Survey of medical teachers' attitudes towards science and motivational orientation for medical research Short title: Attitudes and motivation for research in medicine

Background: Research is an important motivating factor for pursuing a career in academic medicine, but the relation between motivation and factors involved in scientific research are not clear. Purpose: To explore the motivational orientation for doing research and its relation with the attitudes towards science and publication practice among the faculty at a medical school. Methods: We used a Science Attitude Survey and Work Preference Inventory (4 Likert type scales of motivation, possible range 1-5) to survey two groups of teachers at the Zagreb University School of Medicine (n=327, 66% response rate): professors, elected to tenure-track positions (n=150), and instructor/research fellows working on or just completing their thesis (n=177). Results: Overall, teachers scored highest on the Enjoyment subscale of intrinsic motivational orientation (mean score±standard deviation 4.3±0.42 for professors vs 4.1±0.42 for instructors/research fellows, P=0.001, t-test). Professors scored higher than instructors/ research fellows on the Challenge subscale of intrinsic motivational orientation (3.8±0.55 vs. 3.5±0.64, P<0.001, t-test), whereas instructors/ research fellows scored higher than professors on the Compensation subscale of extrinsic motivational orientation (3.5±0.74 vs. 3.1±0.71, P<0.001, t-test). Multiple linear regression analysis showed that the number of publications was positively associated with the scores on the Science Attitude Survey and Challenge intrinsic motivation, and negatively associated with scores on the scale of Compensation extrinsic motivation. Conclusions: Medical faculty differs in motivational orientation depending on their academic status, and their motivation is associated more with requirements for academic advancement than research. These findings have important implications for developing strategies for enhancing academic research production. Zusammenfassung Hintergrund: Forschung ist ein wichtiger Motivationsfaktor für die Verfolgung einer Karriere in der akademischen Medizin, jedoch ist die Beziehung zwischen der Motivation und den Faktoren die mit der wissenschaftlichen Forschung verbunden sind, nicht klar. Ziel: Wir haben die Forschungmotivation, und ihren Verhältnis zu der Haltung zur Wissenschaft und der Publikationspraxis an einer medizinischen Fakultät untersucht. Methoden: Mit Hilfe zweier Fragebögen – "Science Attitudes Survey" und "Work Preference Inventory" (4 Likert-Typ-Skalen, möglicher Umfang 1-5) wurden zwei Gruppen der Lehrer der medizinischen Fakultät in Zagreb, Kroatien (n=327, 66% Antwortquote) befragt. In der ersten Gruppe wahren Lehrer mit abgeschlossener Dissertation, die Professoren (n=150), und in der zweiten die Instruktoren/Assistenten, die ihre Dissertation noch nicht haben oder sie kürzlich erhalten haben (n=177). Studienergebnisse: Überall hatten die Befragten die höhsten Ergebnisse bei der Vergnügensubskale ("Enjoyment") der intrinsischen Motivation (Mittelwert± Standardabweichung 4.3±0.42 für Professoren zu 4.1±0.42 für Instruktoren/Assistenten, P=0.001, t-Test). Die Professoren hatten höhere Ergebnisse als die Instruktoren/Assistenten bei dem "Challenge" (Herausforderung)-Teilaspekt der intrinsischen Motivation (3.8±0.55 zu 3.5±0.64, P<0.001, tTest). Der "Compensation" (Abfindung)-Teilaspekt der extrinsischen Motivation war deutlich höher bei der Gruppe der Instruktoren/Assistenten (3.5±0.74 zu 3.1±0.71, P<0.001, t-Test). Die Ergebnisse der multiplen linearen Regression haben gezeigt, daß die Anzahl der Publikationen im positiven Bezug zu der Haltung zur Wissenschaft und zum ChallengeTeilaspekt der intrinsischen Motivation und im negativen Bezug zu dem CompensationTeilaspekt der extrinsischen Motivation steht. Schlüsse: Die Lehrer der medizinischen Fakultät unterscheiden sich in ihrer Motivation abhängig von ihrem akademischen Grad. Ihre Motivation ist mit den Voraussetzungen für die akademische Förderung gebunden. Diese Befunde sind für die Entwicklung von Strategien wichtig, die wissenschaftliche Produktion der Lehrer fördern würden. Introduction Along with teaching and clinical care, scientific research is one of the three traditional roles of academic medicine [1]. Although there is a general consensus about the importance of research, a decline in the number of clinical academics active in research has been observed in some countries [2,3]. Academic researchers are increasingly concerned about the challenges they face, such as the lack of protected time for research [4,5] or long duration of training at relatively low wages [6]. On the other hand, results of recent studies suggest that research is still an important motivating factor in medical careers. A systematic review has identified the desire to do research as a key incentive to enter and stay in academic medicine [7]. Another study reported a progressively larger fraction of medical students and graduates who expressed serious interest in research careers [6]. Our research group showed that teaching research methodology is associated with increase in positive attitudes towards science among medical students [8], and that among family medicine practitioners there was a positive association between attitude toward science and opinion of research methodology training as a mandatory part of the medical curriculum [9]. Motivation for scientific research cannot be seen as a single phenomenon. Researchers differ not only in the strength of their motivation, but also in the orientation of their motivation [10]. Both intrinsic and extrinsic motivations are related to underlying attitudes and reasons for undertaking an action [10]. In the context of academic medicine, Barnett and colleagues explored the effect of sex on the orientation of career motivation in a sample of full-time faculty of US medical schools [11], and Wright and Beasley looked at the factors that motivate clinician-investigators and clinician-educators in their work [12]. However, these studies did not attempt to analyze possible differences related to the faculties’ teaching ranks or assess the attitudes of faculty towards science and research. We explored the motivational orientation for doing research and its relation with the attitudes towards science in different ranks of medical faculty across different research fields. Our hypothesis was that the motivational orientation of junior faculty would be more extrinsic (i.e. related to the compensation and acknowledgement that come as a result of the research activity), while the motivational orientation of senior faculty would be predominantly intrinsic (i.e. related to challenge and enjoyment of doing research). Subjects and Methods The study was conducted at the Zagreb University School of Medicine. We surveyed all teaching staff, including full, associate and assistant professors (defined as group of “professors”), and junior staff, who worked on their DrSc thesis recently or defended it (defined as group of “instructors/research fellows”). In 2006 there was a total of 495 teaching staff employed at the School: 62 full professors, 134 associate professors, 77 assistant professors, 87 instructors and 135 research fellows. They were also grouped according to the type of department with which they were affiliated: basic sciences, clinical sciences and public health; this grouping was performed regardless of the profession and highest degree of participants. Empty questionnaire sheets were handed out personally to each respondent, and the filled questionnaires were collected in a sealed cardboard box, which ensured the anonymity of respondents. Out of a total of 327 teachers who answered the questionnaire (66.1% response rate), 150 were professors (54.9% response rate) and 177 were instructors or research fellows (79.7% response rate) (Table 1). The study was approved by the Ethics Committee of the Zagreb University School of