Beyond career choice: the role of learning style analysis in residency training

A Multi-Center Comparison of Orthopaedic Attending and Resident Learning Styles

OBJECTIVE

Effective education of orthopedic residents requires an understanding of how they process information. To date however no literature has described resident learning styles based on the updated Kolb Learning Style Inventory (KLSI) v4.0. The purpose of this study is to identify common learning styles amongst orthopedic residents and attendings and evaluate the effect that race, gender, and resident/attending status have on learning styles.

DESIGN

The KLSI v4.0 and a demographic survey were distributed to 103 orthopedic attendings and residents at two academic centers during the 2019 to 2020 academic year. Frequencies and descriptive statistics were reported. Learning styles based on gender, race, attending versus resident status, and institution were evaluated. A p-value < 0.05 was considered significant.

SETTING

This is a multi-center study performed at two academic, university based orthopedic surgery departments.

PARTICIPANTS

Orthopaedic surgery residents and attending surgeons.

RESULTS

At both institutions, the combined response rate for the KLSI v4.0 was 66% and 68% for the demographic surgery. The three most common learning styles recorded were: Deciding (26.5%), Acting (17.6%), and Thinking (17.6%). Learning styles were compared by gender, race, attending and/or resident status, and institution with no statistically significant difference found between any of the comparisons (p > 0.05).

CONCLUSION

The majority of orthopedic surgeons have Deciding, Acting, or Thinking learning styles, which are categorized by motivation to achieve goals, disciplined and logical reasoning, and the use of theories and models to solve problems. However, not all residents and attendings utilize these common learning styles. A mismatch in learning styles between residents and attendings could result in poor educational experiences. Understanding the learning styles of orthopedic surgeons has implications for improving evaluation interpretation, mentorship pairing, quality of life, and resident remediation.

Learning style preferences of internal medicine residents and in-training examination scores: is there a correlation?

The internal medicine in-training examination (IM-ITE) has been traditionally used as a measuring tool to evaluate the base of knowledge of the residents in internal medicine residency programs across the US. Multiple interventions has been applied and studied to increase the first-time passing rate of ABIM, as it is an indicator of each residency program’s performance and ranking. Additionally, studies have demonstrated that different learning styles and preferences are a predictor of exam results; however, it is not well known whether certain preferred learning styles are correlated with certain IM-ITE results. Primary objective of our study was to find a correlation between residents’ preferred learning style, based on Kolb learning style inventory, and their PGY1 and PGY2 IM-ITE performance score difference. Secondary objective was to find the correlation between PGY2s’ IM-ITE score and their preferred learning styles based on the Kolb learning style inventory. Mean scores of PGY1 and PGY2 IM-ITE were compared in each learning style group. Additionally, the mean difference between the PGY1 and PGY2 IM-ITE scores for each learning group was compared as well. The analysis of the mean IM-ITE score from PGY1 to PGY2 between groups revealed a statistically significant improvement in IM-ITE score from PGY1 to PGY2 in all groups, however, with a larger difference in one of the groups.

Preparatory graduate professional training in general practice by using the 'experiential learning' framework

BACKGROUND

General practitioners (GPs) in Indonesia are medical doctors without formal graduate professional training. Only recently, graduate general practice (GP) is being introduced to Indonesia. Therefore, it is important to provide a framework to prepare a residency training in general practice part of which is to equip GP graduate doctors to deliver person-centered, comprehensive care in general practice. Experiential learning theory is often used to design workplace-based learning in medical education. The aim of this study was to evaluate a graduate professional training program in general practice based on the 'experiential learning' framework.

METHODS

This was a pre-posttest study. The participants were 159 GPs who have been practicing for a minimum of 5 years, without formal graduate professional training, from two urban cities of Indonesia (Yogyakarta and Jakarta). A 40-week curriculum called the 'weekly clinical updates on primary care medicine' (WCU) was designed, where GPs met with clinical consultants weekly in a class. The participant's knowledge was assessed with pre-posttests involving 100 written clinical cases in line with each topic in the curriculum. Learning continued with a series of group discussions to gain reflection to reinforce learning.

RESULTS

Participants' knowledge regarding clinical problems in general practice was moderately increased (p < 0.05) after the training from a mean score of 50.64-72.77 (Yogyakarta's doctors) and 39.37-51.81 (Jakarta's doctors). Participants were able to reflect on the principles of general practice patient-care. Participants reported satisfaction during the course, and expressed a desire for a formal residency training.

CONCLUSIONS

A graduate educational framework for GP based on the 'experiential learning' framework in this study could be used to prepare a graduate GP training; it is effective at increasing the comprehension of general practitioners towards better primary care practice.

Students awareness of learning styles and their perceptions to a mixed method approach for learning

BACKGROUND

Individualization of instructional method does not contribute significantly to learning outcomes although it is known that students have differing learning styles (LSs). Hence, in order to maximally enhance learning, one must try to use a mixed method approach.

HYPOTHESIS

Our hypothesis was that awareness of preferred LS and motivation to incorporate multiple learning strategies might enhance learning outcomes.

AIM

Our aim was to determine the impact of awareness of LS among medical undergraduates and motivating students to use mixed methods of learning.

MATERIALS AND METHODS

Before awareness lecture, LS preferences were determined using Visual, Aural, Read/Write, and Kinesthetic (VARK) questionnaire. Awareness of LS was assessed using a validated questionnaire. Through a lecture, students were oriented to various LSs, impact of LS on their performance, and benefit of using mixed method approach for learning. Subsequently, group discussions were organized. After 3 months, VARK preferences and awareness of LSs were reassessed. Student narratives were collected. Qualitative analysis of the data was done.

RESULTS

There was a significant increase in the number of students who were aware of LS. The number of participants showing a change in VARK scores for various modalities of learning was also significant (P < 0.001).

CONCLUSION

Thus, awareness of LSs motivated students to adapt other learning strategies and use mixed methods for learning.

Learning styles of first-year orthopedic surgical residents at 1 accredited institution

BACKGROUND

This study represents 1 arm of a 5-year prospective study investigating the learning styles of orthopedic residents and their surgical educators.

METHODS

This project investigates the learning styles of the 2009-2010 year 1 orthopedic surgical residents. A cross-sectional survey using the Kolb Learning Style Inventory was completed by 13 first year orthopedic residents. Direct 1-to-1 interviews were completed with the primary investigator and each participant using the Kolb Learning Style Inventory and learning styles were determined.

RESULTS

Converging learning style was the most common among the residents (53.8%). Residents demonstrated a high tendency toward the learning skill of abstract conceptualization combined with active experimentation, and a transition from action-oriented to more reflective learning style with age and postgraduate education.

CONCLUSIONS

These results may be useful in creating strategies specific to each learning style that will be offered to residents to enhance future teaching and learning.

Do different pairings of teaching styles and learning styles make a difference? Preceptor and resident perceptions

BACKGROUND

Certain teaching style (TS) and learning style (LS) combinations may enhance learning.

PURPOSE

The objective was to examine the effects of combinations of TS and LS in preceptor-resident (PR-RE) dyads in a long-term teaching-learning environment.

METHODS

Forty-four pediatric PR-RE pairs responded to Grasha's TS and LS inventories, the Clinical Teacher Characteristics Instrument (CTCI) and the Preceptor-Resident Relationship Inventory (PRPRI). Combined CTCI and PRRI means were compared using the t test.

RESULTS

The facilitator or personal model TS and collaborative LS pairs supported a healthy teaching-learning environment. Independent learners rated their preceptors' teaching characteristics positively. Competitive LS residents rated the relationship with the preceptor and preceptor teaching effectiveness less favorably. Residents overall indicated a less favorable relationship and clinical teaching characteristics than preceptors.

CONCLUSIONS

Certain combinations of TS with LS are perceived by preceptors and residents as more positive than others. This suggests TS and LS should be considered when pairing residents and preceptors.

Person-task-context: a model for designing curriculum and in-training assessment in postgraduate education

Structured curricula for senior house officers have often been lacking. The aim of this study was to trial a person-task-context model in designing a curriculum and in-training assessment (ITA) programme for SHOs in internal medicine. A working group designed the programme based on triangulation of information from interviews with trainees and programme directors, analysis of patient case mix and national quality assurance data. The interview data showed that the main difference currently between trainee levels was in expected degree of responsibility for patient management rather than in actual tasks. Key learning needs were how to take a structured approach to the tasks and get an overview of situations. SHOs expressed a need for explicit learning goals and standards of performance. SHOs requested formal teaching in non-medical aspects of competence such as communication, interpersonal skills and professionalism. This article points out how consideration of the type of trainees involved, the tasks they must do and learn, and the context in which they work are important in designing postgraduate curricula. The person-task-context model can be used to tailor curricula and ITA that support learning and may be especially beneficial in promoting learning in non-dominant areas of a specialty.

How can physicians' learning styles drive educational planning?

As changes in health care delivery systems and in the global burden of disease call for a reassessment of how tomorrow's physicians should be educated--indeed, for a reconsideration of the diversity of roles the physician should play--there is an immediate need to produce continuing medical education (CME) programs with real impact. Curriculum planners are questioning both the content of medical education and the methods of instruction and training. The product, or content, and the mechanism for its delivery have been defined and discussed, but a significant body of literature has shown that new knowledge does not necessarily lead to new behavior. Ample evidence exists in the CME literature to support the implementation of more active and self-directed learning strategies to promote the desired change in behaviors. The question, then, that is the focus of this article is how educational planning might be better guided by an understanding of how physicians learn within the continuing medical education domain. Revisiting the principles of David Kolb's Learning Styles Inventory, the authors propose applying his experiential learning model to overall curriculum design work. The authors argue that promoting the application of all learning styles in sequence in an educational encounter is a most desirable approach, and that this approach to learning could extend far beyond individual learners to influence how every component of medical education is designed, from the individual lecture or class activity to entire courses or programs.

Educational impact of in-training assessment (ITA) in postgraduate medical education: a qualitative study of an ITA programme in actual practice

OBJECTIVES

To investigate the experiences and opinions of programme directors, clinical supervisors and trainees on an in-training assessment (ITA) programme on a broad spectrum of competence for first year training in anaesthesiology. How does the programme work in practice and what are the benefits and barriers? What are the users' experiences and thoughts about its effect on training, teaching and learning? What are their attitudes towards this concept of assessment?

METHODS

Semistructured interviews were conducted with programme directors, supervisors and trainees from 3 departments. Interviews were audiotaped and transcribed. The content of the interviews was analysed in a consensus process among the authors.

RESULTS

The programme was of benefit in making goals and objectives clear, in structuring training, teaching and learning, and in monitoring progress and managing problem trainees. There was a generally positive attitude towards assessment. Trainees especially appreciated the coupling of theory with practice and, in general, the programme inspired an academic dialogue. Issues of uncertainty regarding standards of performance and conflict with service declined over time and experience with the programme, and departments tended to resolve practical problems through structured planning.

DISCUSSION

Three interrelated factors appeared to influence the perceived value of assessment in postgraduate education: (1) the link between patient safety and individual practice when assessment is used as a licence to practise without supervision rather than as an end-of-training examination; (2) its benefits to educators and learners as an educational process rather than as merely a method of documenting competence, and (3) the attitude and rigour of assessment practice.

Learning preference and personality type: their association in paediatric residents

The objective of this study was to determine if there is a relationship between the learning preferences and personality types of residents in paediatrics. As part of a study to teach residents in paediatrics how to teach, the authors administered the Learning Preference Inventory (LPI) and Fundamental Interpersonal Relationship Orientation (FIRO-B) instruments to 55 residents in paediatrics at all three levels of training. The instruments provided data that were used to provide feedback to residents on their learning preferences and interaction styles, as well as how these factors might affect teaching and learning in the clinical setting. The Pearson correlation coefficient was used to determine relationships between the LPI and the FIRO-B. Fifty-two of the 55 residents (95%) completed the instruments. The results revealed that residents' learning preferences were significantly related to their personality types. For example, residents with high inclusion and affection scores on the FIRO-B preferred learning with others, which was significantly related to their high interpersonal scores on the LPI. Residents with low inclusion and affection scores were more likely to prefer independent learning (high individual and student-structured scores on the LPI) and abstract learning at statistically significant levels. The scores obtained by residents in paediatrics on the LPI were strongly correlated with those obtained on the FIRO-B. These data may have important implications for the way in which staff recruit, counsel and teach residents. The fact that the LPI is easy to administer and does not purport to measure personality styles makes it an acceptable educational tool that can be used in many areas of training.

Learning by internal medicine residents: differences and similarities of perceptions by residents and faculty

OBJECTIVE

To learn about what enhances or hinders learning in postgraduate medical education.

DESIGN AND PARTICIPANTS

Through the use of critical incident interviews, 20 internal medicine residents and 20 attending physicians/faculty were asked to describe specific situations where resident learning had occurred and where it had not occurred.

SETTING

A large teaching hospital in the Midwest.

MEASUREMENTS AND MAIN RESULTS

Factors positively associated with learning were mentioned frequently (faculty involvement, interaction, and reflection in discussion), and others only rarely (knowing outcomes of effort, resident reading) by both the faculty and the residents. Others were mentioned more often by the residents (feeling relaxed) or by the faculty (technical rationality).

CONCLUSIONS

Residents and attendings do not always agree as to what facilitates resident learning. Recognizing actions that residents believe facilitate learning may help faculty more effectively promote resident learning. Because of the similarities of resident training across the country, the results from this study can be applied to other programs.

Role perceptions of freshman and senior nursing and medical students and attitudes toward collaborative decision making

David Kolb's (1981) experiential learning theory was used to examine differences between first- and fourth-year nursing and medical students' perceptions of competencies important for nursing and medicine. A convenience sample of nursing (n = 109) and medical (n = 108) students from a large Canadian research university was surveyed. Respondents completed the Environmental Press Questionnaire, the Adaptive Competency Scale, and a 6-item measure of attitudes toward collaborative nurse-physician patient care decision making. Nursing students' perceptions of competencies important for medicine were found to be more congruent with medical students' perceptions of these competencies than were medical students' perceptions of competencies important for nursing as seen by nursing students. Gaps in perceptions of each others' roles were significantly negatively related to attitudes toward collaborative patient care decision making.

Learning Style Analysis—A Commentary

Analysis of learning style by whatever instrumentation, needs to move toward synthesis in measurement of students' and teachers' styles and actual practice in the classroom. This requires advance beyond the observation of Goc Karp and Walker that college teaching tends to be done in the same style.