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 Table of Contents  
ORIGINAL RESEARCH PAPER
Year : 2011  |  Volume : 24  |  Issue : 3  |  Page : 459

A Turkish study of medical student learning styles


Marmara University School of Medicine, Department of Public Health, Haydarpasa, Istanbul, Turkey

Date of Submission09-Mar-2010
Date of Acceptance31-Oct-2011
Date of Web Publication16-Dec-2011

Correspondence Address:
S Kalaca
Marmara University School of Medicine, Department of Public Health, Haydarpasa, Istanbul
Turkey
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Source of Support: None, Conflict of Interest: None


PMID: 22267343

  Abstract 

Context: A good understanding of the learning styles of students is necessary for optimizing the quality of the learning process. There are few studies in Turkey on the subject of the learning characteristics of medical students.
Objectives: The aim of this study was to define the learning patterns of Turkish medical students based on the Turkish version of Vermunt's Inventory of Learning Styles (ILS).
Methods: The Turkish version of the ILS was developed and administered to 532 medical students. Learning patterns were investigated using factor analysis.
Findings: Internal consistencies of scales ranged from 0.43 to 0.80. The Turkish version of the ILS identified four learning styles among medical students. In comparing the pre-clinical and clinical phases of medical students related to mental models of learning, statistically significant differences (p<.01) were found between the two groups for the learning characteristics: lack of regulation; certificate; self-test and ambivalent orientation; intake of knowledge; and use of knowledge.
Conclusion: The Turkish version of the ILS can be used to identify learning styles of medical students. Our findings indicate an intermediate position for our students on a teacher-regulated to student-regulated learning continuum. A variety of teaching methods and learning activities should be provided in medical schools in order to address the range of learning styles.

Keywords: Inventory of learning styles, learning patterns, learning strategies, medical students


How to cite this article:
Kalaca S, Gulpinar M. A Turkish study of medical student learning styles. Educ Health 2011;24:459

How to cite this URL:
Kalaca S, Gulpinar M. A Turkish study of medical student learning styles. Educ Health [serial online] 2011 [cited 2017 Apr 26];24:459. Available from: http://www.educationforhealth.net/text.asp?2011/24/3/459/101429

Context

Recent changes in undergraduate medical education perspectives, including new curriculum models with more interactive instructional and assessment methods, are becoming an important challenge for medical faculties in Turkey. According to the Undergraduate Medical Education Report of the Turkish Medical Association1, 54% of medical schools are using teacher-centered learning activities, while 10% report using student-centered methods, such as problem-based learning (PBL). The others employ a mixture of the methods.

Overall, the education system in Turkey, from primary school on, has followed a traditional model of lecture-based and competitively graded courses. There has always been a strong external control in the educational system, which takes over or substitutes learning and thinking activities from students. Teachers are accepted as, and expected to be, the main source of knowledge at all levels of education, including higher education, and are given the main responsibility for student learning.

This has created a significant difficulty for students as well as teachers, when both are exposed to a new system which is based on student-centered learning activities2. This experience is likely even more complicated for medical students where student-centered learning activities have been implemented in combination with more teacher-centered approaches. This is the usual scenario in Turkey where most of the medical schools have adopted a mixture of the two approaches, but a teacher-centered approach still dominates1.

Marmara University School of Medicine (MUSM), together with some other medical faculties in Turkey, is in the process of changing its curriculum as well as revising its educational methods in light of recent developments3. During this transition period, learning and studying patterns of medical students, such as their preferred learning strategies and styles, are being discussed by all those involved in medical education (teachers, administrators, students). Many different opinions are suggested on this issue. Some contend that innovative methods which lead students towards self-learning strategies are not proper, because learning characteristics of our students have been shaped by our traditional education system since childhood. Others disagree or take a position in-between. This issue is one of the foremost topics on the agenda for medical education in Turkey. However, there are few studies in the country on the subject of learning characteristics of medical students.

Learning styles: Learning style can be defined as the usual or characteristic manner in which a learner goes about the task of learning. In the literature, there are different models of learning style designed with different approaches. Examples include 'flexibly stable learning preferences' (e.g. Kolb)4, 'the cognitive structure family' (e.g. Riding)4, 'stable personality style' (e.g. Myers-Briggs)4 and 'learning approaches and strategies' (e.g. Vermunt)4. In Riding’s model, learning styles reflect deep-seated features of the cognitive structure, including ‘patterns of ability’. In Myers-Briggs, learning styles are one component of a relatively stable personality type. According to Kolb’s approach, learning styles are flexibly stable learning preferences. On the other hand, Vermunt, in his model, moves on from learning styles to learning approaches, strategies, orientations and conceptions of learning4. Vermunt aimed to integrate different learning processes, some of which are thought to be relatively stable (mental learning models and learning orientations) and some of which are contextually determined (choice between regulating and processing strategies)4. Cognitive processing activities are those thinking activities that people use to process learning content. Regulation refers to the way students organize and direct their learning processing. Learning orientations refer to the whole domain of personal goals, intentions, attitudes, worries and doubts of students in relation to their studies. Mental models of learning refer to students’ views on what learning is5,6. Based on this approach, Vermunt developed the Inventory of Learning Style (ILS) and identified four qualitatively different ways of learning, or learning styles: meaning-directed; reproduction-directed; application-directed; and undirected learning5. These styles consisted of typical combinations of learning processing. Profiles of these learning styles are presented in Table 1.

Table 1:  Typical profiles of learning styles, according to Vermunt’s model







An undirected learning style is typified by lack of regulation, an ambivalent learning orientation and a learning conception in which great value is attached to cooperation with fellow students and stimulating education. Memorizing and rehearsing, analysing, external regulation of learning, certificate- and self-test-directed learning orientation and a learning conception in which learning is viewed as the intake of existing knowledge are characteristic of a reproduction-directed learning style. A meaning-directed learning style is typical of students who relate structure and process to the subject matter critically, and who self-regulate their learning processes and contents, refer to knowledge construction as their learningconception and are personally interested in their learning orientation. Concrete processing, vocational learning orientation and a learning conception that stresses the use of knowledgecharacterize an application-directed learning style2,5. The reliability and validity of the ILS has been confirmed and the inventory used in different higher educational settings, most often in developed countries. 

Within this context, the main objective of the present study was to examine the ILS among Turkish medical students, to investigate the nature of the learning patterns of medical students.

Methods

Participants: 532 of the 851 MUSM students (62.0%) participated in the study. By class, there were: 118 of 146 (81.0%) first year students; 127 of 153 (83.0%) second year students; 86 of 111 (77.0%) third year; 71 of 111 (64.0%) fourth year; 103 out of 107 (96.0%) fifth year; and 27 of 111 (24.0%) sixth year students.

Measurement of learning style: The instrument used was the 100-item version of Vermunt’s ILS7. The inventory consists of two parts. Part A, Study Activities, included questions on two domains: processing strategies and regulation strategies. Part B, Study Motives and Views on Studying, is divided into B1, Study Motives, which addresses learning orientations, and B2, Study Views, which addresses mental models of learning. Each of the four components includes five subscales containing from four to six items. Each item consists of a statement for which participants indicated, on a five-point scale, the extent to which the statement applied to them.

Pilot study - Instrument development: A pilot study was conducted before developing the Turkish version of the ILS. This was conducted in a qualitative research format, where four interviews were done with a volunteer second-year medical student before and after two subject committee exams during a half semester. To make it applicable to Turkish students, the English version of ILS was translated into Turkish. During this process, data from the qualitative study were also used, especially in wording. The inventory was then back-translated to English and compared with the original version; according to the necessary changes raised from this comparison, the Turkish version of the inventory was re-constructed. Before data collection, the Turkish version of the inventory was tested on 10 medical students, who did not participate in the main study. According to the students’ interpretations of the statements, as necessary, items were reworded.

Data collection: First, second, third and fifth year students completed the ILS-Turkish during their regular lecture time. Fourth and sixth year students completed the ILS-Turkish during their clinical clerkship at the hospital. Formal ethical approval for the study was not sought, since there was no institutional requirement for this project given the observational nature of the research. Students were explicitly informed of the aims, methods and the practical implications of the study and their participation was completely voluntary. The survey, on average, took 15 minutes to complete.

Analysis: The statistical package SPSS was used for data analyses. Cronbach’s alpha coefficients were computed for ILS-Turkish scales. Factor analyses were performed to examine interrelationships among the ILS-Turkish variables. Finally, frequency distributions of the ILS-Turkish subscales were obtained to provide an overview of the learning characteristics of medical students. 

Findings

The internal consistencies of the ILS-Turkish scales ranged from 0.43 to 0.81. The alpha coefficients of the scales were respectable for processing strategies, regulation strategies and mental models of learning, but were lower for learning orientation scales in general. Lower values were obtained for external regulation of the learning process (0.43), personally interested (0.46), certificate-oriented (0.58) and ambivalent (0.55) learning orientation subscales (Table 2).

Table 2:  Means (m), Standard Deviations (sd) and Cronbach’s Alpha (α) coefficients for ILS-Turkish Scales (n=532)







Results of the factor analysis showed that the Turkish version of the ILS identifies four learning styles among Turkish medical students (Table 3). The first factor can be interpreted as a meaning-directed learning style, with high loadings of relating and structuring, critical processing, analyzing, concrete processing and self-regulation. However, loadings for personal interest and construction of knowledge were not as prominent as expected for the components of meaning-directed learning styles. The second factor is characterized by high loadings of use of knowledge, construction of knowledge and stimulating education as well as vocational-oriented and personally-interested learning orientations. There was not a high loading for concrete processing. This dimension most resembles an application-directed learning style. The third factor can be viewed as a reproduction-directed learning style with high loadings of the ILS-Turkish scales memorizing/rehearsing, analyzing and external regulation. In this factor, there are no high loadings for the components of learning orientations and mental models of learning. Finally, the fourth factor can be interpreted as an undirected learning style, with high loadings on lack of regulation and an ambivalent learning orientation, and moderate loadings on cooperation as a mental model of learning.

Table 3:  Factor loading of the ILS-Turkish Scales in a Four Factor Equamax Solution (Principal Components Analysis; loading >-.25 and <.25 omitted; Turkish Students, n= 532)







Table 4 presents the learning style characteristics of all students, as well as students in the preclinical (first three years - I) and clinical phases (4th to- 6th years - II), separately. In total, medical students showed a mixture of three processing strategies, and a mixture of regulation strategies. Comparing the preclinical and clinical phases of medical education, statistically significant differences were found between the two groups related to: lack of regulation; certificate; self-test and ambivalent orientation; and intake of knowledge and use of knowledge as mental models of learning. The proportion of high scores for the following characteristics were lower among clinical than preclinical students: lack of regulation; certificate; self-test and ambivalent orientation; and intake of knowledge. However the proportion of high scores of 'use of knowledge' was greater among clinical students.

Table 4:  Learning style characteristics of medical students in different phases of medical education







Discussion

A good understanding of the learning styles of students is important for optimizing the quality of the learning process. In the present study, the ILS-Turkish was modeled after the ILS, to identify medical students’ learning styles. The alpha coefficients of ILS-Turkish processing and regulation scales were very similar to the alphas of the ILS scales Vermunt found with Dutch students5; yet, the internal consistencies of ILS-Turkish learning orientation scales were consistently lower than those reported by Vermunt. In two other studies, alpha coefficients of the learning orientation scales were also lower8,9.

In our study, 'external regulation of learning process' and 'personally-interested' scales had the lowest values. This result may be due to several reasons. Language (problems experienced during translation of the ILS) and other socio-cultural factors, such as a more paternalistic approach in family and school, may be the two most likely explanations. It was difficult to translate some of the statements into the Turkish language, since there are no clear-cut and commonly used exact equivalents of some terms used in that scale, such as 'instruction', 'subject matter' and 'task'. Therefore, it is possible that students did not understand the meanings in the same way.

According to our study results, the Turkish version of the ILS identified four learning styles among medical students. These styles closely fit Vermunt’s four learning styles, with some differences in factor structures of the ILS-Turkish. In Vermunt’s study, all factors were defined by loadings of at least three learning components, which may be interpreted as manifesting associations between the learning strategies students use and their learning conceptions and orientations8. In our case, these associations were not obvious, especially for an application-directed learning style. This phenomenon is now referred to as 'dissonance' in students’ learning patterns. It is an important topic that has been discussed in the literature, and has been observed in other studies taking place in different learning environments and cultures10. Another result related to dissonance was that while concrete processing strategies were strongly linked to the application-directed learning style in Vermunt’s study, they were strongly linked to the meaning–directed learning styles in our study. This result was also found in Boyle’s work9. These dissonances may be due to different learning environments and/or developmental factors influencing the precise characteristics of each learning style9,10.

In an Indonesian study, where the Indonesian version of the 120 items ILS was used, it was found that the elements within a learning component generally show high loadings on the same factor8. This pattern also appeared in our study where four of five processing strategies showed their highest loading on the first factor. This result indicates that, for our students, analyzing, relating, critical and concrete processing strategies can work together. Similar results were also reported in a study on the learning conceptions of Chinese students11. These consistent results from China, Indonesia and Turkey may reflect some common socio-cultural characteristics of those countries that have some level of influence on their educational systems. Similarities may be related to the general structure of the educational system, whereas differences relate to how teachers and students are viewed and the nature of their relationships. These results seem to indicate that for these students, memorization and understanding are not experienced as opposites, a phenomenonoften found among Western students8.

Vermunt found no links between external regulation and deep processing. However, external regulation of learning processes was related to the selection of critical and concrete processing strategies in our study. This finding indicates an intermediate position for our students on a teacher-regulated to student-regulated learning continuum6. Other evidence for this assumption is that a link was found between stimulating education and relating and structuring processing strategies in our study. According to Vermunt’s model5, stimulating education is expected to be one of the components of an undirected learning style. This indicates that assignments and exercises provided by teachers and textbook authors may help in selection of a deep processing strategy in our case.  

Students’ approaches to learning have been shown to be dependent on a number of factors, some of which can be categorized as contextual (e.g., teaching/learning activities, assessment procedures, institutional values) and others as personal factors (e.g., student gender, age, prior experiences)12. In our study, the only changes in two different phases of medical education were that the proportions of high scores for the lack of regulation, certificate, self-test and ambivalent orientation and intake of knowledge were lower among clinical than pre-clinical students, while the proportion of use of knowledge was higher. This trend is promising to a certain extent, since it shows an improvement towards high-quality learning activities2. In their cross-sectional study, Busato et al13. did not support the premise that students score higher on the application-directed and meaning-directed learning styles as they progress through their courses. In their longitudinal study, Vermetten et al14. found that three out of five processing strategy scales showed improvement over time.

A limitation of the current study was the poor response rate (24%) from final year students. Since our study was a cross-sectional design, it is difficult to measure what changes occurred among students over time with respect to their learning styles. One of the reasons for the obtained difference between the two groups of students in the current study could be due to the changes in assessment procedures in different phases of their medical education.

Conclusion

Overall, information about students’ learning styles may provide an evidence base for educational change, which is especially important in Turkey where many medical schools are in the process of changing their curriculum as well as revising their educational methods. Our study points to an intermediate position for our students on a teacher-regulated to student-regulated learning continuum. Based on this result, one of the practical implications is that we need to find a good balance of teaching methods and learning activities in this continuum in our medical schools. Our results may also have implications for the different phases of medical education. A gradual transition can be planned towards a more student-centered education by reducing the support of external regulation of students as they advance from their pre-clinical to the clinical phase of education. This may also indicate the need for congruence between styles of learning and teaching since our students show a preference for shared regulation of learning processes between teachers and students. Further studies are needed to get a representative picture of learning styles in the health professions in Turkey.

Acknowledgements

We would like to thank Professor Jan Vermunt for his valuable help at the initiation and completion stages of this study. We especially want to thank Dr. Ahmet C. Arzık and Vera Bulgurlu for their excellent work in translating the inventory. We also would like to thank Dr. Dilsad Save for her help in conducting the factor analysis.

References

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4Coffield F, Moseley D, Ecclestone K. Learning styles and pedagogy in post-16 learning. A systematic and critical review. Learning and Skills Research Centre. 2004. Available from: http://www.lsnlearning.org.uk

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9Vermunt JD. Inventory of Learning Styles in higher education: Scoring key. Tilburg University, Department of Educational Psychology. 1994

10Vermunt J, Minnaert A. Dissonance in student learning patterns: When to revise theory? Studies in Higher Education. 2003; 28(1):49-61.

11Marton F, Watkins D, Tang C. Discontinuities and continuities in the experience of learning: An interview study of high-school students in Hong Kong. Learning and Instruction. 1997; 7:21-48.

12Zeegers P. Approaches to learning in science: A longitudinal study. British Journal of Educational Psychology. 2001; 71:115-132.

13Busato VV, Prins FJ, Elshout JJ, Hamaker, C. Learning styles: A cross-sectional and longitudinal study in higher education. British Journal of Educational Psychology. 1998; 68:427-441.

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