“When people are more autonomous—that is, when people are motivated more by their value for the behavior, or by their interest and enjoyment of the behavior—they tend to be more persistent in their behavior, feel more satisfied, and have higher well-being overall.” --UMRC
Self-directed, or autonomous, learning can be the key differentiating factor in the success of our CNA students, both in terms of passing their exam and skills test, and more importantly, how they perform on-the-job. Many studies have shown that autonomous learning, “which means that a student learns out of genuine interest or personal value,” present an advantage for medical education.
To create truly self-directed learning programs, we need to shift the learner’s motivation from extrinsic to intrinsic. This approach may require change on the part of the learner and in some cases, the facilitator. Many students may be finishing high school, directly out of high school, or have completed their GED. Other students may be career changers and have not attended school for some time. It’s likely all of them experienced a more traditional education where academic performance was rewarded with grades; the learner performed without understanding information’s relevance beyond completing the assignment and receiving the grade. External sources and pressures drove motivation–fear of failing, wanting to please parents, or fitting in with peers.
If we look more closely at the two types of motivation, we can see that for long-term performance, intrinsic (or self-directed) motivations are more effective.
Extrinsic motivation can work for the short-term until that goal is met, however, once the pressing factor is gone, so is the motivation. For long-term change to happen, learners need Intrinsic motivation. Specifically, to maintain the motivation to complete a CNA training program (and remain satisfied on the job) there needs to be something more internal at play. Daniel Pink, in his book Drive: The surprising truth about what motivates us identifies one of these motivation drivers as purpose. Long-term care is an excellent environment for the right individual to find their purpose. We talk a lot about CNAs finding their “Why.” You can help learners find it early and reinforce it throughout the training. Ultimately, we want our students to become great CNAs and have long careers. We can do this by communicating the importance of the profession, and help learners internalize the value of being a CNA as part of our training approach.
“When people are more autonomous—that is, when people are motivated more by their value for the behavior, or by their interest and enjoyment of the behavior—they tend to be more persistent in their behavior, feel more satisfied, and have higher well-being overall.”–UMRC
While not everyone is suited to be a nurse aide in long-term care, providing a learning environment where students are more intrinsically motivated to learn can result in higher pass rates and better CNAs.
How do we do this?
To understand how we can create a learning environment that fosters self-directed learning, we can look to Self-determination theory, which we touched on in our previous blog post.
Let’s look at how we can leverage each factor in the classroom:
Autonomy: Perhaps for the first time, many students are in a classroom of their own volition. It’s essential to allow the student to continue have a say in as much of their learning as possible. This is consistent with what we know about adult learning:
- Adults need to be involved in the planning and evaluation of their instruction.
- Experience (including mistakes) provides the basis for the learning activities.
- Adults are most interested in learning subjects that have immediate relevance and impact to their job or personal life.
- Adult learning is problem-centered rather than content-oriented. 
How does this play out in the classroom? While you will have a set lesson plan, skills labs, and a final exam, its important to allow for self-directed discovery. Use role playing, classroom activities, and discussions so that learners can explore their ideas and learn from each other. Let students know you value their input and feedback. Keep in mind that autonomy does not mean independence. You are still there to provide structure and guidance, but you are doing so in a way the allows the learner’s interest to drive their performance.
Competence: Ultimately, we want competent CNAs who can perform the tasks of their job with confidence. Problem-based learning and a motivation feedback loop within the training can assist in cultivating student competence. Create learning situations where student can learn and then apply the information. Provide real-time feedback so learners can improve performance. As a learner gains competence, they also experience first-hand the reward of gaining a new skill. This leads to both confidence and the motivation to continue learning.
Relatedness: As our students are creating careers tied to patient care, it’s important to help them recognize the connection between what they learn and what they can do. The more you can create a community within the classroom, your facility, and on-the-job with staff and residents, the more this sense of relatedness will support CNAs’ continued motivation — even on those days when they experience frustration and setbacks.
Beyond the Classroom
As CNAs pass their exams and begin their careers in long-term care, the need for autonomy remains. Just as it does for learning, further “work motivation varies depending on the work environment. In an autonomy-supportive environment, which fosters motivation, individuals perceive that they have the right to choose and to make decisions, and that they are supported in their work.” Extending the environment of guided, self-directed learning on-the-job can mean reduced attrition and higher levels of patient care.
Cook, D. A. and Artino, A. R. (2016), Motivation to learn: an overview of contemporary theories. Med Educ, 50: 997-1014. doi:10.1111/medu.13074
Olle Th.J. ten Cate, Rashmi A. Kusurkar & Geoffrey C. Williams (2011) How self-determination theory can assist our understanding of the teaching and learning processes in medical education. AMEE Guide No. 59, Medical Teacher, 33:12,961-973, DOI: 10.3109/0142159X.2011.595435
 Rashmi A. Kusurkar & Gerda Croiset (2015) Autonomy support for autonomous motivation in medical education, Medical Education Online, 20:1, DOI: 10.3402/meo.v20.27951
 Pink, D. 2011. Drive: The Surprising Truth About What Motivates Us. New York: Riverhead Books.
 1. Kearsley, G. (2010). Andragogy (M.Knowles). The theory into practice database. Retrieved from http://tip.psychology.org
 The effects of work motivation on employee exhaustion and commitment:
An extension of the JD-R model Claude Ferneta*, Ste´phanie Austina and Robert J. Work & Stress Vol. 26, No. 3, July-September 2012, 213-229 http://selfdeterminationtheory.org/SDT/documents/2012_FernetAustinVallerand_WS.pdf