An assessment of learning styles of undergraduate medical students in three different types of curriculum

Abdulrahman Alfawzan; Moeber Mahzari; Sajida Agha; Aamir Omair; Omar Alfawzan; Reema Alessa; Abdulaziz Alturki; Kholoud Alshiha

doi:10.4103/jnsm.jnsm_126_20

ORIGINAL ARTICLE

Year : 2021 | Volume : 4 | Issue : 3 | Page : 267-273

An assessment of learning styles of undergraduate medical students in three different types of curriculum

Abdulrahman Alfawzan¹, Moeber Mahzari², Sajida Agha¹, Aamir Omair¹, Omar Alfawzan³, Reema Alessa¹, Abdulaziz Alturki⁴, Kholoud Alshiha⁴
¹ College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
² College of Medicine, King Saud bin Abdulaziz University for Health Sciences; Department of Medicine, Ministry of National Guard-Health Affairs; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
³ College of Medicine, King Saud University, Riyadh, Saudi Arabia
⁴ College of Medicine, Imam Muhammad Ibn Saud Islamic University, Riyadh, Saudi Arabia

Date of Submission	10-Oct-2020
Date of Decision	06-Dec-2020
Date of Acceptance	23-Dec-2020
Date of Web Publication	26-Jul-2021

Correspondence Address:
Abdulrahman Alfawzan
King Abdullah International Medical Research Center, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, National Guard Health Affairs Ar Rimayah, Riyadh 14611
Saudi Arabia

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jnsm.jnsm_126_20

Abstract

Background: Research in academia suggests that types of school may have an impact on learning styles. The study is aimed to examine the learning styles of students from medical institutions using different types of curriculum. Methods: This descriptive cross-sectional study was conducted in the three largest public-sector medical colleges using conventional, hybrid, and a problem-based learning-based curriculum in Saudi Arabia. By using convenient sampling, we collected 316 responses. The questionnaire consisted of sociodemographic data and index of learning style instrument. The categorical data were presented as percentages and descriptive data were analyzed using the Chi-square test. Value of P < 0.05 level was considered statistically significant. Results: Of the 316 participants, the male-to-female ratio was 1:1. Gender was associated with a significant difference in the visual/verbal dimension (P = 0.034). Irrespective of college, most of the participants are primarily balanced in active/reflective (67.2%), visual (51.1%), and sequential (68.8%) with slight shift toward sensing (47.6%). Significant differences between colleges were found in sensing/intuitive (P = 0.005) and sequential/global (P = 0.012) dimensions. There was no significant association between academic years with learning styles in the three medical colleges from public sector universities. Conclusion: Irrespective of college, most of the participants' preferred style was visual illustrations supported by hands-on teaching in a stepwise process. Although, medical students in different universities possessed different learning styles. It has also been shown that students in a single university tend to develop the same learning styles as they advance through the years. The collaboration between institutions using different types of the curriculum may increase the quality of education by developing effective teaching and learning methods that correspond with the learning styles of students.

Keywords: Curriculum type, learning style, medical students, public sector

How to cite this article:
Alfawzan A, Mahzari M, Agha S, Omair A, Alfawzan O, Alessa R, Alturki A, Alshiha K. An assessment of learning styles of undergraduate medical students in three different types of curriculum. J Nat Sci Med 2021;4:267-73

How to cite this URL:
Alfawzan A, Mahzari M, Agha S, Omair A, Alfawzan O, Alessa R, Alturki A, Alshiha K. An assessment of learning styles of undergraduate medical students in three different types of curriculum. J Nat Sci Med [serial online] 2021 [cited 2023 Jan 28];4:267-73. Available from: https://www.jnsmonline.org/text.asp?2021/4/3/267/322316

Introduction

Recently, medical education has shifted from traditional, teacher-focused learning into a student-centered approach. Knowledge of the favorable student learning style can enhance the learning process as well as student performance, and provide a better understanding of the learning difficulties that learners may encounter.^[1],[2] Learning style refers to how students prefer to receive, process, and recall information In general, student learning can be enhanced when the medical curriculum teaching methods are suitable for different learning styles.^[3] A study on the effect of the types of curriculum reported that an integrated lecture-based, which consists of lectures include basic and clinical knowledge are as effective as problem-based learning (PBL) curriculums in developing students deeper approach to learning.^[4] Furthermore, it has been shown that PBL-based curriculums can accommodate broader range of different learning styles in comparison to the traditional teaching method. Both students and instructors enjoy multimodal approach to learning.^[5] It can be argued, however, that the influence of the medical curriculum type on students' learning is not well studied.

The student-centered approach focuses on delivering information in various ways to different students. It is crucial to use effective tools that help identify specific types of learning styles. Many instruments have been invented to determine students' learning styles to make the most of their abilities.^[6],[7] Another widely used learning style instrument is the index of learning styles (ILS), invented by Felder and Soloman.^[8] ILS has been recently validated for research in the medical field,^{[9],[10],[11]} and several studies utilized ILS due to its simplicity and accessibility.^{[12],[13],[14]} It has four dimensions: Active/reflective, sensing/intuitive, visual/verbal and sequential/global. Every dimension has two categories, and learners could be strong in one category or balanced. In Saudi Arabia, several studies have been conducted to determine the learning style preferences of medical students.^{[15],[16],[17],[18]} However, none compared the different learning styles of medical students in colleges with different curriculum types.

Considering the suggestions to investigate the learning values of learning styles of students from institutions using different curriculum types, some questions raise in mind: Does a curriculum type have an impact on students' learning styles? Is there any difference of learning styles among male and female students? Does learning style have an impact on student performance? To answer these questions, this descriptive cross-sectional research intends to explore the learning styles of medical students in three public sector universities, namely King Saud bin Abdulaziz University for Health Sciences (KSAUHS), King Saud University (KSU), and Imam Mohammad Ibn Saud Islamic University (IMSIU). This study results will guide the institutions in the selection of teaching strategies that may improve the quality of teaching and learning process. The findings will approve the collaborative role of institutions in achieving greater learning outcomes for students with different learning styles.

Methods

This descriptive cross-sectional study was conducted on preclinical year students in three medical colleges of KSAU-HS, KSU, and Al-Imam Mohammad Ibn Saud Islamic University (IMSIU), the largest public sectors accredited universities in Riyadh, Saudi Arabia. IMSIU has a medical program that consists of three basic medical years (preclinical) while KSU and KSAU-HS have two basic medical years. Each university follows a distinct curriculum and mode of delivery. In KSAU-HS, the main principle is self-directed learning represented by PBL during the preclinical phase where students are innovative and active throughout the learning process. KSU adopts an approach to teaching in which lectures are the primary focus. Finally, IMSIU uses a hybrid approach to teach strategies, focusing on lectures, and student-centered learning such as PBL. Prior to data collection, an institutional review board approval was obtained with the reference number RC19/080/R from King Abdullah International Medical Research Center (KAIMRC) on April 2019. Informed consent was secured before participants' enrollment in the study.

The sample size was calculated at the 95% confidence level. The expected response for the main outcome variable, which is the learning style, was kept at 50%. The number of basic years medical student is estimated to be 1743 according to the student's affairs from each university. The minimum required sample size for margin of accuracy of 5% is estimated to be 315. By using nonprobability convenient sampling techniques, we collected data from 334 preclinical year medical students in three institutions. Only those who consented to participate were included. Students in the preparatory year and clinical year programs, interns, and incomplete ILS responses were excluded.

We used a self-administered ILSs questionnaire (English version) to assess the different learning styles, developed by Felder and Soloman.^[8] This instrument is widely used for the educational purpose which helps teachers in identifying the learning styles of students and providing a basis to design a teaching method that fulfil the needs of all students. The ILS has four dimensions: active/reflective, sensing/intuitive, visual/verbal, and sequential/global. Each dimension consists of 11 statements (a total of 44 statements) and has two options: (A) which score for active, sensing, visual, and sequential, and (B) which corresponds to other categories in the dimensions. The highest score in A or B determines the participant's inclination toward that learning style. The ILS further divides the learners into categories. A score on the scale from 1 to 3 for one dimension reflects a well-balanced learning style. If scores are between 5–7 and 9–11 this shows a moderate to strong preference for one dimension. The questionnaire is valid and reliable tool to measure learning preferences.^{[9],[10],[11]}

The learner's styles in each dimension are represented in [Table 1].

Table 1: Four dimensions of learning style

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The students were approached in their respective colleges by coauthors after taking permission from the colleges' administration. The ILSs were distributed among students along with sociodemographic data, including age, gender, university, basic medical year, and grade point average (GPA).

We utilized excel sheets for data entry and SPSS version 22 for data analysis. We presented categorical data as percentages and frequencies and used Chi-squared test to compare students' learning styles. A P < 0.05 is considered statistically significant.

Results

Out of 334 students, we excluded 18 questionnaires with missing data. A total of 316 responses were found eligible. The male-to-female ratio was 1:1. Most of the students were in the 20-year-old age group. The most received responses were from IMSIU (36%), as 40% of the participants have a 5-4.75 GPA. The complete demographic information is illustrated in [Table 2]. Comparing the learning style prevalent among colleges, most of the participants are primarily balanced in active/reflective (n = 213, 67.2%), visual (n = 162, 51.1%), and sequential (n = 218, 68.8%) with slight shift toward sensing (n = 151, 47.6%).

Table 2: Participants' characteristics

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[Table 3] represents the association of participants' learning styles with gender, age, and GPA. A significant difference between males and females was shown in the visual/verbal dimension (P = 0.034). Females (9.5%) were slightly more verbal than males (2.5%). Other demographic characteristics such as GPA and age showed no association with learning styles.

Table 3: Association of participants' learning styles according to participants' characteristics

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The comparative assessment of medical students' learning styles in the three institutions revealed similar patterns among students, in particular the active/reflective and visual/verbal dimensions. Negative mean indicates the preference of learning toward active, sensing, sequential, and visual, whereas positive mean indicates preference toward reflective, intuitive, global, and verbal. The mean of active/reflective is 0.9, 0.6, and 0.6 for KSAU-HS, KSU, and IMSIU, respectively. The equal mean is shown in visual/verbal category −3.6, −3, and −3.2 for KSAU-HS, KSU, and IMSIU, while the mean (−2.5) is slightly less sensing in KSU than KSAU-HS (−3.3) and IMSIU (−3.7) participants. Furthermore, KSU students have a more balanced mean (−1) in sequential/global dimension compared with KSAU-HS (−1.7) and IMSIU (−2.2) students. In sensing/intuitive and sequential/global categories, there was a marked difference in the median, minimum, and maximum results, as shown in Graph 1. The median (−3) of IMSIU was shifted to sequential in comparison to KSAU-HS and KSU, while KSU participants had narrower quartiles than KSAU-HS and IMSIU. KSU median was less in sensing (−3) in comparison to KSAU-HS (−4) and IMSIU (−5) [Figure 1].

Figure 1: Box whisker plot of participants' learning styles according to participants' university

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The comparative assessment also showed no significant association in the active/reflective and visual/verbal dimensions. However, a significant association between universities in sensing/intuitive (P = 0.005) and sequential/global (P = 0.012) categories was reported. In the active/reflective dimension, two-quarters of each college are balanced. KSAU-HS (50%) and IMSIU (57.9%) participants shifted toward sensing while most KSU participants were balanced. In visual/verbal and sequential/global categories, most of the participants were balanced [Table 4].

Table 4: Association of participants' learning styles according to participants' university

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There was no significant association between academic years in each university, but it should be noted that a slight significance (P = 0.064) was found in the visual/verbal category in IMSIU. The visual/verbal domain in IMSIU showed that as students' progress toward the last year of basic science; they become more balanced (74.1%) in comparison with the first (43.5%) and second (48.8) years, respectively [Table 5].

Table 5: Association of participants' learning styles according to participants' academic year

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Discussion

One of the most effective ways to achieve quality education in student-centered learning is to identify and adapt the learning styles to the education system, which can ultimately improve students' learning performance. To this end, we identified the learning styles of basic science year medical students and found discrepancies in the learning styles between the three universities.

Most of the participants are primarily balanced in active/reflective with a slight shift toward sensing, visual, and sequential, which means they can learn effectively from active discussions in groups, or independently, and think the situation through before acting. Furthermore, they slightly prefer facts and use visual materials such as pictures, graphics, and books for stepwise learning. A study conducted on undergraduate health education students (n = 505) showed similar results.^[19] Out of 505 participants, 72 Premedicine students are more likely to be reflective (56.9%), sensing (83.4%), visual (76.4%), and sequential (70.8).^[19] First-year medical students' learning preferences were sensing (54.9%), active (50.9%), sequential (60.5%), and visual (80.8%) with medians equal −0.9, 0.7, −0.8, and −5.1, respectively.^[12] Two studies revealed that participants were mainly more visual (81.2% and 90%) and sensing (85.1% and 64%).^[19],[20]

The current study reported a significant difference between colleges and information perception P = 0.005 (sensing/intuitive dimension). About 90% of the participants shifted toward sensing and balanced. Only KSU had more balanced participants than sensing. The higher number of sensing learners in IMSIU could be attributed to the diverse teaching sessions, as sensing learners prefer to learn facts, solve problems, and perform hands-on tasks and dislike being tested on materials that have not been fully explained during the sessions. On the other hand, KSAUHS delivers less lectures and provides more PBL's and case discussions. The sessions conducted in KSAUHS offer general information about the subject and depend mostly on self-learning. For example, case-discussions and PBL are introduced to encourage students to become more active and articulate when sharing their thoughts and ideas with colleagues, while the tutor, i.e., supervisor, corrects mistakes and directs the session with limited interference. In general, KSAUHS and IMSIU have PBL case every week. KSU curriculum has lower number of PBL in comparison for the other universities.

It is usually assumed that medical students are more sequential (learning stepwise) than global (gaining knowledge by covering a lot of ground). Medical students learn step-by-step because the nature of subjects studied, for example, microbiology, anatomy, and embryology, requires a process of incremental phases that reflect the sequential aspect. However, KSU students tend to be more global than KSAU-HS, and IMSIU with significant difference (P = 0.012). Similarly, a study conducted in 2014 to identify the differences between learning styles in Indian versus Malaysian medical schools showed no difference between the students.^[21] However, the study includes only two categories, for example, sensing and global without including balanced learners. In this study, the learning styles of junior medical students were comparable to those of the seniors. The lack of distinctiveness between the two groups indicates that if medical students failed to adapt or improve their learning styles, they would likely develop a static form of learning throughout college.

In this data, gender was not associated with the learning styles of medical students, except in the visual/verbal category. Although both have low verbal preference, it was slightly higher in females than in males. Females are more likely to learn from listening, writing, and reading than males. A study that uses the ILS instrument showed that there is a gender difference in learning, where females are more sequential than males.^[12] Two studies carried out in Saudi Arabia, which adopt the VARK questionnaire, showed that gender affects learning preferences among medical and dental students, consecutively (P = 0.019 and P = 0.04).^[22],[23] In contrast, a study on dental students concluded that there is no gender difference.^[24] In the present study, GPA was not associated with the learning styles. The results correspond with the findings of other studies that reported a similar conclusion.^{[24],[25],[26]} The results are in contrast to a study that reported significantly better performance of students who have a visual learning style preference than without.^[27] There was also a study that showed a similar result for surgery residents on their performance in the American Board of Surgery In-Training Examination.^[28] These findings suggest that medical students' from different learning styles have preferred ways of preparing for the examination which they use to perform better irrespective of the types of curriculum.

The study highlights the importance of learning preferences among medical students. Educators are advised to incorporate discussions and hands-on activities into the classroom, and students should be given enough time to grasp new information. Through visual illustrations, step-by-step learning could be highly beneficial. Educators should also evaluate their teaching methods to determine whether the instructional materials complement students' learning preferences. For example, some educators tend to give lectures in a disjointed manner, where they jump from one point to another, then return to the previous point. In this class, students with sequential learning style, most of whom are medical students, may find it difficult to keep up with the progress of the lesson.

Despite the pedagogical benefits of the study, it has some limitations. The cross-sectional design was one of the drawbacks that proved inadequate to determine a causal relationship. Another bias might be related to the comparability of the subjects. We tried to ensure the homogeneity of the students from three institutions of conventional, hybrid, and PBL-based curriculum, however generalization of the results to the specific medical students should need to be taken with caution. Further, the sample was considerably small and only examined the preclinical years. It is recommended to opt for longitudinal studies on a larger sample, including clinical-year students, which will provide more reliable data on the learning preferences among medical students in Saudi Arabia.

Conclusion

Irrespective of college, most of the participants can learn alone, and/or in groups, and prefer visual illustrations supported by hands-on teaching in a stepwise process. Medical students in different universities have different learning styles. It has also been shown that students in a single university tend to develop the same learning styles as they advance through the years.

Acknowledgment

The completion of our great project could not have been possible without the participation and assistance of these people, and we gratefully acknowledge their contributions. We would like to express our deep appreciation for the following: Ms. Maysoon AlTameem for her contribution with data collection.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	Fan K, Xiao P, Su C. The effects of learning styles and meaningful learning on the learning achievement of gamification health education curriculum. EURASIA J Math Sci Tech Ed 2015;11:1211-29.
2.	Feeley AM, Biggerstaff DL. Exam success at undergraduate and graduate-entry medical schools: Is learning style or learning approach more important? A critical review exploring links between academic success, learning styles, and learning approaches among school-leaver entry (”Traditional”) and graduate-entry (”Nontraditional”) medical students. Teach Learn Med 2015;27:237-44.
3.	Surjono HD. The effects of multimedia and learning style on student achievement in online electronics course. Turk Online J Educ Technol 2015;14:116-22.
4.	Gustin MP, Abbiati M, Bonvin R, Gerbase MW, Baroffio A. Integrated problem-based learning versus lectures: A path analysis modelling of the relationships between educational context and learning approaches. Med Educ Online 2018;23:1489690.
5.	Wood SJ, Woywodt A, Pugh M, Sampson I, Madhavi P. Twelve tips to revitalise problem-based learning. Med Teach 2015;37:723-9.
6.	Fitkov-Norris ED, Yeghiazarian A. Validation of VARK learning modalities questionnaire using rasch analysis. J Phys Conf Ser 2015;588:012048.
7.	Borracci RA, Arribalzaga EB. Kolb's learning styles in medical students. Medicina (B Aires) 2015;75:73-80.
8.	Felder RM, Soloman BA. Index of Learning styles Questionnaire. Available from: https://www.webtools.ncsu.edu/learningstyles/. [Last accessed on 15 Jul 2020].
9.	Suhaini M, Ahmad A, Bohari N, Mohamad N. Validity and reliability of index of learning styles for vocational students using the rasch measurement model. Int J Psychosoc Rehabil 2020;24:1714-24.
10.	Aljojo N, Adams C, Alkhouli A, Saifuddin H, Alsaleh I. In-depth analysis of the Arabic version of the felder-silverman index of learning styles. Am J Inf Syst 2015;3:22-30.
11.	Hosford CC, Siders WA. Felder-soloman's index of learning styles: Internal consistency, temporal stability, and factor structure. Teach Learn Med 2010;22:298-303.
12.	Hernández-Torrano D, Ali S, Chan CK. First year medical students' learning style preferences and their correlation with performance in different subjects within the medical course. BMC Med Educ 2017;17:131.
13.	Jiraporncharoen W, Angkurawaranon C, Chockjamsai M, Deesomchok A, Euathrongchit J. Learning styles and academic achievement among undergraduate medical students in Thailand. J Educ Eval Health Prof 2015;12:38.
14.	Dumbauld J, Black M, Depp CA, Daly R, Curran MA, Winegarden B, et al. Association of learning styles with research self-efficacy: Study of short-term research training program for medical students. Clin Transl Sci 2014;7:489-92.
15.	Almigbal TH. Relationship between the learning style preferences of medical students and academic achievement. Saudi Med J 2015;36:349-55.
16.	Rezigalla AA, Ahmed OY. Learning style preferences among medical students in the College of Medicine, University of Bisha, Saudi Arabia (2018). Adv Med Educ Pract 2019;10:795-801.
17.	Al-Mohrej OA, Al-Ayedh NK, Masuadi EM, Al-Kenani NS. Learning methods and strategies of anatomy among medical students in two different Institutions in Riyadh, Saudi Arabia. Med Teach 2017;39:S15-S21.
18.	Guraya SS, Guraya SY, Habib FA, Khoshhal KI. Learning styles of medical students at Taibah University: Trends and implications. J Res Med Sci 2014;19:1155-62.
19.	Quinn MM, Smith T, Kalmar EL, Burgoon JM. What type of learner are your students? Preferred learning styles of undergraduate gross anatomy students according to the index of learning styles questionnaire. Anat Sci Educ 2018;11:358-65.
20.	Parmar AS, Balsara PH, Shailaja S. Jaywant. Difference between learning style preferences among second year MBBS and second year engineering students from metropolitan city. Indian J Physiother Occup Ther 2020;14:1-6.
21.	Heethal JP, Sahana GN, Ghosh S, Chitra G. Learning style preferences: A comparison between students of an Indian and a Malaysian medical school. South-East Asia J Med Educ 2014;8:14-9.
22.	Nuzhat A, Salem RO, Al Hamdan N, Ashour N. Gender differences in learning styles and academic performance of medical students in Saudi Arabia. Med Teach 2013;35:S78-82.
23.	AlQahtani N, AlMoammar K, Taher S, AlBarakati S, AlKofide E. Learning preferences among dental students using the VARK questionnaire: A comparison between different academic levels and gender. J Pak Med Assoc 2018;68:59-64.
24.	Akhlaghi N, Mirkazemi H, Jafarzade M, Akhlaghi N. Does learning style preferences influence academic performance among dental students in Isfahan, Iran? J Educ Eval Health Prof 2018;15:8.
25.	Alharbi HA, Almutairi AF, Alhelih EM, Alshehry AS. The learning preferences among nursing students in the king saud university in Saudi Arabia: A cross-sectional survey. Nurs Res Pract 2017;2017:3090387.
26.	Paiboonsithiwong S, Kunanitthaworn N, Songtrijuck N, Wongpakaran N, Wongpakaran T. Learning styles, academic achievement, and mental health problems among medical students in Thailand. J Educ Eval Health Prof 2016;13:38.
27.	Nasiri Z, Gharekhani S, Ghasempour M. Relationship between learning style and academic status of babol dental students. Electron Physician 2016;8:2340-5.
28.	Kim RH, Viscusi RK, Collier AN, Hunsinger MA, Shabahang MM, Fuhrman GM, et al. Learning preferences of surgery residents: A multi-institutional study. Surgery 2018;163:901-5.