Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Do you want a doctor or a demotivated test-taking machine?

Shirie Leng, MD
Education
February 20, 2015
280 Shares
Share
Tweet
Share

shutterstock_169002578

Last week, my best friend took the recertification exam in anesthesia, the so-called MOCA exam.  Like a good doobie, she paid her $2,100, paid her nanny extra so she could study, took a day off in which she missed the funeral of a friend’s husband, and took the test.  Wow, she must be the most awesome, most well-read, most skilled, most enthusiastic anesthesiologist ever now!  Well, she always was, but the test didn’t make her that way.  In fact, there is a large body of evidence that suggests such testing requirements have the potential to reduce the quality of her work.

In 2010, the American Board of Medical Specialties did a survey in which they found that 95 percent of the public rates participation by their physicians in Maintenance of Certification (MOC) as important. Doctors have derided the requirement of MOC as costly, irrelevant, and time-consuming, accusing professional boards of using such requirements as moneymaking ventures.  Plus the whole thing doesn’t make sense since doctors originally certified before 2000 or so don’t have to do it at all.  The public has said the doctors are whiny and just don’t want to keep up their skills and be accountable.  That doctors are, in effect, lazy.  Plus they have plenty of money, what do they care about fees?  We demand our high-quality health care dammit!

In 1973 three guys named Lepper, Greene, and Nisbett did a study with a bunch of preschoolers. They choose an activity that the kids all liked, drawing in this case, and tested whether kids were more or less interested in drawing when they were given a reward for doing so.  It was an if-then scenario: If you do this, you will get that.  The kids who got rewarded showed much less interest in drawing two weeks later.  They had lost their motivation for drawing.  Studies like this were repeated many times in kids and adults, and in 1999 some researchers reanalyzed thirty years of such studies and found that, “When institutions –– families, schools, businesses, and athletic teams, for example — focus on the short-term and opt for controlling people’s behavior, they do considerable long-term damage.”

Daniel Pink, in his book Drive, points out these and many other examples of solid literature suggesting that making people do things makes them less likely to want to.  Not only that, but Pink cites plenty of evidence that forcing people to do things reduces the quality of the work.  It is true of preschoolers, and it is true of adults.  The problem is the difference between External and Internal motivation.  My best friend has always kept up her knowledge and skills because of her internal drive to be the best she can be.  That drive can be diminished by randomly imposed requirements.

Extrinsic motivators narrow our focus and reduce the breadth and depth of our thinking.  If the extrinsic motivator is the most important or prominent motivator, the focus becomes pinpointed to the externally imposed goal.  This is certainly true for education.  One of the main problems with standardized testing is that students are extrinsically motivated by the imposition of a test.  The test becomes the most important motivator for studying.  The students’ focus narrows to the regurgitation of facts.  Extrinsic motivation is applied over and over in the case of students who do well on such tests.  The breadth and depth of knowledge is substantially reduced.  Plus, being made to take the tests has the effect of decreasing students’ intrinsic motivation, which is the kind of motivation that results in the best results over time.  The same sort of thinking explains why a kid who is interested in music will often lose motivation when external pressures to succeed are placed on him by parents and teachers.

And the same thing happens to doctors.  Doctors are no more noble or less human than the rest of us.  Being made to do things decreases our intrinsic motivation just a surely as making a kid practice diminishes his desire to make music.  The kid will push back.  Doctors do too.  Maintaining skills and knowing the latest research are important for doctors, just as they are for any profession.  We need to adjust the system in such a way that the intrinsic drive to be the best we can be is fostered.

Do you want a physician who loves his work, is internally motivated to read the literature because he is interested in the subject, one who has breadth and depth of thinking?  Or do you want a demotivated, narrowly focused test-taking machine?

Shirie Leng, a former nurse, is an anesthesiologist who blogs at medicine for real.

Image credit: Shutterstock.com

Prev

I am proud of our society. We provide care to everyone.

February 20, 2015 Kevin 27
…
Next

When should parents be vaccinated against measles?

February 20, 2015 Kevin 2
…

Tagged as: Surgery

Post navigation

< Previous Post
I am proud of our society. We provide care to everyone.
Next Post >
When should parents be vaccinated against measles?

More by Shirie Leng, MD

  • The choice between medicine and nursing

    Shirie Leng, MD
  • New technology might help us become more empathetic to others’ suffering

    Shirie Leng, MD
  • Does practice really make perfect?

    Shirie Leng, MD

More in Education

  • The pros and cons of taking a gap year during medical school

    Med School Insiders
  • Breaking the silence: the truth about mental health challenges among medical students and why medical schools must take action

    Erin Waldrop
  • Breaking the stigma: Encouraging mental health help-seeking in medical trainees

    Anonymous
  • I’m not so different from Lionel Messi – and neither are you

    Lauren Tien
  • 6 ways ChatGPT can help you succeed in medical school

    Drew Bergman
  • Is it time to say goodbye to medical school rankings?

    James Goldchild
  • Most Popular

  • Past Week

    • Physician entrepreneurs offer hope for burned out doctors

      Cindy Rubin, MD | Physician
    • Boxing legends Tyson and Foreman: powerful lessons for a resilient and evolving health care future

      Harvey Castro, MD, MBA | Physician
    • Is chaos in health care leading us towards socialized medicine? How physician burnout is a catalyst.

      Howard Smith, MD | Physician
    • We need a new Hippocratic Oath that puts patient autonomy first

      Jeffrey A. Singer, MD | Physician
    • Unveiling the intricate link between housing costs and health care

      Harvey Castro, MD, MBA | Policy
    • Breaking free from restrictive covenants to combat burnout

      Raya E. Kheirbek, MD | Physician
  • Past 6 Months

    • It’s time to replace the 0 to 10 pain intensity scale with a better measure

      Mark Sullivan, MD and Jane Ballantyne, MD | Conditions
    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
    • An inspiring tribute to an exceptional radiologist who made a lasting impact

      Kim Downey, PT | Conditions
  • Recent Posts

    • Breaking free from restrictive covenants to combat burnout

      Raya E. Kheirbek, MD | Physician
    • Fixing the system and prioritizing patient care [PODCAST]

      The Podcast by KevinMD | Podcast
    • From medical student to intern: Discovering a deeper connection with patients

      Johnathan Yao, MD, MPH | Physician
    • A physician’s typical day, as envisioned by a non-clinician health care MBA: a satire

      Jennifer Lycette, MD | Physician
    • Unveiling the global pandemic threat: insights into risk factors and urgent measures for prevention

      Ton La, Jr., MD, JD | Policy
    • Decoding name displays in health care: Privacy, identification, and compliance unveiled

      Deepak Gupta, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 16 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Novel IDH1/2 Inhibitor Shows 'Dramatic Effect' in Low-Grade Glioma
  • Nivolumab-AVD Boosts PFS in Untreated Hodgkin Lymphoma
  • 'You Can't Yoga Your Way Out of This': What We Heard This Week
  • New Standard in Operable EGFR-Positive Lung Cancer
  • New Ovarian Cancer Drug Extends Survival in Resistant Disease

Meeting Coverage

  • Novel IDH1/2 Inhibitor Shows 'Dramatic Effect' in Low-Grade Glioma
  • Nivolumab-AVD Boosts PFS in Untreated Hodgkin Lymphoma
  • New Standard in Operable EGFR-Positive Lung Cancer
  • New Ovarian Cancer Drug Extends Survival in Resistant Disease
  • Neoadjuvant Chemo Flops Versus Upfront Surgery for Resectable Pancreatic Cancer
  • Most Popular

  • Past Week

    • Physician entrepreneurs offer hope for burned out doctors

      Cindy Rubin, MD | Physician
    • Boxing legends Tyson and Foreman: powerful lessons for a resilient and evolving health care future

      Harvey Castro, MD, MBA | Physician
    • Is chaos in health care leading us towards socialized medicine? How physician burnout is a catalyst.

      Howard Smith, MD | Physician
    • We need a new Hippocratic Oath that puts patient autonomy first

      Jeffrey A. Singer, MD | Physician
    • Unveiling the intricate link between housing costs and health care

      Harvey Castro, MD, MBA | Policy
    • Breaking free from restrictive covenants to combat burnout

      Raya E. Kheirbek, MD | Physician
  • Past 6 Months

    • It’s time to replace the 0 to 10 pain intensity scale with a better measure

      Mark Sullivan, MD and Jane Ballantyne, MD | Conditions
    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
    • An inspiring tribute to an exceptional radiologist who made a lasting impact

      Kim Downey, PT | Conditions
  • Recent Posts

    • Breaking free from restrictive covenants to combat burnout

      Raya E. Kheirbek, MD | Physician
    • Fixing the system and prioritizing patient care [PODCAST]

      The Podcast by KevinMD | Podcast
    • From medical student to intern: Discovering a deeper connection with patients

      Johnathan Yao, MD, MPH | Physician
    • A physician’s typical day, as envisioned by a non-clinician health care MBA: a satire

      Jennifer Lycette, MD | Physician
    • Unveiling the global pandemic threat: insights into risk factors and urgent measures for prevention

      Ton La, Jr., MD, JD | Policy
    • Decoding name displays in health care: Privacy, identification, and compliance unveiled

      Deepak Gupta, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Do you want a doctor or a demotivated test-taking machine?
16 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...