<clinical_study>
  <!-- This xml conforms to an XML Schema at:
    https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
  <required_header>
    <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
    <link_text>Link to the current ClinicalTrials.gov record.</link_text>
    <url>https://clinicaltrials.gov/ct2/show/NCT02263521</url>
  </required_header>
  <id_info>
    <org_study_id>AMAHSA0901</org_study_id>
    <nct_id>NCT02263521</nct_id>
  </id_info>
  <brief_title>Understanding Physician Work Motivation</brief_title>
  <official_title>Physician Work Motivation: A Measure Validation Study</official_title>
  <sponsors>
    <lead_sponsor>
      <agency>American Medical Association</agency>
      <agency_class>Other</agency_class>
    </lead_sponsor>
    <collaborator>
      <agency>American Medical Group Association</agency>
      <agency_class>Other</agency_class>
    </collaborator>
    <collaborator>
      <agency>Illinois Institute of Technology</agency>
      <agency_class>Other</agency_class>
    </collaborator>
    <collaborator>
      <agency>Advocate Physician Partners</agency>
      <agency_class>Other</agency_class>
    </collaborator>
    <collaborator>
      <agency>University of California, San Francisco</agency>
      <agency_class>Other</agency_class>
    </collaborator>
    <collaborator>
      <agency>University of Rochester</agency>
      <agency_class>Other</agency_class>
    </collaborator>
    <collaborator>
      <agency>Johns Hopkins University</agency>
      <agency_class>Other</agency_class>
    </collaborator>
  </sponsors>
  <source>American Medical Association</source>
  <oversight_info>
    <has_dmc>No</has_dmc>
  </oversight_info>
  <brief_summary>
    <textblock>
      Development and validation of a measure of physician work motivation.&#xD;
    </textblock>
  </brief_summary>
  <detailed_description>
    <textblock>
      Not that long ago, most physicians were solo practitioners. Today, more physicians are&#xD;
      working in large, integrated delivery systems, and many are employed by hospitals and&#xD;
      multispecialty group practices. These dramatic changes in the physician work environment&#xD;
      raise important questions on how evolving physician payment and care delivery models support&#xD;
      or undermine your motivation and ability to deliver high-quality patient care.&#xD;
&#xD;
      To evaluate the impact of workplace changes on what motivates physician to deliver good&#xD;
      patient care, this study aims to develop an accurate measure of physician work motivation.&#xD;
      Simultaneously, the investigators plan to test hypotheses on the role of various workplace&#xD;
      and psychological factors in physicians' work motivation. Namely, the investigators&#xD;
      hypothesize that:&#xD;
&#xD;
      20 to 25% of the variance in work motivation is explained by psychological needs&#xD;
      satisfaction; 5 to 10% of the variance in self-reported overall health status and depression&#xD;
      is explained by work motivation; 5% of the variation in work motivation is explained by work&#xD;
      that is seen as a calling; and 5 to 10% of the variation in medicine viewed as a calling is&#xD;
      explained by the learning environment.&#xD;
    </textblock>
  </detailed_description>
  <overall_status>Unknown status</overall_status>
  <last_known_status>Enrolling by invitation</last_known_status>
  <start_date>October 2014</start_date>
  <completion_date type="Anticipated">September 2015</completion_date>
  <primary_completion_date type="Anticipated">May 2015</primary_completion_date>
  <study_type>Observational</study_type>
  <has_expanded_access>No</has_expanded_access>
  <study_design_info>
    <observational_model>Cohort</observational_model>
    <time_perspective>Cross-Sectional</time_perspective>
  </study_design_info>
  <primary_outcome>
    <measure>Internalization of work motivation (self-reported)</measure>
    <time_frame>Up to 4 months</time_frame>
    <description>Composite measure comprised of 15 items using 7-point Likert-type response categories (not at all true-very true) to assess extent of psychological internalization of work motivation</description>
  </primary_outcome>
  <secondary_outcome>
    <measure>Psychological needs satisfaction at work (self-reported)</measure>
    <time_frame>Up to 4 months</time_frame>
    <description>Composite measure comprised of 12 statements using 7-point Likert-type response categories (not at all true-very true) to assess perceived fulfillment of needs for autonomy, self-efficacy/competence, relatedness, and purpose in work context</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Overall health status (self-reported)</measure>
    <time_frame>Up to 4 months</time_frame>
    <description>Proportion of respondents reporting own overall health as &quot;excellent,&quot; &quot;very good,&quot; or &quot;good&quot; vs. &quot;fair&quot; or &quot;poor&quot;</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Depression (self-reported)</measure>
    <time_frame>Up to 4 months</time_frame>
    <description>Proportion of respondents reporting a score of &gt;3 on a two-item depression screening instrument (patient health questionnaire-2)</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Medicine as a calling</measure>
    <time_frame>Up to 4 months</time_frame>
    <description>Composite measure comprised of 15 statements using true/false response scale to assess view of work as &quot;calling,&quot; &quot;career,&quot; or &quot;job&quot;</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Medical learning environment that supports professionalism</measure>
    <time_frame>Up to 4 months</time_frame>
    <description>Composite measure comprised of 13 statements using 5-point Likert-type response scale (strongly disagree-strongly agree) to assess experiences of medical professionalism in medical students' learning environments</description>
  </secondary_outcome>
  <number_of_groups>3</number_of_groups>
  <enrollment type="Anticipated">4500</enrollment>
  <condition>Physician Work Motivation</condition>
  <arm_group>
    <arm_group_label>physicians</arm_group_label>
    <description>Nationally-representative sample of physicians in all specialties who have direct or indirect patient care responsibilities</description>
  </arm_group>
  <arm_group>
    <arm_group_label>resident physicians</arm_group_label>
    <description>Nationally-representative of resident physicians in all specialties</description>
  </arm_group>
  <arm_group>
    <arm_group_label>medical students</arm_group_label>
    <description>Nationally-representative sample of 4th year medical students in all US allopathic medical schools.</description>
  </arm_group>
  <intervention>
    <intervention_type>Other</intervention_type>
    <intervention_name>No intervention employed. Study is based on a cross-sectional observational design.</intervention_name>
    <arm_group_label>medical students</arm_group_label>
    <arm_group_label>physicians</arm_group_label>
    <arm_group_label>resident physicians</arm_group_label>
  </intervention>
  <eligibility>
    <study_pop>
      <textblock>
        Population #1 includes practicing physicians in all medical specialties. Population #2&#xD;
        includes resident physicians in all medical specialties. Population #3 includes fourth year&#xD;
        medical students in all US allopathic medical schools.&#xD;
      </textblock>
    </study_pop>
    <sampling_method>Probability Sample</sampling_method>
    <criteria>
      <textblock>
        Inclusion Criteria:&#xD;
&#xD;
          -  practicing physicians in all medical specialties&#xD;
&#xD;
          -  resident physicians in all medical specialties&#xD;
&#xD;
          -  fourth year medical students in US allopathic medical schools&#xD;
&#xD;
        Exclusion Criteria:&#xD;
&#xD;
          -  physicians without an active medical license.&#xD;
&#xD;
          -  resident physicians without an active medical license.&#xD;
&#xD;
          -  fourth year medical students in US osteopathic medical schools&#xD;
      </textblock>
    </criteria>
    <gender>All</gender>
    <minimum_age>21 Years</minimum_age>
    <maximum_age>90 Years</maximum_age>
    <healthy_volunteers>Accepts Healthy Volunteers</healthy_volunteers>
  </eligibility>
  <overall_official>
    <last_name>Audiey Kao, MD, PhD</last_name>
    <role>Principal Investigator</role>
    <affiliation>American Medical Association</affiliation>
  </overall_official>
  <reference>
    <citation>Shearer DA. Management styles and motivation. Radiol Manage. 2012 Sep-Oct;34(5):47-52.</citation>
    <PMID>23130386</PMID>
  </reference>
  <reference>
    <citation>Wright SM, Beasley BW. Motivating factors for academic physicians within departments of medicine. Mayo Clin Proc. 2004 Sep;79(9):1145-50. doi: 10.4065/79.9.1145.</citation>
    <PMID>15357036</PMID>
  </reference>
  <reference>
    <citation>Williams GC, Rodin GC, Ryan RM, Grolnick WS, Deci EL. Autonomous regulation and long-term medication adherence in adult outpatients. Health Psychol. 1998 May;17(3):269-76. doi: 10.1037//0278-6133.17.3.269.</citation>
    <PMID>9619477</PMID>
  </reference>
  <reference>
    <citation>Williams GC, Deci EL. Internalization of biopsychosocial values by medical students: a test of self-determination theory. J Pers Soc Psychol. 1996 Apr;70(4):767-79. doi: 10.1037//0022-3514.70.4.767.</citation>
    <PMID>8636897</PMID>
  </reference>
  <reference>
    <citation>Williams GC, Wiener MW, Markakis KM, Reeve J, Deci EL. Medical students' motivation for internal medicine. J Gen Intern Med. 1994 Jun;9(6):327-33. doi: 10.1007/BF02599180.</citation>
    <PMID>8077997</PMID>
  </reference>
  <reference>
    <citation>Cerasoli CP, Nicklin JM, Ford MT. Intrinsic motivation and extrinsic incentives jointly predict performance: a 40-year meta-analysis. Psychol Bull. 2014 Jul;140(4):980-1008. doi: 10.1037/a0035661. Epub 2014 Feb 3.</citation>
    <PMID>24491020</PMID>
  </reference>
  <reference>
    <citation>Gonzalez MG, Swanson DP, Lynch M, Williams GC. Testing satisfaction of basic psychological needs as a mediator of the relationship between socioeconomic status and physical and mental health. J Health Psychol. 2016 Jun;21(6):972-82. doi: 10.1177/1359105314543962. Epub 2014 Aug 7.</citation>
    <PMID>25104782</PMID>
  </reference>
  <reference>
    <citation>Murayama K, Matsumoto M, Izuma K, Matsumoto K. Neural basis of the undermining effect of monetary reward on intrinsic motivation. Proc Natl Acad Sci U S A. 2010 Dec 7;107(49):20911-6. doi: 10.1073/pnas.1013305107. Epub 2010 Nov 15.</citation>
    <PMID>21078974</PMID>
  </reference>
  <reference>
    <citation>Wrzesniewski A, Schwartz B, Cong X, Kane M, Omar A, Kolditz T. Multiple types of motives don't multiply the motivation of West Point cadets. Proc Natl Acad Sci U S A. 2014 Jul 29;111(30):10990-5. doi: 10.1073/pnas.1405298111. Epub 2014 Jun 30.</citation>
    <PMID>24982165</PMID>
  </reference>
  <verification_date>January 2015</verification_date>
  <study_first_submitted>September 28, 2014</study_first_submitted>
  <study_first_submitted_qc>October 10, 2014</study_first_submitted_qc>
  <study_first_posted type="Estimate">October 13, 2014</study_first_posted>
  <last_update_submitted>January 12, 2015</last_update_submitted>
  <last_update_submitted_qc>January 12, 2015</last_update_submitted_qc>
  <last_update_posted type="Estimate">January 14, 2015</last_update_posted>
  <responsible_party>
    <responsible_party_type>Principal Investigator</responsible_party_type>
    <investigator_affiliation>American Medical Association</investigator_affiliation>
    <investigator_full_name>Audiey Kao, MD, PhD</investigator_full_name>
    <investigator_title>Vice President, Ethics</investigator_title>
  </responsible_party>
  <!-- Results have not yet been posted for this study                                          -->
</clinical_study>


download date: ClinicalTrials.gov processed this data on September 20, 2023
link text: Link to the current ClinicalTrials.gov record.
url: https://clinicaltrials.gov/ct2/show/NCT02263521
org study id: AMAHSA0901
nct id: NCT02263521
lead sponsor: 
collaborator: 
collaborator: 
collaborator: 
collaborator: 
collaborator: 
collaborator: 
has dmc: No
Development and validation of a measure of physician work motivation.
Not that long ago, most physicians were solo practitioners. Today, more physicians are
      working in large, integrated delivery systems, and many are employed by hospitals and
      multispecialty group practices. These dramatic changes in the physician work environment
      raise important questions on how evolving physician payment and care delivery models support
      or undermine your motivation and ability to deliver high-quality patient care.

      To evaluate the impact of workplace changes on what motivates physician to deliver good
      patient care, this study aims to develop an accurate measure of physician work motivation.
      Simultaneously, the investigators plan to test hypotheses on the role of various workplace
      and psychological factors in physicians' work motivation. Namely, the investigators
      hypothesize that:

      20 to 25% of the variance in work motivation is explained by psychological needs
      satisfaction; 5 to 10% of the variance in self-reported overall health status and depression
      is explained by work motivation; 5% of the variation in work motivation is explained by work
      that is seen as a calling; and 5 to 10% of the variation in medicine viewed as a calling is
      explained by the learning environment.
observational model: Cohort
time perspective: Cross-Sectional
measure: Internalization of work motivation (self-reported)
time frame: Up to 4 months
description: Composite measure comprised of 15 items using 7-point Likert-type response categories (not at all true-very true) to assess extent of psychological internalization of work motivation
measure: Psychological needs satisfaction at work (self-reported)
time frame: Up to 4 months
description: Composite measure comprised of 12 statements using 7-point Likert-type response categories (not at all true-very true) to assess perceived fulfillment of needs for autonomy, self-efficacy/competence, relatedness, and purpose in work context
measure: Overall health status (self-reported)
time frame: Up to 4 months
description: Proportion of respondents reporting own overall health as "excellent," "very good," or "good" vs. "fair" or "poor"
measure: Depression (self-reported)
time frame: Up to 4 months
description: Proportion of respondents reporting a score of >3 on a two-item depression screening instrument (patient health questionnaire-2)
measure: Medicine as a calling
time frame: Up to 4 months
description: Composite measure comprised of 15 statements using true/false response scale to assess view of work as "calling," "career," or "job"
measure: Medical learning environment that supports professionalism
time frame: Up to 4 months
description: Composite measure comprised of 13 statements using 5-point Likert-type response scale (strongly disagree-strongly agree) to assess experiences of medical professionalism in medical students' learning environments
arm group label: physicians
description: Nationally-representative sample of physicians in all specialties who have direct or indirect patient care responsibilities
arm group label: resident physicians
description: Nationally-representative of resident physicians in all specialties
arm group label: medical students
description: Nationally-representative sample of 4th year medical students in all US allopathic medical schools.
intervention type: Other
intervention name: No intervention employed. Study is based on a cross-sectional observational design.
arm group label: medical students
arm group label: physicians
arm group label: resident physicians
study pop: 
sampling method: Probability Sample
criteria: 
gender: All
minimum age: 21 Years
maximum age: 90 Years
healthy volunteers: Accepts Healthy Volunteers
last name: Audiey Kao, MD, PhD
role: Principal Investigator
affiliation: American Medical Association
citation: Shearer DA. Management styles and motivation. Radiol Manage. 2012 Sep-Oct;34(5):47-52.
PMID: 23130386
citation: Wright SM, Beasley BW. Motivating factors for academic physicians within departments of medicine. Mayo Clin Proc. 2004 Sep;79(9):1145-50. doi: 10.4065/79.9.1145.
PMID: 15357036
citation: Williams GC, Rodin GC, Ryan RM, Grolnick WS, Deci EL. Autonomous regulation and long-term medication adherence in adult outpatients. Health Psychol. 1998 May;17(3):269-76. doi: 10.1037//0278-6133.17.3.269.
PMID: 9619477
citation: Williams GC, Deci EL. Internalization of biopsychosocial values by medical students: a test of self-determination theory. J Pers Soc Psychol. 1996 Apr;70(4):767-79. doi: 10.1037//0022-3514.70.4.767.
PMID: 8636897
citation: Williams GC, Wiener MW, Markakis KM, Reeve J, Deci EL. Medical students' motivation for internal medicine. J Gen Intern Med. 1994 Jun;9(6):327-33. doi: 10.1007/BF02599180.
PMID: 8077997
citation: Cerasoli CP, Nicklin JM, Ford MT. Intrinsic motivation and extrinsic incentives jointly predict performance: a 40-year meta-analysis. Psychol Bull. 2014 Jul;140(4):980-1008. doi: 10.1037/a0035661. Epub 2014 Feb 3.
PMID: 24491020
citation: Gonzalez MG, Swanson DP, Lynch M, Williams GC. Testing satisfaction of basic psychological needs as a mediator of the relationship between socioeconomic status and physical and mental health. J Health Psychol. 2016 Jun;21(6):972-82. doi: 10.1177/1359105314543962. Epub 2014 Aug 7.
PMID: 25104782
citation: Murayama K, Matsumoto M, Izuma K, Matsumoto K. Neural basis of the undermining effect of monetary reward on intrinsic motivation. Proc Natl Acad Sci U S A. 2010 Dec 7;107(49):20911-6. doi: 10.1073/pnas.1013305107. Epub 2010 Nov 15.
PMID: 21078974
citation: Wrzesniewski A, Schwartz B, Cong X, Kane M, Omar A, Kolditz T. Multiple types of motives don't multiply the motivation of West Point cadets. Proc Natl Acad Sci U S A. 2014 Jul 29;111(30):10990-5. doi: 10.1073/pnas.1405298111. Epub 2014 Jun 30.
PMID: 24982165
responsible party type: Principal Investigator
investigator affiliation: American Medical Association
investigator full name: Audiey Kao, MD, PhD
investigator title: Vice President, Ethics