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Background  We aimed to explore the influence of a motivationally-enhanced instructional design on motivation to learn and knowledge, hypothesizing that outcomes would be higher for the enhanced instructional format.    Methods  Medicine residents completed four online learning modules on primary care topics. Using a crossover design, learners were randomized to receive two standard and two motivationally-enhanced learning modules. Both formats had self-assessment questions, but the enhanced format questions were framed to place learners in a supervisory/teaching role. Learners received a baseline motivation questionnaire, a short motivation survey before and after each module, and a knowledge posttest.    Results  One hundred twenty seven residents were randomized. 123 residents (97%) completed at least one knowledge posttest and 119 (94%) completed all four posttests. Across all modules, a one-point increase in the pretest short motivation survey was associated with a 2.1-point increase in posttest knowledge. The change in motivation was significantly higher for the motivationally enhanced format (standard mean change −0.01, enhanced mean change +0.09, difference = 0.10, CI 0.001 to 0.19; p = 0.048). Mean posttest knowledge score was similar (standard mean 72.8, enhanced mean 73.0, difference = 0.2, CI −1.9 to 2.1; p = 0.90).    Conclusions  The motivationally enhanced instructional format improved motivation more than the standard format, but impact on knowledge scores was small and not statistically significant. Learners with higher pre-intervention motivation scored better on post-intervention knowledge tests, suggesting that motivation may prove a viable target for future instructional enhancements.

Enhancing motivation with the “virtual” supervisory role: a randomized trial