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A student might find a particular question threatening and intimidating in one context yet stimulating and challenging in a different context. What makes one learning context unpleasant and another pleasant?Learning depends on several factors, but a crucial step is the engagement of the learner. This is affected by their motivation and perception of relevance. These, in turn, can be affected by learners' previous experiences and preferred learning styles and by the context and environment in which the learning is taking place. In adult learning theories, teaching is as much about setting the context or climate for learning as it is about imparting knowledge or sharing expertise. MotivationMotivation can be intrinsic (from the student) and extrinsic (from external factors). Assessments are usually a strong extrinsic motivator for learners. Individual learners' intrinsic motivation can be affected by previous experiences, by their desire to achieve, and the relevance of the learning to their future.A teacher's role in motivation should not be underestimated. Enthusiasm for the subject, interest in the students' experiences, and clear direction (among other things) all help to keep students' attention and improve assimilation of information and understanding.Even with good intrinsic motivation, however, external factors can demotivate and disillusion. Distractions, unhelpful attitudes of teachers, and physical discomfort will prompt learners to disengage. Maslow described a model to illustrate the building blocks of motivation. Each layer needs to be in place before the pinnacle of "self actualisation" is reached.

There is a relative scarcity of published papers on validation of assessment for postgraduate medical certification considering the influence these high stakes processes have on doctors career progression and employment opportunities. General and family practice institutions in a number of English speaking countries have set an example to others, by showing that rigour and transparency in assessment development and implementation can be reflected in publication.

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