Factors associated with academic motivation among Tunisian medical students: a cross-sectional study

According to Self Determination Theory, motivation is divided into intrinsic and extrinsic types. The type desired for students is intrinsic motivation, which is associated with successful achievements. Some factors could modify the profile of motivation and then the outcomes. There is a huge lack of literature data concerning the motivation profile and its associated factors, among Tunisian and North-African medical students. This study aimed to identify the academic motivate on profiles of medical students in Tunisia and assess the factors influencing their motivation. This cross-sectional study was conducted over four months: from August to November 2024. An auto-administered anonymous questionnaire based on the validated Academic Motivation Scale (AMS-C28) was distributed to medical students in the four faculties of medicine in Tunisia. A total of 689 medical students mainly aged between 18 and 22 years (65%) were enrolled in the current study. They were mostly female (71.8%) and in the second study cycle (64.3%). The median scores were 1.75 [1.00–3.00] for amotivation, 4.66 [3.75–5.41] for intrinsic motivation (IM), and 5.16 [4.41–5.75] for extrinsic motivation (EM), which was identified as the predominant profile in our cohort. According to the results of multivariate analysis, having a choice of medicine affected by family (aOR = 2.3 [1.4–3.7]), history of academic failure (aOR = 1.6 [ 1.1–2.7]), and lack of support from peers (aOR = 1.5 [1.3–1.8]) were identified as independent risk factors for amotivation. The three subscales of IM (to know, toward accomplishment and toward experience stimulation) were independently associated with female gender, students who perceived satisfaction with the quality of teaching, and those who chose medicine as a personal preference. When focusing on EM, we have shown that personal choice in choosing medicine was associated with external regulation (aOR = 1.8 [1.3–2.5]) and that identified regulation was higher among female students (OR = 2.1 [1.4–3.1]), in case of personal choice of studying medicine (aOR = 2.2 [1.5–3.2]) and when students were satisfied with the teaching quality (aOR = 1.4 [1.0–2.1]). Students whose first choice was not medicine had higher introjection scores (aOR = 2.211 [1.374–3.56]), while self-reported psychological distress were inversely associated with introjection (aOR = 0.594 [0.386–0.594]). Our study revealed that extrinsic motivation is the main profile of Tunisian medical students. It also provides the basis to pedagogical interventions aiming to improve the educational environment through the analysis of factors associated with amotivation.