Chiang Mai Med Bull 2004;43(1):25-31.

Original article

                        MEDICAL EDUCATION

                                    Kannika Vitsupakorn, M.Sc.

    Department of Community Medicine, Faculty of Medicine, Chiang Mai University

       Background Identifying the characteristics of individual students is seen as a potential
       way of improving course design and the learning outcomes of the individual. This study
       examined the learning style of pre-clinical students in medical school.
       Methods The Index of Learning Styles (ILS) questionnaire was administered to a group
       of second and third-year medical students at Chiang Mai University. ILS assesses
       preferences on a four dimensional (active vs. reflective, sensing vs. intuitive, visual vs.
       verbal, and sequential vs. global) learning style model.
       Results A total of 198 (51%) second and third-year medical students in the 2002
       academic year participated in the study. Most of the students showed a preference for
       information being put in the form of pictures, graphs or diagrams (visual learners). The
       type of information next preferred was sights, sounds or physical sensation (sensing
       learners), which tended to process them through their engagement in physical activity or
       discussion (active learners). They progressed holistic approach toward understanding
       (global learners). There were fifteen types of learning styles, which were ascertained
       from combining individual preferences to one particular type.
       Conclusion Learning style models that categorize preferred and less preferred modes of
       learning in medical students can provide a good framework for designing instruction.
       Helping students to build necessary skills will enhance effectiveness of the curriculum.
       Chiang Mai Med Bull 2004;43(1):25-31.

       Keywords: learning style, problem-based learning, education

   Problem-based learning (PBL) has                     tion, while claiming to provide numerous
been extensively used in medical educa-                 benefits for professional development

Address requests for reprints: Kannika Vitsupakorn, M.Sc., Department of Community Medicine, Faculty of
Medicine, Chiang Mai University, Chiang Mai 50200, Thailand, Tel. 66 53 945474; Fax. 66 53 945476.
E-mail: kvitsupa@mail.med.cmu.ac.th
Received 3 November, 2003, and in revised form 8 January 2004.
26                                                                        Vitsupakorn K.

and lifelong learning. A significant part     teaming, students can become frustrated.
of the PBL process involves the same          Peterson’s study showed that students
activities required for self-directed         who possess these skills have a better
learning (SDL). With the rapidly              opportunity to learn than those who do
expanding information age, the need for       not.(5)
lifelong learners is greater than ever           The Faculty of Medicine at Chiang
before. Self directness and learning style    Mai University is a northern regional
are presumed to be related learning           medical school, which has developed a
characteristics that influence how an         strategic plan to integrate PBL and SDL
individual approaches and interacts with      into the new curriculum by the year
the learning situation.(1)                    2003. The purpose of this paper is to
    Learning style has generally been         discuss the necessity of assessing the
described as a characteristic of an indivi-   students learning style preferences and
dual who interacts with instructional         suggest the skills needed to be learned
circumstances in such a way as to pro-        prior to the implementation of PBL.
duce differential learning outcomes.(2)
Learning style preference relates to the      Participants and methods
likes and dislikes that individuals have         The Index of Learning Styles (ILS)-
for certain sensory modes and conditions      Thai version was administered to a class
of learning as well as preferred learning     of second and third-year medical students
strategies.(3) Information about style can    during the 2002 academic year. Partici-
help a faculty become more sensitive to       pation was voluntary. Students were
the differences students bring to the         asked to complete the self-administered
classroom. It can also serve as a guide       questionnaire at the end of one lecture
in designing learning experiences that        period in the first semester. This instru-
match or mismatch the styles of students.     ment consisted of 44-item sentences in
Some studies show that identifying a          the Thai language, translated with per-
student’s style and then providing instruc-   mission from the English version. ILS
tion consistent with that style contribute    was developed by Barbara A. Soloman
to more effective learning.(4)                and Richard M. Felder of North Carolina
    Thai students are taught from elemen-     State University, USA.(6) It is an instru-
tary school through many graduate level       ment used to assess preferences on four
programs in a traditional style: lecture      dimensions of learning style model com-
and textbook generated learning. PBL          prising 11-items for each dimension. The
depends upon the ability of students to       instrument was peer reviewed by the
work together in identifying and analy-       MERLOT (Multimedia Educational
zing problems, and/or generating solu-        Resource for Learning and Online
tions. In forcing them to learn in a new      Teaching) on August 30, 2001 as an
environment without preparing them with       “excellent all around” material in three
the necessary skills for successful           rating dimensions (Quality of Content,
Learning style and medical education                                                               27

Potential Effectiveness, and Ease of               males (78/176). In each of the four
User).(7) Reliability coefficients (∝) for         dimensions of learning style, more than
the ILS-Thai version was 0.554.                    half of the second and third-year medical
    The leaning style model of the ILS             students demonstrated to have strong
was intending to explain the following             preference for one of four categories :
four questions.(6)                                 visual, sensing, active, and global learners.
    1. Active/Reflective: How does the             The visual style was preferred (83.3%),
student prefer to process information:             followed by sensing, active, and global
actively---through engagement in physi-            (74.7%, 72.2%, and 61.6%, respectively)
cal activity or discussion, or reflectively-       (Table 1).
--through introspection?                              An individual’s type is expressed as
    2. Sensing/Intuitive: What type of             one of sixteen possible combinations of
information does the student preferen-             those preferences. For example, an AIBG
tially perceive: sensory---sights, sounds,         would have a preference for active, intui-
physical sensations, or intuitive---memo-          tive, verbal, and global learning. Table 2
ries, ideas, insights?                             shows the distribution of the fifteen dif-
    3. Visual/Verbal: Through which                ferent type preference among the second
modality is sensory information most               and third-year medical students. The
effectively perceived: visual---pictures,          three most common were ASLG - active,
diagrams, graphs, demonstrations, or               sensing, visual, and global (24.2%), ASLQ
verbal---sounds, written and spoken                - active, sensing, visual and sequential
words and formulas?                                (19.2%), and AILG - active, intuitive,
    4. Sequential/Global: How does the             visual, and global (12.1%).
student progress toward understanding:
sequentially---in a logical progression of         Discussion
small incremental steps, or globally---in             Various individuals have a tendency
large jumps, holistically?                         to both perceive and process knowledge
                                                   differently, they form ideas and think
Results                                            differently, and they act differently.
   Of the 385 medical students in the              Learning style is the composite of charac-
2002 cohort, 198 (51%) participated in             teristic cognitive, affective, and psycho-
the study by completing the ILS. Female            logical factors that serves as an indicator
students (120/209) participated more than          of how an individual interacts with and

Table 1. Learning style dimensions of the second and third-year medical students
     Learning style        Second year (n=118)        Third year (n=80)            Total (n=198)
 % Visual                         84.7                      81.3                       83.3
 % Sensing                        76.3                      72.5                       74.7
 % Active                         73.7                      70.0                       72.2
 % Global                         62.7                      60.0                       61.6
28                                                                                   Vitsupakorn K.

Table 2. Learning style type distribution among second and third year medical students
     Learning Style Types     Second year (n=118)       Third year (n=80)          Total (n=198
           ASLG                        26.3                   21.3                       24.2
           ASLQ                        19.5                   18.8                       19.2
           AILG                        13.6                   10.0                       12.1
           RSLG                         8.5                   12.5                       10.1
           RSLQ                         9.3                   6.3                         8.1
           RILG                         5.9                   7.5                         6.6
           ASBQ                        5.9                    6.3                         6.1
           ASBG                        4.2                    6.3                         5.1
           AILQ                         1.7                   3.8                         2.5
           AIBG                        2.5                    1.3                         2.0
           AIBQ                          -                     2.5                        1.0
           RSBG                        1.7                      -                         1.0
           RSBQ                        0.8                    1.3                         1.0
           RIBG                          -                     1.3                        0.5
           RILQ                          -                     1.3                        0.5
Note:    A–Active       vs. R-Reflective,           B–VerBal     vs. L–VisuaL
         S–Sensing      vs. I–Intuitive             Q–SeQuential vs. G–Global

responds to the learning environment.               PBL class environment. Sensors often
Allison & Hayes pointed out that an                 like solving problems by well-established
individual's learning orientation is possi-         methods, but dislike complications, while
bly the most important determinant of               PBL also requires students to confront a
that student’s educational attainment.(8)           tangible problem and carry out legal
   From this study, the majority of                 dispute. The sampled students prefer to
second-and third year medical students              understand things globally (holistic, learn
were visual learners who preferred visual           in large jumps) rather than in the
presentations and material (pictures,               sequential style. Sequential learners tend
diagram, flow charts, time lines, films,            to gain understanding in linear steps,
and demonstrations). They also tended to            while global learners may be able to solve
be sensors (concrete, practical toward              complex problems quickly.(9)
facts and procedures) and active learners              Functioning effectively in any pro-
(learn by trying things out, discussing,            fessional capacity requires working well
working with others), which outnum-                 in all learning modes. Medical and
bered intuitive perception and reflective           health professionals, who have used PBL
processing. In the PBL classroom,                   in the classroom, reported symptoms of
students need to work in a group, and               weak group process and interaction skills
discuss in class where they require in-             among the students.(10) PBL should be
teraction skills. Students who are active           able to help students build their skills in
learners will be more comfortable in the            both their preferred and less preferred
Learning style and medical education                                                          29

modes of learning in order to improve          personality. There are no good or bad
overall learning.                              types, they merely predict the way
    PBL depends upon the ability of            students will learn if they have freedom
students to work together in identifying       of choice. Students may not change their
and analyzing problems, and generating         types, but they can learn skills. Since
solutions. Peterson suggested the skills       PBL has not been the educational
necessary for successful teaming. They         method in the majority of premedical
include(5)                                     education systems, many students lack
    - Consensual decision skills: every        these skills upon entering the medical
member of the team participates in the         school curriculum. By training students
decision, and everyone agrees with the         (as well as the faculty) in those skills
decision;                                      prior to or within existing medical courses,
    - Dialogue and discussion skills: dia-     which utilize PBL, learning can be
logue is a process by which students           enhanced.
seek to understand one another and build
shared meanings and definitions of pro-        Acknowledgement
blems between students within a group;            The author would like to thank the second
discussion is a skill that makes thought       and third-year medical students who participated
processes visible, and exposes the sources     in this study and the Faculty of Medicine, Chiang
of disagreement;                               Mai University, who provided funds for the
    - Team maintenance skills: commit-         presentation of this paper in the 1st MEDINF
ment to the task and team, affective           International Conference on Medical Informatics
development, team’s efficacy and ability       and Engineering, Craiova, Romania from October
to resolve conflict;                           9-11, 2003.
    - Team leadership skills: ability of all
team members to lead the team and share        References
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                                                   teacher-directed problem-based learning cur-
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    In knowing their own preferences and        3. Ostmoe PM, Van Hoozer HL, Scheffel AL,
strengths in learning, students can develop        Crowell CM. Learning style preferences and
                                                   selection of learning strategies: Considera-
new ways to learn. Learning style pre-
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ferences are part of dimensions that               Nurs Educ 1984;23:27-30.
consist of two polar ways of opposite           4. Murrell PH, Claxton CS. Experiential
thinking. Type is only one way of des-             Learning Theory as a Guide for Effective
cribing the dimensions of an individual’s          Teaching. J Assoc Counsel Educ Supervis
30                                                                                  Vitsupakorn K.

5. Peterson M. Skills to enhance Problem-           8. Allison CW, Hayes J. The learning styles
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   (serial online) 1997 Available online at:           tory. J Manag Stud 1988; 25:269-81.
   http://www.utmb.edu/meo/. Accessed on May        9. Soloman BA, Felder RM. Learning styles
   2002.                                               and strategies. Available online at: http://
6. Soloman BA, Felder RM. Index of Learning            www2.ncsu.edu/unity/lockers/users/f/felder/
   Styles. Available online at: http://www.ncsu.       public/ILSdir/styles.htm. Accessed on May
   edu/felder-public/ILSpage.html. Accessed on         2002.
   May 2002.                                       10. Kalain HA, Mullan PB. Exploratory factor
7. MERLOT (Multimedia Educational Resource             analysis of students’ ratings of problem
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   on April 2002.
Learning style and medical education                                                                   31

                              ี         

                                     กรรณิกา วิทยสุภากร, วท.ม.
                ภาควิชาเวชศาสตรชุมชน คณะแพทยศาสตร มหาวิทยาลัยเชียงใหม

      บทคัดยอ ผลงานวิจัยหลายเรื่องบงชี้วาความเขาใจถึงลักษณะที่แตกตางกันของผูเรียน จะชวยให
                                  ่
      ผูสอนสามารถใชเปนแนวทางเพือปรับปรุงกระบวนวิชาและชวยใหเกิดการเรียนรูไดดขน  ี ้ึ
      วัตถุประสงค เพือประเมินวิธีการเรียนรูของนักศึกษาแพทยระดับปรีคลินิกชั้นปที่ 2 และ 3 คณะ
      แพทยศาสตร มหาวิทยาลัยเชียงใหม
      วิธีการ ใชแบบสอบถามชนิดใหตอบดวยตนเอง ประกอบดวยขอความใหเลือกตอบจํานวน 44
           ่                                                   ่
      ขอทีแปลและดัดแปลงจาก Index of learning style (ILS) ซึงเปนเครื่องมือประเมินรูปแบบความ
      ชอบวิธีการเรียนรูของผูเรียนออกมาเปน 4 มิติ ไดแก ชอบทําหรือชอบไตรตรอง ชอบรูปธรรม
      หรือชอบนามธรรม ชอบมองเห็นหรือชอบฟง และชอบรายละเอียดหรือชอบภาพรวม
      ผลการศึกษา มีนกศึกษาเขารวมในการตอบแบบประเมินจํานวน 198 คน คิดเปนรอยละ 51 ของ
      จํานวนนักศึกษาแพทยชนปที่ 2 และ 3 ในปการศึกษา 2545 ผลการประเมินพบวานักศึกษาสวน
      ใหญ (ประมาณ 3 ใน 4) มีวิธีการเรียนรูโอนเอียงไปดานใดดานหนึ่งของการวัดทั้ง 4 มิติดังนี้ มิติ
                                           ี                           ิ
      ที่ 1 : นักศึกษาชอบหรือจะเขาใจไดดถาไดเห็นรูป แผนผัง หรือแผนภูมมากกวาไดฟงเพียงคําอธิบาย
      (visual learner) มิติที่ 2 : นักศึกษาชอบใหมการยกตัวอยางหรือนําเสนอขอมูลอยางเปนรูปธรรม
      มากกวาเรียนรูแนวคิดหรือทฤษฎี (sensing learner) มิติที่ 3 : นักศึกษาชอบที่จะไดลงมือทําหรือ
                             ่ื
      ทํางานรวมกับผูอนมากกวาจะใชเวลาในการคิดไตรตรองเอง (active learner) มิติที่ 4 : นักศึกษา
                          ่                                               ้
      จะเขาใจไดดเี มือไดเห็นภาพโดยรวมมากกวาการแสดงรายละเอียดทีละขันตอน (global learner)
          ่           ้                                                    ้        ู
      เมือพิจารณาทัง 4 มิติของนักศึกษาแตละคนพรอมกัน พบวากลุมตัวอยางทังหมดมีรปแบบของวิธี
      การเรียนรูแตกตางกัน 15 รูปแบบ
                       ี         ึ่
      สรุป รูปแบบวิธการเรียนรูซงแสดงถึงความชอบและไมชอบในวิธเี รียนของนักศึกษาแพทยสามารถ
                    ํ        ่                                                   ้
      ดานตางๆ ที่จาเปน เพือเสริมใหการเรียนการสอนตามหลักสูตรมีประสิทธิภาพมากขึน เชียงใหม
      เวชสาร 2547;43(1):25-31.
      คําสําคัญ : วิธการเรียนรู การเรียนโดยใชปญหาเปนฐาน การศึกษา

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