Introduction

The aging of populations is one of the most significant demographic challenges facing the modern world. Globally, the proportion of older adults in the population is steadily increasing, and projections indicate that by the middle of the 21^st century, people aged 60 and older will account for more than one-fifth of the world’s population. This phenomenon poses a challenge to healthcare systems, increasing the demand for medical services and specialized care in the field of gerontology [1].

A key aspect is the development of geriatric care and the training of appropriately qualified medical staff to work with older adults [2, 3]. Many healthcare systems in Europe are facing a shortage of medical staff, which, combined with an aging population, could lead to increased demand for healthcare services [4]. Although geriatrics is recognized as a priority field of medicine, the Polish gerontological care system remains limited in terms of human resources. An audit conducted by the Supreme Audit Office (NIK) between 2017 and 2021 revealed a shortage of physicians specializing in geriatrics and nurses with geriatric specializations in Poland. Ensuring an adequate number of qualified medical staff and developing competencies in geriatric care are crucial for effectively addressing current and future needs [5, 6].

Medical students represent the future workforce of the healthcare system, and their interests and motivation to pursue a career in geriatric care can influence their career choices and the quality of care provided to older adults. From the perspective of medical education, it is therefore crucial to understand the extent to which medical students are motivated to pursue a career in this field. Students’ choice of career path is a multifaceted decision that may be driven by various motivations [7]. Motivation is an internal driving force that determines a person’s activity, engagement, and learning effectiveness [8]. This study is based on self-determination theory (SDT), which posits that the role of personal and social factors influences the nature of human motivation [9]. According to SDT, motivation is not homogeneous; it is a spectrum. Three basic types of motivation are distinguished: intrinsic motivation, external motivation, and amotivation. Intrinsic motivation may be directed toward acquiring knowledge, seeking experiences, or a personal desire to achieve goals. External motivation, on the other hand, may be driven by the desire to receive a reward or avoid punishment (external regulation), introjected regulation – where actions stem from feelings of guilt or fear – and identified regulation, where actions are undertaken voluntarily because the individual identifies with the accompanying goal. Motivation is valued for its results, which lead to the achievement of specific outcomes. For this reason, it is highly regarded in healthcare professionals, as their work requires them to encourage and mobilize others to take action [10].

The aim of this study was to assess the level and type of motivation to work with older adults among medical students. Analyzing the intensity and type of motivation allows for an in-depth assessment of students’ commitment in the context of their future work with older adults and provides knowledge relevant to the planning of medical education. Understanding the motivational structure of future healthcare professionals can serve as a basis for designing educational activities that support the pursuit of a professional career in gerontological care. Material and methods

The study was conducted between September 2025 and February 2026 using a diagnostic survey method involving an electronic questionnaire made available to respondents via the Jagiellonian University Medical College Survey Platform, among students in medical fields (nursing, midwifery, emergency medical services, physiotherapy, medicine, and dentistry). The introductory section of the questionnaire included information regarding the study’s purpose, inclusion criteria, and obtaining informed consent to participate in the study. Participant anonymity was ensured, the voluntary nature of participation was emphasized, and participants were informed of their right to withdraw from the study at any stage.

The inclusion criteria for the study were providing informed consent to participate in the study and being a medical student. The exclusion criteria included refusal to participate in the study, not being a medical student, and failing to complete the survey questionnaire.

The questionnaire consisted of two parts. The first part concerned sociodemographic data (gender, age, marital status, field of study and year of study, current employment status, having an older adult family member requiring care, career plans after graduation, and factors motivating and demotivating work with older adults). The second part concerned the Academic Motivation Scale (AMS).

The AMS is used as a measure of motivation in education. Motivation is divided into amotivation, intrinsic motivation, and extrinsic motivation. According to SDT, individuals feel that they themselves control and decide on their actions and behaviors. This idea is particularly important in the academic environment, where it influences decision-making regarding the choice of actions intended to lead to student success. The scale consists of 28 items divided into 7 subscales. These subscales reflect the types of motivation distinguished in SDT, including: amotivation, extrinsic motivation (distinguished into external, introjected, and identified regulation), and intrinsic motivation (oriented toward acquiring knowledge, achieving goals, and seeking stimulation). Participants respond using a 7-point Likert scale, where 1 indicates complete disagreement with the statement and 7 indicates complete agreement. The Polish version of the AMS was adapted by M. Ardeńska, A. Ardeńska, and R. Tomik, whose research confirmed the original seven-factor and 28-item structure of the scale [11].

The study was conducted after obtaining approval from the Bioethics Committee of the Jagiellonian University Medical College in Kraków (No. 118.0043.1.329.2025 dated July 23, 2025).

Statistical analyses were performed using IBM SPSS Statistics version 29. This software was used to conduct an analysis of basic descriptive statistics, including the Kolmogorov-Smirnov test (for the entire sample) and the Shapiro-Wilk test (when dividing the sample into groups). Due to the presence of outliers and unequal group sizes, nonparametric analyses were chosen. To examine the relationships between sociodemographic variables and motivation indicators, the Mann-Whitney U test was performed; to examine gender differences, Spearman’s rho correlation analysis was used; and to examine the relationship with the year of study, the Kruskal-Wallis test was employed. In addition, the Kruskal-Wallis test was used to examine differences in the intensity of motivation depending on the field of study. In the final step, individuals who do and do not provide care for an older adult family member were compared in terms of motivation levels using the Mann-Whitney U test. The standard significance level of p = 0.05 was adopted.

Results

Among the 240 medical students, women were in the majority (81.7%). The mean age in the study group was 24.18 (SD ±4.00) years. More than half of the respondents (51.7%) were studying nursing. The remaining participants studied midwifery (12.1%), physiotherapy (12.9%), medicine (12.5%), emergency medical services (9.6%), and dentistry (1.3%). One-third of the students (33.3%) were in their third year of a bachelor’s program, while one-quarter (25.8%) were in their second year of either a bachelor’s or a master’s program. The largest group consisted of students working full time in a medical profession (30.8%), followed by those in another profession (28.8%), and one-fifth of the group (20.0%) worked in a medical profession but not full time. Additionally, 20.4% of the respondents were not working in a profession. The sociodemographic characteristics, as well as the circumstances and motivations for working with older adults in the study group of students, are presented in Table 1.

Among the types of motivation analyzed, as measured by the AMS, the highest mean scores in the group of medical students were observed for external regulation (M = 5.36, SD = 1.10) and identification (M = 5.30, SD = 0.98). The lowest level of motivation was found in the case of amotivation (M = 2.94, SD = 1.60). The results of the Kolmogorov-Smirnov test indicated that the distributions of all analyzed variables significantly deviate from the normal distribution (p < 0.05) (Table 2).

The Shapiro-Wilk test was used to verify whether the distributions of the variables conformed to a normal distribution (Table 3). In the group of women, all analyzed variables deviated significantly from a normal distribution (p < 0.05). In the group of men, significant deviations from normality were found for sensation-oriented internal motivation, introjective regulation, and external regulation (p < 0.05). For the remaining variables, no significant deviations from the normal distribution were found (p > 0.05).

To assess the conformity of the distributions of the analyzed types of motivation with the normal distribution, the Shapiro-Wilk test was applied to individual groups of fields of study (Table 4). In the group of nursing students, all analyzed variables deviated significantly from the normal distribution (p < 0.05). Among midwifery students, significant deviations from normality were found in the areas of internal motivation oriented toward knowledge and experience, amotivation, and the self-determination index. In the group of emergency medical services students, significant deviations were observed regarding achievement-oriented intrinsic motivation and the self-determination index. Among physical therapy students, a significant deviation from normality was demonstrated regarding achievement-oriented intrinsic motivation and amotivation. In the group of medical and dental students, significant deviations from the normal distribution were found in the areas of internal motivation oriented toward knowledge and experience, introjective regulation, external regulation, and amotivation.

To assess the conformity of the distributions of the analyzed types of motivation with the normal distribution in groups categorized by planned workplace, the Shapiro-Wilk test was used (Table 5). In the group of students planning to work in a hospital, all analyzed variables deviated significantly from the normal distribution (p < 0.05). Among those intending to work in a clinic or outpatient healthcare setting, most variables showed significant deviations from normality, with the exception of knowledge-oriented intrinsic motivation (p > 0.05). In the group planning to work in long-term care facilities, significant deviations from the normal distribution were found only in the areas of identification and introjective regulation.

To assess the conformity of the distributions of the analyzed types of motivation with the normal distribution in groups distinguished by their role in caring for the elderly, the Shapiro-Wilk test was used (Table 6). In the group of non-caregivers, all analyzed variables deviated significantly from the normal distribution (p < 0.05). Among caregivers, most variables also showed significant deviations from normality (p < 0.05). The exceptions were intrinsic motivation for knowledge and the self-determination index, for which no significant deviations from the normal distribution were found (p > 0.05).

To assess differences in specific types of motivation between women and men, the Mann-Whitney U test was used (see Table 7). No statistically significant differences were found between gender and any of the analyzed types of motivation (p > 0.05). The effect size (h²) values indicate a very small effect size (h² < 0.01), which confirms the absence of significant differences between women and men in terms of academic motivation as measured by the AMS scale.

A Spearman’s rho correlation analysis conducted on the study group revealed that the number of years of study was significantly and positively correlated with identification (rho = 0.16, p = 0.012) and external regulation (rho = 0.14, p = 0.026) (Table 8). The observed relationships were weak, indicating that as the number of years of study increased, the level of motivation related to identification and external regulation increased slightly. However, no significant relationships were found between the number of years of study and the remaining motivation subscales or the self-determination index (p > 0.05).

To assess differences in the specific types of motivation for working with older adults depending on the planned workplace, the Kruskal-Wallis test was used (Table 9). No statistically significant differences were found between the groups of students planning to work in hospitals, clinics/outpatient care, and long-term care facilities with respect to any of the analyzed types of motivation (p > 0.05).

To assess differences in specific types of motivation for working with older adults among students from different fields of study, the Kruskal-Wallis test was used (see Table 10). Statistically significant differences were found between fields of study regarding intrinsic motivation for knowledge (H(4) = 10.39, p = 0.034, h² = 0.04), intrinsic motivation oriented toward experience (H(4) = 9.65, p = 0.047, h² = 0.04), and identification (H(4) = 10.16, p = 0.038, h² = 0.04). It was found that physical therapy students exhibited a lower level of sensation-seeking motivation than medical and dental students. However, no significant differences were found between the fields of study in terms of achievement motivation, introjective regulation, external regulation, amotivation, or the self-determination index (p > 0.05).

An analysis of differences in the types of motivation for working with older adults, depending on whether the respondent cares for an older family member, conducted using the Mann-Whitney U test, revealed statistically significant differences only with regard to demotivation (Z = –2.28, p = 0.023, h² = 0.02) (Table 11). Analysis of medians and rank averages indicates that individuals caring for an older family member exhibited a significantly lower level of amotivation than those not providing such care. For the remaining types of motivation and the self-determination index, no statistically significant differences were found between the groups (p > 0.05).

Discussion

The aim of this study was to determine the level and structure of motivation in accordance with SDT. An analysis conducted using the AMS enabled the assessment of both the level of motivation and its type in relation to the motivational continuum described in this theory. The results obtained allowed for the identification of motivation types among the surveyed medical students in the context of working with older adults.

It has been shown that motivation to work in the field of geriatric care may be linked to the individual characteristics of the participants and their prior experience in caring for older adults. It was also observed that senior medical students – likely due to their participation in clinical rotations – exhibit a higher level of identified motivation, indicating an increase in autonomy. Similar results were obtained in a study conducted among 1,534 nursing students in Rome, which analyzed motivational factors influencing the decision to pursue a career in geriatric care after graduation. The results indicated that exposure to professional practice and direct work with older adults may foster a deeper understanding of the meaning of the actions undertaken [12].

Among the students in this study, external regulation predominated as the motivational structure – focused on obtaining a reward or avoiding punishment. Similar results were obtained in a study conducted in 2022 by Lemska et al., involving nurses and midwives from across Poland. The willingness to work in geriatric care among nurses and midwives is largely linked to external motivational factors, such as job stability, salary, and career development prospects [13].

Personal experiences caring for an older family member can influence the direction of one’s future career [14]. The presence of such individuals in a student’s family environment can foster a better understanding of the unique aspects of their lives and the interactions associated with them. Volunteering can also serve as a motivating factor for working in the field of gerontology. A lack of contact with older adults or previous negative experiences with them often result in a reluctance to work in this area of gerontological care [15]. According to a systematic review analyzing 24 scientific articles by Dai et al. on nursing students’ readiness to work in geriatric nursing, it is emphasized that one of the main factors encouraging a career in this field is the experience of living with older adults in the family, as well as providing care for them [16].

A study conducted by Sesiuk et al. among medical students from across Poland showed that respondents more often choose their future career path based on individual personality traits, their own preferences regarding the nature of the work, and the type of relationship they expect to have with patients. Geriatric specialization was a relatively rare choice. Additionally, positive clinical experiences and contact with leading figures in the field of medicine inspired students to choose a specific specialty [17]. In the context of an aging population and the need for qualified medical personnel in the field of geriatric care, the role of mentors as role models becomes increasingly important. Properly trained faculty can not only impart theoretical knowledge but also foster in students attitudes of empathy, patience, and understanding toward geriatric patients.

According to a study by Kanios and Bocheńska-Brandt, which analyzed the motivational factors of German and Polish students preparing to work with older adults, students from Germany were more focused on finding a job, earning money, and their own interests. This indicates a greater role of extrinsic motivation. It was found that the Polish students surveyed were primarily guided by their interests and an internal need to help others [18].

An analysis of the research findings suggests that intrinsic motivation – including the desire to care for older adults – increases when individuals feel a sense of autonomy, develop their skills, and form relationships that bring them satisfaction [19]. Recognizing these needs can help shape clinical training programs and support systems, enabling students to better cope with the emotional and professional challenges of working with older adults.

Few studies in Poland have examined the motivation of medical students to work with older adults, which gives this study its exploratory value. The use of a standardized tool – the AMS scale – allows for a reliable assessment of the level and structure of motivation. The study was conducted using an electronic survey, which made it possible to obtain responses from students across various regions of Poland. The study results are statistically significant, which enhances the reliability of the conclusions. Ensuring the anonymity of the respondents may have encouraged honest responses and data reliability. At the same time, some limitations should be acknowledged, including the uneven distribution of participants across different fields of study, which limits the interpretation of differences between groups. The study was cross-sectional in nature, so it does not allow for an assessment of how students’ motivation changes over time or whether it persists after they begin their professional careers. Although the study included medical students from Poland, it does not permit a detailed analysis of motivational factors across specific regions and universities. Consequently, it cannot be unequivocally determined whether the level and structure of motivation differ depending on local educational, cultural, or environmental conditions. The results obtained may serve as a guide for planning instructional activities that support students’ motivation to work in the field of gerontological care. Despite these limitations, the study provides valuable practical insights: it highlights the role of caregiving experiences and contact with older adults in shaping autonomous motivation. Conducting high-quality practical classes and promoting activities that support the development of competencies in the context of working with older adults may contribute to increased interest in this career path among medical students.

Conclusions

In the study group of medical students, motivation to work with older adults was moderately high, with a predominance of external regulation and identification, and a low level of demotivation. Students with experience caring for an older family member exhibited a significantly lower level of amotivation, indicating a rarer manifestation of attitudes associated with a lack of a sense of purpose in their actions. Caregiving experiences and direct contact with older adults may support the development of autonomous motivation. The predominance of identified regulation suggests that the participants recognized the personal significance of working with older adults and identified with its purpose, whereas the presence of external regulation may reflect a realistic approach to career planning that takes into account job stability and development prospects. The results of this study highlight the importance of caregiving experiences and direct contact with older adults in shaping the motivation of medical students, suggesting a need to plan educational activities and clinical internships that foster the development of competencies in gerontological care.

Disclosures

This research received no external funding.

The study was approved by the Bioethics Committee of the Jagiellonian University Medical College (Approval No. 118.0043.1.329.2025).

The authors declare no conflict of interest.

References