy in an effort to impact functioning and wellness.

Other examples of where this theory might apply in both the classroom & clinical setting

The education and professional development of a physician rely on his desire to be a better physician. According to SDT, physicians with intrinsic motivation to improve will succeed. Physicians that rely on extrinsic motivators will be less successful because their development will stall when the extrinsic motivation is removed. Residency programs therefore should cultivate a resident’s natural intention and desire to do well (i.e. intrinsic motivation). The program provides the third basic element: the social environment necessary to encourage a resident’s ability to control their internal forces and support the innate desire to grow and flourish. Therefore, a residency should build a community that allows a learner to have control of their learning, interact with their patients and colleagues, and be true to themselves. Supporting residents in this way will introduce healthy and nurtured physicians into the field and provide an example to others.

Annotated Bibliography of Key Papers on this theory

Deci, E. L., & Vansteenkiste, M. (2004). Self-determination theory and basic need satisfaction: Understanding human development in positive psychology. Ricerche di Psichologia, 27, 17-34.

This article describes the basics of the theory and brings the reader through every level of the theory, from the differentiation of motivation to the three basic elements and three essential psychological needs. It also lays out the timeline of the evolution of SDT.

Ryan, R. M. (2000). Intrinsic and extrinsic motivations: Classic definitions and new directions. Contemporary Educational Psychology, 54-67.

This article distinguishes intrinsic and extrinsic motivation within an education framework. It highlights the need, as educators, to create environments that foster intrinsic behavior; however it also provides evidence for the use of extrinsic motivation to support individuals. It also describes the various types of extrinsic motivation.

Kusurkar RA, Ten Cate TJ, van Asperen M, Croiset G. 2011. Motivation as an independent and a dependent variable in medical education: a review of the literature. Med Teach. 33:e242–e262.

This article looks at SDT within the field of medical education. The authors suggest that residencies should try to harness the power of intrinsic and extrinsic motivation to improve the success of their learners.

Limitations of this theory

The limitations in SDT revolve around a person’s natural intrinsic motivation. Conflict develops when a person’s intrinsic motivation does not line up with the goals of the training program. Through fostering their own individual needs, a person may detour from program expectations. SDT also has also limited effectiveness in patients with psychiatric illness namely obsessive compulsive disorder or depression.14


Part 3: The Denouement
 The residency leadership is concerned about burnout in this resident. The resident has expressed thoughts that indicate he doesn’t feel like he has control over his actions and the community isn’t supportive; namely that the resident has lost their competence and autonomy. This has led to dysfunctions in all aspects of the SDT theory, namely competence, autonomy. The residency leadership needs to reconnect the resident into their internal motivation.

The resident meets with his program leadership and their first steps is to ask the resident to reflect on why he originally wanted to go into medicine. The resident is then shown the progress he has made; graduating medical school, getting into a competitive residency and developing their first year. By connecting to the intrinsic motivation and demonstrating the process he has already mastered; aka becoming a physician; it hopes to show that he is in control of his actions. It also focuses on his next goal; becoming a specialized emergency medicine physician.

Another aspect of the meeting is to recognize and praise him for what he has done well, in order to help and build support for future growth. The residency leadership must also stress the importance of combating the tendency to lose his patience. To address the deficiencies in education, the resident is encouraged to submit his own supplemental education plan for remediating the poor in-service score rather than be given a mandatory plan.  The goal is to support the resident’ own individual competence, autonomy and relatedness. In case the resident feels that he needs additional support then a mentor should be assigned for his close supervision and support.15

Please leave your peer review in the comments below

  1. Ryan RM, Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol. 2000;55(1):68-78.
  2. Deci EL, Vansteenkiste M. Self-determination theory and basic need satisfaction: Understanding human development in positive psychology. Ric di Psicol. 2004;27(1):23-40.
  3. Deci EL. Effects of externally mediated rewards on intrinsic motivation. J Pers Soc Psychol. 1971;18(1):105-115. doi:10.1037/h0030644.
  4. Lepper MR, Greene D, Nisbett RE. Undermining children’s intrinsic interest with extrinsic reward: A test of the “overjustification” hypothesis. J Pers Soc Psychol. 1973;28(1):129-137. doi:10.1037/h0035519.
  5. Ryan RM, Deci EL. Intrinsic and Extrinsic Motivations: Classic Definitions and New Directions. Contemp Educ Psychol. 2000;25(1):54-67. doi:10.1006/ceps.1999.1020.
  6. Deci EL, Cascio WF. Changes in Intrinsic Motivation as a Function of Negative Feedback and Threats. Present Meet East Psychol Assoc. 1972;(February 2016):1-24.
  7. Amabile TM, DeJong W, Lepper MR. Effects of externally imposed deadlines on subsequent intrinsic motivation. J Pers Soc Psychol. 1976;34(1):92-98. doi:10.1037/0022-3514.34.1.92.
  8. Koestner R, Ryan RM, Bernieri F, Holt K. Setting limits on children’s behavior: The differential effects of controlling vs. informational styles on intrinsic motivation and creativity. J Pers. 1984;52(3):233-248. doi:10.1111/j.1467-6494.1984.tb00879.x.
  9. Reeve J, Deci EL. Elements of the Competitive Situation that Affect Intrinsic Motivation. Personal Soc Psychol Bull. 1996;22(1):24-33. doi:10.1177/0146167296221003.
  10. Deci EL, Ryan RM. Intrinsic Motivation and Self-Determination in Human Behavior. 1st ed. New York: Plenum; 1985.
  11. Ryan R, Deci E. Self-determination theory: An organismic dialectical perspective. Handb Self-Determination Res. 2002:3-33. doi:citeulike-article-id:10086705.
  12. Kasser T, Ryan RM. Further examining the American dream: Differential correlates of intrinsic and extrinsic goals. Personal Soc Psychol Bull. 1996;22(3):280-287. doi:10.1177/0146167296223006.
  13. Deci EL, Ryan RM. Autonomy and need satisfaction in close relationships: Relationships motivation theory. In: Human Motivation and Interpersonal Relationships: Theory, Research, and Applications. ; 2014:53-73. doi:10.1007/978-94-017-8542-6_3.
  14. Gazelle G, Liebschutz JM, Riess H. Physician Burnout: Coaching a Way Out. J Gen Intern Med. 2015;30(4):508-513. doi:10.1007/s11606-014-3144-y.
  15. Fernet C, Guay F, Senécal C. Adjusting to job demands: The role of work self-determination and job control in predicting burnout. J Vocat Behav. 2004;65(1):39-56. doi:10.1016/S0001-8791(03)00098-8.