What influences clinical educators' motivation to teach? A BEME systematic review and framework synthesis based on self-determination theory: BEME Review No. 90.

Background: Health professions learners are taught by full-time university faculty and by clinicians who teach alongside their clinical practice. This distributed healthcare education model ensures high-quality education but is at risk due to high learner demand, shortage of educators, and economic pressures. Understanding what factors influence clinical educators' motivation to teach may contribute to the model's sustainability and educator retention. The present review therefore aimed to systematically search and synthesise factors influencing clinical educators' motivation to teach.

Methods: Multiple databases, relevant journals, and the grey literature were searched for studies reporting on clinical educators' motivation to teach. Data were analysed using a framework synthesis method, based on self-determination theory's amotivation (e.g. disinterest or unachievable challenges), controlled (e.g. interest in rewards or pressure avoidance), and autonomous (e.g. personal importance and interest) concepts, and nested within a motivation from 'above' (i.e. interactions with stakeholders and societal expectations), 'within' (i.e. personal beliefs and personality dispositions), and 'below' (i.e. perception on learners' motivation and engagement) framework.

Results: Twenty-nine studies were included, published between 1998 and 2022, which reported on educators from diverse disciplines and settings. Educators reported autonomous over controlled motivation to teach, favouring enjoyment, connectedness, professional development, feeling valued for their teaching efforts, and altruistic reasons to teach, over being motivated by incentives and rewards. These results are presented in relation to their origin, as factors influencing motivation 'above', 'within', and 'below'.

Conclusions: Results from this study have important implications for the development of contextual strategies to optimise learning/work environments and maximise autonomous reasons to teach, enhancing clinical educators' job satisfaction and retention.