Does learning style influence performance in objective structured clinical examinations? | BMC Medical Education

Our results do not reveal a significant correlation between learning style and performance in the OSCEs, contrary to some expectations. However, it is worth noting that the average score of students with a predominantly pragmatic style was slightly higher than that of other student groups. Although this difference did not reach statistical significance, it could suggest a slight advantage of the pragmatic style in the context of the OSCEs.

Learning style frameworks and their relevance

Learning styles can be defined as “the way in which individuals choose or are inclined to approach a learning situation”. Several learning style frameworks have been described in the literature and several assessment modalities described. These include the Visual, Auditory, Reading/Writing, Kinesthetic (VARK) model [10], Kolb’s Learning Style Inventory (LSI) [11], Honey and Mumford’s Learning Style Questionnaire (LSQ) [9] and the Index Learning Style (ILS) developed by Felder and Silverman [12]. No one model has been shown to be superior to the others. We chose the LSQ-Fa because, along with the LSI, it is one of the most widely used models [13].

Students entering medical training have varied prior educational and academic backgrounds and have already met a diverse range of learning experiences that affect their success in medical education [14]. As a result of these experiences, students develop a preferred approach to acquiring and processing information. Students’ learning preferences could also be influenced by other factors, such as gender, age, and socio-cultural factors [3].

The theoretical style was the most frequent predominant style among the students in our study. In contrast to our results, the reflective style was the most frequent predominant style in many studies involving health-care students [15,16,17]. Bhalli et al., for example, found that 46.8% of students had a reflective learning style, compared with 27.3% with a pragmatic style, 16.9% with a theoretical style, and 9.1% with an active style [10]. This difference may be attributed to the academic environment and the seniority of the medical students, as our study included students from various years of study, while the study by Bhalli et al. was only focused on fourth-year medical students.

Gender differences and learning styles

Our study showed a certain preponderance of students in the theoretical style. There was a significant gender difference, with no active profile among male students. Studies analysing gender differences in the learning styles of medical students have produced contradictory results. Some studies found a predominance of active style in women and a lower prevalence of reflective style [18]. Other studies, such as that by Alghasham et al., found no difference in the distribution of learning styles according to gender [19].

Learning styles and academic performance

The relationship between learning styles and academic performance in medical education has been the subject of numerous studies, with varying results [10,11,12,13,14,15,16,17,18,19]. Awareness of their learning style preference may, however, enable students to improve their performance [20]. We found that there was no correlation between different learning styles and OSCE scores (p = 0.06). Our results tally with a study conducted at Queen’s University Belfast on a cohort of first-year medical and dental students. This study found varied learning styles, but no effect on academic performance [13]. These results have been replicated in other countries (18, 24–20).

Conversely, some authors have found differences in academic performance according to students’ learning styles. Hur and Kim showed that Korean medical students with a preference for a reflective learning style obtained better results in terms of participation, problem solving, questioning, and teamwork (15,25). Sharif et al. studied the relationship between learning style and examination results in 275 pharmacy students [17]. Students with a preference for a reflective or theoretical learning style performed better in first-year examinations, while students with a preference for an active learning style performed less well in first-year examinations. The correlation, although statistically significant, was weak, with a Pearson coefficient of + 0.2 for the reflective style, + 0.1 for the theoretical style, and − 0.2 for the active style. Interestingly, Wilkinson found this statistically significant weak correlation between theoretical style and good results in multiple-choice questions with a Pearson coefficient of + 0.17 (p = 0.006), but this correlation was no longer positive or statistically significant between theoretical style and OSCE results, with a Pearson coefficient of -0.02 [13].

Practical implications for OSCE Performance

In the context of the OSCEs, it could have been assumed that students with a predominantly pragmatic style would perform better than those with a predominantly theorist style, due to the emphasis on practical application of clinical knowledge. However, our results do not confirm this hypothesis. It is possible that other factors, such as specific preparation for the OSCEs, prior clinical experience, and stress management, could modulate the relationship between learning style and performance in the OSCEs.

Strengths and limitations

The LSQ-Fa proved to be a useful tool for identifying the predominant learning style of students. However, the predominant learning style is only one aspect of the LSQ-Fa’s combination of students’ appetite for the four learning styles. This is evidenced by the fact that two students had two predominant styles. This complexity and multidimensionality of learning styles has been underlined in a critical review by the Learning and Skills Research Centre, which highlighted the interactions between the different styles and their implications for academic performance [7].

While our study provides valuable insights into the relationship between learning styles and OSCE performance, it is important to acknowledge the limitations related to the participation rate. With a participation rate of 45% (55 out of 121 students), the generalizability of our findings may be limited. This relatively low response rate could introduce bias, as there might be differences between those who chose to participate and those who did not. For instance, participants may have been more motivated, more interested in the OSCEs, or more confident in their abilities, which could have influenced the results. Additionally, demographic factors such as gender, age, and academic year may also play a role in the decision to participate. Future studies should aim to explore these potential differences between participants and non-participants more thoroughly to better understand how they might impact the findings. This would help to identify whether certain groups are underrepresented in the study and whether their inclusion might change the observed outcomes.

Certain limitations should be considered in our study. First, the sample size of students is small, and recruitment was limited to a single institution, which may limit the generalizability of the results. Using the established parameters, the power analysis conducted with G*Power indicated that a sample size of 180 participants was required to achieve a statistical power of 80% at a significance level of 0.05. In our study, however, out of the 121 eligible medical students, only 55 completed the questionnaire. Although this number falls short of the sample size recommended by the power analysis, the findings of our study offer valuable insights into medical education.

The use of a self-reported questionnaire to assess learning style may be subject to response bias. Finally, while the Kruskal-Wallis test allows for the detection of significant differences between groups, these differences do not necessarily imply a causal relationship.

Our study also has several strengths, the main one being the assessment of learning style close in time to the OSCE, while not being on the exact day of the OSCE, to avoid the influence of anxiety related to the OSCE.

These findings serve as a foundation for future research with larger cohorts, which could further validate and expand upon the conclusions of our study.