Liew et al.

BMC Medical Education (2015) 15:44

DOI 10.1186/s12909-015-0327-0

RESEARCH ARTICLE

Open Access

The relationship between learning preferences

(styles and approaches) and learning outcomes
among pre-clinical undergraduate medical
students
Siaw-Cheok Liew1*, Jagmohni Sidhu1 and Ankur Barua2

Abstract
Background: Learning styles and approaches of individual undergraduate medical students vary considerably and
as a consequence, their learning needs also differ from one student to another. This study was conducted to
identify different learning styles and approaches of pre-clinical, undergraduate medical students and also to
determine the relationships of learning preferences with performances in the summative examinations.
Methods: A cross-sectional study was conducted among randomly selected 419 pre-clinical, undergraduate medical
students of the International Medical University (IMU) in Kuala Lumpur. The number of students from Year 2 was
217 while that from Year 3 was 202. The Visual, Auditory, Read/Write, Kinesthetic (VARK) and the Approaches and
Study Skills Inventory for Students (ASSIST) questionnaires were used for data collection.
Results: This study revealed that 343 students (81.9%) had unimodal learning style, while the remaining 76 (18.1%)
used a multimodal learning style. Among the unimodal learners, a majority (30.1%) were of Kinesthetic (K) type.
Among the middle and high achievers in summative examinations, a majority had unimodal (Kinaesthetic) learning
style (30.5%) and were also strategic/deep learners (79.4%). However, the learning styles and approaches did not
contribute significantly towards the learning outcomes in summative examinations.
Conclusions: A majority of the students in this study had Unimodal (Kinesthetic) learning style. The learning
preferences (styles and approaches) did not contribute significantly to the learning outcomes. Future work to
re-assess the viability of these learning preferences (styles and approaches) after the incorporation of teachinglearning instructions tailored specifically to the students will be beneficial to help medical teachers in facilitating
students to become more capable learners.
Keywords: Learning, Styles, Approach, Assist, Vark, Medical, Students

Background
The learning styles and learning approaches constitute
the learning preferences of undergraduate medical students. The learning styles are preferred methods of
learning adopted by students in attaining, analysing and
interpreting their knowledge [1]. The Visual, Auditory,
Read/Write, Kinesthetic (VARK) model, developed by
* Correspondence: [email protected]
1
Department of Clinical Skills and Simulation Centre, International Medical
University, No. 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000 Kuala Lumpur,
Malaysia
Full list of author information is available at the end of the article

Fleming and Mills [2] is an acronym for Visual (V), Auditory (A), Read/Write (R) and Kinaesthetic (K) modalities
which are used to assess learning styles.
The Visual (V) learner learns best by visualizing the
information e.g., use of charts, diagram and mindmaps.
The Auditory (A) learner learns best by hearing the information. The Read/Write (R) learner learns best when
the information is displayed in words. The Kinaesthetic
(K) learner learns best with practice or simulation [2].
The Approaches and Study Skills Inventory for Students (ASSIST) questionnaire which was developed by
Entwistle and Ramsden [3] helps in the identification of

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Liew et al. BMC Medical Education (2015) 15:44

students preferences in adopting any of the deep, surface

or strategic approaches for learning. In the deep approach,
the students actively relate their own ideas to the learning
principles [4], use evidence and examine its logic and continue to monitor their own level of understanding [5].
In the strategic approach, students aim to achieve the
highest scores possible. This involves good time management and study organization. Hence, they pay more attention to the content as well as assessment requirements [5].
In surface approach, learning of the students is restricted
to routine memorisation as their intention is merely to
complete the task [5]. The deep/strategic approach has
been reported to be associated with better academic outcomes as compared to those with the surface approach [6].
Assessment is an important determinant which affects
the way students learn and subsequently determines the
learning outcomes [7]. It is a goal oriented approach
which drives learning. Harris and Bell, [8] reported that
students often modify their learning approaches in order
to cope with the demands of assessment [8]. Many studies
were conducted in the past to determine the association
between learning approaches and summative examination
results as a measure of learning outcomes. A majority of
them had reported contradictory results on the relationship between learning approaches and outcomes [9-11].
The learning styles (VARK) were found to have a significant impact on the academic performances of undergraduate students of physiotherapy, nursing, dentistry
and allied healthcare professional programmes [12-15].
The meshing hypothesis states that the learning outcomes could be highly achieved if learning was matched
with predominant learning style of the learner [16,17].
However, Pashler et al. argue that the meshing theory was
not necessarily correct because the undergraduate medical
students were not always exposed to multiple types of
learning styles for the same subject. Different subjects
required different kinds of learning styles and instructions
to optimally potentiate and benefit the students [17].
In the past, study methods were limited to lectures,
tutorials and self-study. Major part of knowledge acquisition depended heavily on lectures. A shift to the skill of
self-acquiring knowledge via information technology had
widely changed the preferences and adaptation modes of
knowledge acquirements of our 21st century learners. In
Asia, students are not spared from the advancement of
technology, therefore their learning preferences had also
changed with time along with this advancement. Many
Asian higher institutions already have adopted information technology as one of their platforms for student
learning and assessments [18,19]. With a variety of learning aids available these days, there is need to identify the
most efficient way to match and deliver the teaching and
learning instructions to help the undergraduate medical
students to become more capable learners.

Page 2 of 7

An in-depth understanding of modes of approach to

learning would be beneficial for medical teachers to
improve their delivery of learning materials. It would
also help in tailoring the classroom instructions to
suit the needs of undergraduate medical students in a
more efficient and cost-effective manner. A majority
of the previous studies on learning styles and learning
approaches were conducted in western countries. This
is the first study undertaken in a Malaysian context
that examines the relationship between the learning
preferences of pre-clinical undergraduate medical students and learning outcomes by using the VARK and
ASSIST questionnaires. This study was conducted to investigate the learning preferences (styles and approaches)
of the pre-clinical (Year 2 & 3) undergraduate medical
students and also to associate the learning preferences
(styles and approaches) with learning outcomes as performances in the summative examinations.

Methods
This cross-sectional study was conducted for four
months (September 2013 to December 2013) at the Clinical Skills and Simulation Centre, International Medical
University, Kuala Lumpur, Malaysia.
Sample size

The sample frame consisted of 470 undergraduate

medical students. Among these, 230 belonged to Year
2 while 240 belonged to Year 3 of the undergraduate
medical programme. The probability sample size for
finite population was calculated by using confidence
interval = 95%, absolute precision of estimate = 5% and
prevalence rate of any one of the learning styles among
the students = 50% (as previously no similar study was
conducted in Malaysia). The minimum sample size
required was estimated to be 293 which included 145
from Year 2 and 148 from Year 3 respectively. However,
depending on feasibility and applying the inclusion and
exclusion criteria, the total number of respondents in this
study was found to be 419.
Inclusion and exclusion criteria

All the pre-clinical, undergraduate medical students of

Year 3, who attended their summative first Professional
Examination were invited to participate in this study. All
the undergraduate medical students of Year 2, who
attended their summative examination at end of second
semester, were also invited to participate in this study.
These summative examinations were written/theoretical
papers covering various aspects of basic sciences i.e.
physiology, anatomy, biochemistry, pharmacology and
pathology. All these examinations were conducted in
English. Participation in this study was on a voluntary
basis. All the Year 2 and Year 3 students who provided

Liew et al. BMC Medical Education (2015) 15:44

informed written consent to participate in this study

were included. The designated undergraduate medical
students who were absent and could not be contacted
during the data collection period were excluded from
this study. Stratified random sampling method was
adopted to randomly select the respondents from both
these strata of year 2 and Year 3. The required sample
was redistributed according to the proportion of sampling frame in these two groups.

Page 3 of 7

adding the responses across all the items which produced

a total scale score which identified whether the students
adopted deep, strategic or surface approach during learning. The summative examination scores of the students
of Year 3 (first professional examination) and Year 2 (end
of second semester examination) were compared to the
VARK scores, ASSIST scores and the number of attendances at medical lectures. The educational background of
the students was compared against their summative examination scores along with VARK and ASSIST scores.

Study instruments

The demographic data, educational background and preferred methods of studying among the undergraduate
medical students were captured in a pre-tested pro
forma. The latest version (v7.1) of VARK (Visual/Aural/
ReadWrite/Kinesthetic) was used to assess the learning
styles. The Cronbachs Alpha score for individual components of VARK were found to be V (0.85), A (0.82), R
(0.84), K (0.77) respectively. The VARK questionnaire
consisted of 16 questions with four options each and the
respondents could select more than one response for each
question if deemed suitable [20]. A short version of ASSIST (Approaches and Study Skills Inventory for Students)
was used to assess the learning approaches. The Cronbachs
Alpha score for individual components of ASSIST were as
follows: deep (0.85), strategic (0.88) and surface (0.81). The
ASSIST questionnaire required the respondents to rate
the degree of their agreement on a five-point Likert-scale
(ranging from strongly disagree to strongly agree) with a
series of related items that covered various aspects of a
specific construct [21]. The students were provided
30 minutes to complete these questionnaires.
Ethical considerations

The study protocol was in compliance with the Helsinki

Declaration and it was approved by the Joint Committee
of Research and Ethics of the International Medical University (IMU) in Kuala Lumpur, Malaysia. Informed written consent was obtained from every participant before
data collection and confidentiality of all responses was
maintained throughout this study.

Statistical analysis

The data collected were tabulated and analysed by using

the Statistical Package for Social Sciences (SPSS) version
17.0. Results were presented in terms of number and
proportions. The Chi-square Test and Odds Ratio along
with its 95% Confidence Interval (CI) were used for
comparison purposes. In this study, p-value <0.05 was
considered as statistically significant.

Results
Baseline information

Table 1 shows the socio-demographic information of

the students (n = 419). The Year 2 students (n = 217) are
those who had sat for their end of second semester summative examination while the Year 3 students (n = 202)
are those who had taken their first professional summative examination at the end of Year 2. A majority of the
students are females (55.1%). A majority of the students
are Malaysians (91.4%) while the minority are international students (8.6%). The Malaysian students are
those who had either attended the National educational
system (n = 320) or those who have undergone the private/international schooling system in Malaysia (n = 63).
The international students (n = 36) are from various
countries like Australia, Nigeria, Singapore, Indonesia,
Brunei, New Zealand, Canada, Hong Kong, Korea, Japan
and Myanmar. The undergraduate students (n = 410)
are those who are taking medical course as their first
degree whereas postgraduate students (n = 9) are those
Table 1 Baseline demographic data

Data collection procedure

After obtaining informed written consent, the participants

were invited to respond to the questionnaires anonymously. Three consecutive attempts were made on separate
occasions to contact a designated student who was found
to be absent on the first day of data collection. If a student
was found to be absent on all four occasions then he/she
was excluded from this study and replaced by another
randomly selected respondent belonging to the same
group. The completed VARK questionnaire was evaluated
using the scoring instructions provided in the guidelines.
The completed ASSIST questionnaire was evaluated by

Components

Year 2

Year 3

Total
n (%)

n (%)

n (%)

No of students

217 (51.8)

202 (48.2)

419 (100)

Malaysian students

196 (90.3)

187 (92.6)

383 (91.4)

International Students

21 (9.7)

15 (7.4)

36 (8.6)

Undergraduate

211 (97.2)

199 (98.5)

410 (97.9)

Postgraduate

6 (2.8)

3 (1.5)

9 (2.1)

Male

98 (45.2)

90 (44.6)

188 (45)
231 (55)

Female

119 (54.8)

112 (55.4)

Age (mean SD)

20.64 1.24

21.57 1.12

Liew et al. BMC Medical Education (2015) 15:44

Page 4 of 7

who have previously obtained a previous graduate degree and this medical course is their additional graduate
degree programme. Most of these students have GCSE
A-Levels as their pre-university entrance qualification
(n = 279), others have Foundation in Science and International Baccalaureate as their pre-university qualifications. The mid/high achievers are those who scored 65%
and above at their summative examinationsa.
Comparison of learning approaches

Table 2 shows the comparison of the learning approaches.

A majority of the Year 2 (74.7%) and Year 3 (80.2%) students were found to be deep/strategic learners. There was
no significant difference between the learning approaches
of the younger medical students as compared to their
immediate senior counterparts (p = 0.176). Similar to
the international students (86.1%), a majority of the
Malaysian students were found to be deep/strategic

learners (76.5%). The deep/strategic groups were found

to use all the four aids to learning (online lectures
78.2%, books 77.8%, discussion 75.8% and own notes
84.8%) than their counterpart. Most of the deep/strategic learners read textbooks (80.2%) and listened to
online lectures (73.1%). They were less engaged in discussion (22.2%) and did not have their own notes for
revision (20.7%). There was no significant gender variation in learning approaches (p = 0.207). The possession of a primary degree prior to joining medical
school did not contribute significantly to the types of
learning approaches among the respondents. Seniority
in terms of age was not found to be significantly associated with the types of learning approaches. There was
also no significant relationship between study approaches
and study styles (p = 0.592). Though a majority of the
mid/high achievers were deep/strategic learners, this
association was not found to be statistically significantb.

Table 2 Comparison of the learning approaches

Superficial

Deep/Strategic

Chi square

Odds ratio

n (%)

n (%)

p-value

Year 2

55 (25.3)

162 (74.7)

0.176

1.375

Year 3

40 (19.8)

162 (80.2)

(Yr2 & Yr3)

95 (22.7)

324 (77.3)
0.188

1.904

Malaysian

90 (23.5)

293 (76.5)

International

5 (13.9)

31 (86.1)

Online Lectures

66 (21.8)

237 (78.2)

0.482

1.197

Books

74 (22.2)

260 (77.8)

0.616

1.153

Discussion

23 (24.2)

72 (75.8)

0.684

0.894

Own Notes

12 (15.2)

67 (84.8)

0.078

1.803

Male

48 (25.5)

140 (74.5)

0.207

1.342

Female

47 (20.3)

184 (79.7)

Undergraduate

92 (22.4)

318 (77.6)

0.440

0.579

Postgraduate

3 (33.3)

6 (66.7)
0.570

0.864

0.592

0.854

0.062

1.624

Age 20

27 (20.9)

102 (79.1)

Age > 20

68 (23.4)

222 (76.6)

Unimodal

76 (22.2)

267 (77.8)

Multimodal

19 (25)

57 (75)

Mid/High Achievers

66 (20.6)

255 (79.4)

Low Achievers

29 (29.6)

69 (70.4)

p-value < 0.05 was considered as statistically significant.

Liew et al. BMC Medical Education (2015) 15:44

Page 5 of 7

Comparison of learning styles

Table 3 shows the distribution of learning styles. In this

study, 343 respondents (81.9%) had adopted unimodal
learning style while the remaining 76 students (18.1%)
embraced multimodal learning styles. However, there
was no significant difference between the two groups
(p = 0.592). The learning styles between the Year 2 and
Year 3 undergraduate medical students were also not significantly different (p = 0.243). A majority of the students
who embraced unimodal learning style were found to be
Kinesthetic (K) learners (30.1%). The Malaysian (29.8%)
and the international students (33.3%) mostly adopted the
Kinesthetic (K) learning style. There was no significant
gender variation in learning styles as equal proportions
of males (31.9%) and females (28.6%) had adopted
Kinesthetic (K) learning style. Those who did prior
graduation before joining the medical course (33.3%)
preferred the Read/Write (R) learning styles. Both the
age groups (those above and below 20 years) preferred
the Kinesthetic (K) learning styles. However, a higher
proportion of those aged 20 years and above adopted
multimodal learning styles (21%) as compared to those
aged less than 20 years (11.5%). Within the Kinaesthetic
(K) group, the more preferred methods of studying were
online lectures (65.9%) and textbooks (79.4%). A majority

of the mid/high (30.5%) and low achievers (28.6%) had

Kinesthetic (K) learning styles. Although not statistically significant (p = 0.714), a majority of the unimodal
learners were mid/high achievers (82.2%) as compared
to the multimodal learners.

Discussion
It was observed that most of the respondents in this
study were Kinesthetic learners (30.1%) regardless of
their gender, age, nationality and educational backgrounds. This finding was similar to those reported by
Kharb et al. for Indian medical students [1] as well as
Baykan and Nacar for Turkish medical students [22].
Lujan and DiCarlo reported that the most preferred
learning style of first year medical students from Indiana,
USA was of Read/Write (R) modality [23]. In this study,
the same was observed amongst the medical students who
already possessed a primary degree prior to their entry to
the medical school (postgraduate students). However,
Nuzhat et al. reported that the most preferred learning
style among medical students in Saudi Arabia was the
auditory mode [24]. The dental students in Philadelphia
were found to prefer the Visual (V) learning more
than the Kinesthethic (K) learning [25]. These variance
in learning styles according to countries could be due

Table 3 Comparison of the study styles

V

Chi square

n (%)

n (%)

n (%)

n (%)

p-value

Year 2

23 (10.6)

46 (21.2)

47 (21.7)

69 (31.8)

0.243

Year 3

24 (11.9)

31 (15.3)

46 (22.8)

57 (28.2)

Overall (Yr2 & Yr3)

47 (11.2)

77 (18.4)

93 (22.2)

126 (30.1)

Malaysian

42 (11)

72 (18.8)

86 (22.5)

114 (29.8)

International

5 (13.9)

5 (13.9)

7 (19.4)

12 (33.3)

Male

23 (12.2)

36 (19.1)

43 (22.9)

60 (31.9)

Female

24 (10.4)

41 (17.7)

50 (21.6)

66 (28.6)

Ugrade

45 (11)

77 (18.8)

90 (22)

124 (30.2)

Pgrade

2 (22.2)

0 (0)

3 (33.3)

2 (22.2)

20 years

14 (10.9)

29 (22.5)

26 (20.2)

45 (34.9)

>20 years

33 (11.4)

48 (16.6)

67 (23.1)

81 (27.9)

Low achievers

12 (12.2)

23 (23.5)

16 (16.3)

28 (28.6)

Mid/High achievers

35 (10.9)

54 (16.8)

77 (24)

98 (30.5)

Deep/Strategic

42 (13.0)

55 (17.0)

71 (21.9)

99 (30.6)

Superficial

5 (5.3)

22 (23.2)

22 (23.2)

27 (28.4)

p-value < 0.05 was considered as statistically significant.

0.911

0.358

0.482

0.096

0.390

0.214

Liew et al. BMC Medical Education (2015) 15:44

to cultural differences as well as previous exposures

to different teaching styles during the years at premedical schools.
A majority of the participants in this study had unimodal learning style (81.9%). A study by Fleming on
31,243 students reported that the ratio of unimodal
against multimodal learning style preference was 42:58
[20,25]. Other studies reported the preferences for multimodal learning styles with percentages ranging between
53% and 85%. The proportions of students preferring
multimodal learning style from various studies were as
follows: proportion reported by Dinakar et al. was 58%
[26], Lujan et al. was 63.8% [23], Baykan and Nacar was
63.9% [22], Nuzhat et al. was 72.6% [24], Bahadori et al.
was 59% [27] and Ding et al. was 85.7% [28]. However, in
this study, only a small proportion of Malaysian students
adopted the multimodality learning style. This could be
due to their exposure to different kinds of teaching learning instructions at pre-medical schools. In Malaysia, the
educational system is mostly didactic in nature, with
very minimal hands-on, discussion and practical sessions.
However, a majority of the respondents with multimodal
learning styles belonged to the age group of (20-29)
years as they were graduates before joining the medical
programme. This finding was similar to a study conducted
by McKean J et al. during 2009 in Hong Kong [29].
There was no significant difference in learning styles
and performances at the summative examinations. This
could be due to the fact that learning styles mainly
focussed on strategies adopted by students in acquiring
knowledge. There was no evidence in this study that any
particular learning style in itself was superior as compared to others in the attainment of academic success.
However, there were some reports that the knowledge
and understanding of ones own learning style could
greatly enhance ones success in the summative examinations [30,31]. The students in this study were not provided with any specific teaching and learning method
which was tailored according to their preferred learning
style. A blend of activities covering all the learning
modalities were made available to them. The response of
the participants would have been different if they were
exposed to matched learning strategies according to
their respective learning styles.
In this study, a majority of the students among the
mid/high achievers category (79.4%) embraced the deep/
strategic learning approach. Interestingly, a majority of
the low achievers were also found to be deep/strategic
learners. Hence, this difference was not found to be
statistically significant. However, some of the previous
studies reported that students with deep/strategic learning approaches performed better during their final summative examinations as compared to their superficial
learning counterparts [32-34]. We concur with a study

Page 6 of 7

by Newble et al. which found that undergraduate medical students with deep/strategic learning approach did
not perform better during summative examinations [35].
The deep/strategic learning approach was believed
to be able to help students to attain more successes in
summative examinations as compared to the superficial
learning approach [6]. Although there was no statistically significant relationship between the learning
approaches (deep/strategic) and learning outcomes in
terms of summative examinations in this study, many
other studies had reported a positive beneficial association [9-11].
Both the VARK and ASSIST questionnaires analysed
only one aspect of the learning preferences (styles and
approaches). Hence, multiple aspects of learning preferences (styles and approaches) could not be assessed in
this study. The students in this study were not exposed
to their preferred learning styles and approaches during
their learning activities prior to the summative examinations. This prevented the investigators from studying the
true effects of their learning preferences on learning
outcomes.
The teaching and learning strategies should be redesigned to promote deep/strategic learning among the
pre-clinical undergraduate medical students. The teaching and learning instructions should be tailored according to the learning preferences (styles and approaches)
of the students. More active hands-on learning strategies
like simulations, role playing, problem based discussions
and debates should to be incorporated in the teaching
and learning activities. This would create better learning
environment for the kinesthetic learners.

Conclusions
This study revealed that the learning preferences (styles
and approaches) of the students in this study did not
contribute significantly towards their learning outcomes.
Tailoring the delivery of teaching and learning instructions matching with the learning preferences (styles and
approaches) of the pre-clinical undergraduate medical
students followed by a re-assessment of their performances at summative examinations would be beneficial
to genuinely gauge the potential of these teachinglearning strategies. This study should be replicated in
other medical institutions in this region to confirm the
findings.
Endnotes
a

At the International Medical University, a score of

65% determines the cut off point for those who scores a
grade B and above- therefore would be defined as mid/
high achievers compared to those who scored lower
than this.

Liew et al. BMC Medical Education (2015) 15:44

We have combined the deep/strategic approach

instead of having them as a separate entity because
a published data have shown that the deep, strategic
approach, without any elements of surface apathetic, is
generally associated with successful academic performance (Entwistle, [6]).
Competing interests
The authors declare that they have no competing interests.
Authors contributions
SCL participated in the conception of the study, the inception of the study
design, carried out the student recruitments and distribution of
questionnaires, statistical analysis and the primary author of the manuscript.
JS participated in the recruitment of students and drafting of the manuscript.
AB participated in the inception of the study design and performed the
statistical analysis. All authors read and approved the final manuscript.
Acknowledgements
The authors would like to thank the International Medical University
(Grant Number: IMU 285/2013) for supporting this study. We thank
Professor N. Entwistle (ASSIST) and Dr. N Fleming (VARK) Copyright
Version 7.3 (2001) held by Neil D. Fleming, Christchurch, New Zealand for
their kind permission to reproduce and use these questionnaires for this
study.
Author details
1
Department of Clinical Skills and Simulation Centre, International Medical
University, No. 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000 Kuala Lumpur,
Malaysia. 2Department of Community Medicine, International Medical
University, Kuala Lumpur, Malaysia.
Received: 1 August 2014 Accepted: 25 February 2015

References
1. Kharb P, Samanta P, Jindal M, Singh V. The learning styles and the preferred
teaching-learning strategies of first year medical students. J Clin Diagn Res.
2013;7:108992.
2. Fleming N, Mills C. Not another inventory, rather a catalyst for reflection. To
improve the academy. 1992;11:13755.
3. Entwistle N, Ramsden P. Understanding Student Learning. London: Croom
Helm; 1983.
4. Pask G. Learning strategies, teaching strategies, and conceptual or learning
style. Schmeck. 1988;Ch4(Ch4):83100.
5. Entwistle N, Tait H, McCune V. Patterns of response to an approaches to
studying inventory across contrasting groups and contexts. Eur J Psychol
Ed. 2000;15:3348.
6. Entwistle NJ. Approaches to Studying and Levels of Understanding: The
Influences of Teaching and Assessment. In: Smart JC, editor. Higher
Education: Handbook of Theory and Research (Vol. XV). New York: Agathon
Press; 2000. p. 156218.
7. Ramsden P. Student learning research: retrospect and prospect. Higher Ed
Res Dev. 1985;4:5169.
8. Harris D, Bell C. Evaluating and Assessing for Learning. London: Kogan Page;
1986.
9. Newble DI, Entwistle NJ, Hejka EJ, Jolly BC, Whelan G. Towards the
identification of student learning problems: the development of a
diagnostic inventory. Med Educ. 1988;22:51826.
10. Trigwell K, Prosser M. Relating approaches to study and quality of learning
outcomes at the course level. Brit J Ed Psychol. 1991;61:26575.
11. Sadler-Smith E. Approaches to studying: age, gender and academic
performance. Ed Studies. 1996;22:36779.
12. Wessel J, Loomis J, Rennie S, Brook P, Hoddinott J, Aherne M. Learning
styles and perceived problem-solving ability of students in a baccalaureate
physiotherapy programme. Physiother Theory Pract. 1999;15:1724.
13. Sandmire DA, Vroman KG, Sanders R. The influence of learning styles on
collaborative performances of allied health students in a clinical exercise.
J Allied Health. 2000;29:1439.

Page 7 of 7

14. El Tantawi MM. Factors affecting postgraduate dental students performance

in a biostatistics and research design course. J Dent Educ. 2009;73:61423.
15. Cavanagh SJ, Coffin DA. Matching instructional preference and teaching
styles: a review of the literature. Nurse Educ Today. 1994;14:10610.
16. Sankey M, Birch D, Gardiner M. The impact of multiple representations of
content using multimedia on learning outcomes across learning styles and
modal preferences. Int J Ed Dev Using Inf Commun Technol. 2011;7:1835.
17. Pashler H, McDaniel M, Rohrer D, Bjork R. Learning styles concepts and
evidence. Psychol Sci Publ Int. 2008;9:10519.
18. Ao X. A comparative study on the students concepts on learning. Int J Res
Stud Ed. 2014;3:418.
19. Mao C. A study on college students use intention of internet learning
resources in Chongqing. Asian Soc Sci. 2014;10:708.
20. Fleming N. VARK: a Guide to Learning Styles. 2007 http://www.vark-learn.
com/english/page.asp?pquestionnaire [Retrieved in August 2013]
21. Ballantine J, Duff A, Larres P. Accounting and business students approaches
to learning : a longitudinal study. J Account Ed. 2008;26:188201.
22. Baykan Z, Nacar M. Learning styles of first year medical students attending
Erciyes University in kayscri, Turkey. Adv Physiol Educ. 2007;31:15860.
23. Lujan L, Dicarlo S. Too much teaching, not enough learning: what is the
solution? Adv Physiol Educ. 2006;30:1722.
24. Nuzhat A, Salem R, Mohammad S, Nasir A. Learning style preferences of
medical students : a single institute experience from Saudi Arabia. Int J Med
Edu. 2011;2:703.
25. Murphy R, Gray S, Straja S, Bogert M. Student learning preferences and
teaching implications. J Dent Educ. 2004;68:85966.
26. Dnakar C, Adams C, Brmer A, Slva M. Learning preferences of caregivers of
asthmatic children. J Asthma. 2005;42:6837.
27. Bahadori M, Sadeghifar J, Tofighi S, Mamikhani J, Nejati M. Learning styles of
the health services management students: a study of first-year students
from the medical science universities of Iran. J Appl Sci Res. 2011;7:1227.
28. Ding Y, Liu J, Ruan H, Zhang X. Learning preferences to physiology students
in a Chinese medical school. IJEME. 2012;2:15.
29. McKean J, Brogan S, Wrench J. A cross-cultural comparison of east Asian
and American higher education criminal justice student learning
preferences using the VARK questionnaire. J Crim Just Ed. 2009;20:27291.
30. Williamson M, Watson R. Learning styles research: understanding how
teaching should be impacted by the ways learners learn: part III:
understanding how learners personality styles impact learning. Christian
Ed J. 2007;4:6277.
31. Sternberg R, Grigorenko E, Zhang L. Styles of learning and thinking matter
in instruction and assessment. Pers Psychol Sci. 2008;3:486506.
32. McManus I, Richards P, Winder B, Sproston K. Clinical experience,
performance in final examinations, and learning style in medical students:
prospective study. BMJ. 1998;3116:34550.
33. Smith C, Mathias H. An investigation into medical students approaches to
anatomy learning in a systems-based prosection course. Clin Anat.
2007;20:8438.
34. Ward P. First year medical students approaches to study and their
outcomes in a gross anatomy course. Clin Anat. 2011;24:1207.
35. Newble D, Entwistles N. Learning styles and approaches: implications for
medical education. Med Educ. 1986;20:16275.

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