Assessing changes in academic motivation across medical training stages: a longitudinal study in Malaysia

Sustained academic motivation is essential for the success and well-being of medical students. As students progress from pre-clinical to clinical training, the transition in learning environments is theorized to facilitate motivation internalisation, consistent with Self-Determination Theory (SDT). Unlike cross-sectional studies, a longitudinal approach allows tracking of individual changes over time, offering deeper insights into developmental trends. This study examined changes in academic motivation at the start of medical school, after pre-clinical training, and following two years of clinical training. The Academic Motivation Scale (AMS) was administered to 292 students from a five-year undergraduate medical programme in Malaysia across three stages: entry, post pre-clinical, and after two years of clinical training. Three cohorts (2016–2018) were followed longitudinally over seven years (2016–2022). Analysis involved confirmatory factor analysis (CFA) to validate AMS and assess reliability using composite reliability (CR), followed by repeated measures ANOVA to examine motivational changes. CFA confirmed the AMS as valid and reliable. At entry, students showed moderate to high extrinsic and intrinsic motivation with low amotivation. Amotivation rose from Year 1 (M = 6.64) to Year 3 (M = 8.51) and Year 5 (M = 10.27). Identified regulation remained high in Year 1 (M = 23.37) and Year 3 (M = 23.57) before declining in Year 5 (M = 22.47). External and introjected regulation peaked in Year 3 (M = 18.92, 19.42) then dropped or stabilized in Year 5. Intrinsic motivation declined steadily across all domains from Year 1 to Year 5 (all p < .05). The decline in intrinsic motivation and rise in amotivation highlight challenges in sustaining motivation through medical training. These trends may impact academic performance, mental health, and professional growth, underscoring the need for curriculum adaptations, mentorship, and stress-reduction initiatives to better support students. The study revealed a moderate to significant decline in both intrinsic and extrinsic motivation subscales as medical students progressed through their training, accompanied by a gradual but notable increase in amotivation, suggesting emerging concerns about student engagement and well-being.The challenges and stressors inherent in medical education, such as cognitive overload and the evolving complexity of clinical responsibilities, contribute to these shifts in motivation, impacting students’ learning experiences.Targeted interventions such as mentorship, academic support, mental health resources, and curriculum reforms alongside qualitative research into students’ experiences, are vital for addressing declining motivation and supporting medical students’ well-being throughout their training. The study revealed a moderate to significant decline in both intrinsic and extrinsic motivation subscales as medical students progressed through their training, accompanied by a gradual but notable increase in amotivation, suggesting emerging concerns about student engagement and well-being. The challenges and stressors inherent in medical education, such as cognitive overload and the evolving complexity of clinical responsibilities, contribute to these shifts in motivation, impacting students’ learning experiences. Targeted interventions such as mentorship, academic support, mental health resources, and curriculum reforms alongside qualitative research into students’ experiences, are vital for addressing declining motivation and supporting medical students’ well-being throughout their training.