A global item-level normalization approach to compare profiles of motivation in medical students.

Background: Academic success and students' well-being are influenced by several factors, with motivation being a critical element. Previous studies in the literature have typically focused on comparing variations in motivation levels across distinct demographic or curricular subgroups. However, the measurement of the relative magnitude of different motivational levels within the same cohort has been overlooked. The main reason for this apparent lack of interest in defining a motivational profile through comparisons of various motivation types (such as intrinsic motivation, identified regulation, introjected regulation, external regulation, and amotivation) lies mainly in the psychometric complexity, particularly when subscales differ in item count and variance. Objective: In this study, we aimed to compare the relative levels of different motivation types within a single cohort of medical students, using a global item-level normalization procedure that enables valid cross-subscale comparisons. Methods: We conducted a cross-sectional study involving 266 medical students. The scores of a validated motivation scale, consisting of 18 items and based on self-determination theory, were globally standardized to a common metric (z-scores). Then, subscales were reconstructed from the normalized items, and a repeated-measures ANOVA, followed by Bonferroni-corrected pairwise comparisons, was performed to measure differences across motivation types. Results: Significant differences were observed among the various types of motivation. Identified regulation was significantly higher than all other forms of motivation. Intrinsic motivation exceeded both controlled forms (introjected and external regulation) and amotivation. Amotivation was significantly lower than all other motivation types, while introjected and external regulation did not differ significantly, which is consistent with their adjacent positions on the self-determination theory continuum. This motivational profile appears to be consistent across the academic stages evaluated at the time of assessment, as no significant interaction was observed between motivation types and stages of training; further longitudinal studies are required to confirm its temporal stability. Conclusion: This global item-level normalization approach offers a psychometrically valid method for comparing motivation types. The results reveal that medical students show a profile dominated by autonomous regulation, particularly identified regulation, followed by intrinsic motivation. Controlled regulation is found in the mid-range, while amotivation remains low. These findings are relevant to designing and tailoring interventions that support autonomous motivation in medical curricula.