Purpose: Medical education is dependent on clinicians and other faculty who volunteer time and expertise to teaching. Unfortunately, the literature reports increasing levels of dissatisfaction, burnout, and attrition. Incentivization provides an obvious intervention, but rewards must be implemented judiciously or risk unintended consequences. With little known about the effects of incentives in medical education, the authors investigate key insights across three disciplines to explain how, why, and when incentives can be used effectively.
Method: In this critical synthesis, a purposeful and iterative literature search was conducted by exploring a variety of databases to identify seminal articles, key concepts, and generative search terms. Particularly fruitful disciplines were then explored more deliberately.
Results: Psychologists argue that the impact of an incentive depends on an individual's motivational drives. Organizational behaviorists draw attention to environmental incentives and disincentives that build or detract from motivation. Behavioral economists posit that size, type, and way in which an incentive is provided affect motivation differently.
Conclusions: The influence of an incentive depends on how it interacts with underlying mechanisms deemed important for motivation. These mechanisms change across tasks, individuals, and contexts. Recommendations derived from the effort include being deliberate about (1) determining what is driving the individual to act, (2) considering the unique interactions between incentives and motivation types, and (3) considering barriers that may interfere with incentive effectiveness. In examining each of these, the authors argue that the field needs greater clarity regarding how, when, and why incentives operate within the many contexts in which medical educators work.