Learning styles or study approaches in medical schools: a study of a pebble thrown into the water | BMC Medical Education

Medical schools employ diverse instructional methods, immersing students in varied learning environments such as large-group lectures, seminars, small-group sessions, and laboratory or clinical internships. Across these settings, students encounter a range of teaching strategies delivered by healthcare professionals with different instructional styles. This diversity is crucial, because medical education encompasses a broad array of learning demands: acquiring physical skills for examinations and procedures; mastering complex, specialized knowledge; engaging with multidimensional core disciplines; and retaining detailed information from imaging, diagnostics, and pathology. Moreover, competencies such as communication, research, empathy, and professionalism are vital for effective patient care [1].

In recent decades, the shift from didactic instruction to interactive, problem-based, and student-centered learning —supported by advances in information technology— has encouraged students to manage their own learning and adopt context-specific strategies tailored to various topics and assessments [2,3,4]. Since the 1970 s, extensive research on student learning in higher education has led to the development of influential theoretical frameworks [5,6,7,8]. Among the earliest contributions was Marton and Saljo’s (1984) work, which introduced the concepts of deep and surface learning approaches. Subsequent studies explored individual learning preferences and strategies using self-report instruments, such as Kolb’s Learning Style Inventory [9], Biggs’s Study Process Questionnaire [6], Tait, Entwistle, and McCune’s Approaches to Learning [10], and Vermunt’s Learning Patterns [8]. These foundational studies have shaped our understanding of cognitive processes in learning [9], the quality of learning in higher education [7, 11], and the regulation of effective learning outcomes [8].

This study focuses on two constructs that have generated considerable discussion in educational research: learning styles and study approaches. Interest in these areas originally emerged from a broader concern with individual differences in learning [12]. However, the terminology surrounding these constructs is often conflated, with some studies treating learning styles and approaches as part of a single conceptual framework [12, 13].

While learning approaches describe the dynamic interaction between the learner and a given task —emphasizing contextual and affective influences —learning styles are typically viewed as relatively stable individual traits that shape how a person generally prefers to learn [14]. In this distinction, learning styles are often associated with personality-linked characteristics, whereas study approaches are seen as situational preferences that may shift depending on context.

Among the frameworks developed to assess learning styles, two have gained prominence in medical and higher education: the VARK Learning Styles Inventory [15] and Kolb’s Learning Style Inventory [9], as noted by Stirling [16] and Hernandez et al. [3]. In contrast, study approaches refer to the underlying motivations and intentions that guide students’ engagement with learning tasks [6, 7, 17]. Initially conceptualized as deep and surface approaches [5], the strategic approach was later added to capture performance-oriented learning behaviors.

Several instruments have been developed to assess study approaches. Some, such as Biggs’ Study Process Questionnaire [6], and the Experiences of Teaching and Learning Questionnaire [18,19,20] —were designed for course-specific contexts [21]. Among these, the Approaches and Study Skills Inventory for Students (ASSIST) [10] is the most widely used tool for evaluating students’ approaches at a general level [22].

Given these conceptual distinctions, the interplay between learning styles and study approaches in medical education remains an area of active scholarly interest. This study seeks to explore how these constructs relate to one another using well-established measurement instruments.

The following section begins by introducing the concept of learning styles, followed by a discussion of the major criticisms surrounding their use. Subsequently, the concept of study approaches is presented. Finally, a brief review of studies examining the intersection of these two constructs is provided, leading to the statement of the current study’s research aims and sub-questions.

Learning styles

Learning style (LS) is defined as the features, preferences, choices, and ways in which students prefer receiving, processing [17], and retaining information [23] in a learning environment. LSs were analyzed by organizing them into three strata as follows [12]: (a) Cognitive personality, which includes a student’s established learning habits that happen independently of their settings; (b) information processing, which defines the learner’s approach to unfamiliar content; and (c) instructional format preference, an environmental factor which reflects the setting a student chooses for learning. Vermunt (1998) employs the term “learning style”, later called as “learning patterns”, which are broader categories of how students prefer to engage with learning [8, 24]. Vermunt proposed four main LSs: meaning-directed learners, application-directed learners, reproduction-directed learners, and undirected learners. LSs have been assessed using various tools in the current literature. In this study, we used the VARK scale primarily used in medical education to collect data. While categorizing types of learners, Boland and Amonoo [25] categorized VARK under neurocognitive approaches, which consider how our senses assimilate information.

VARK stands for the initials of the four modalities: visual, Aural, Read-Write, and Kinesthetic. An individual identified as a Visual learner prefers to learn with visual stimuli [26], a Kinesthetic learner prefers learning by doing, an Aural learner prefers to receive input by sound [26], and individuals who prefer the Read-Write modality are text-based [15]. Those whose modality scores are close to each other and do not have a specific modality that stands out are defined as Multimodal learners.

Criticism of learning styles

The status of LSs as fixed or variable traits remains debated, with numerous factors—such as age [27], discipline [28,29,30], institutional culture [29], course demands [22, 28, 30], subject matter, instructional style, assessment methods [23, 29, 31, 32], prior learning experiences [29, 32], and task nature [32]—influencing them. Several studies [26, 30, 33, 34] have strongly criticized LSs, even labeling them a “neuromyth” due to insufficient empirical support and issues in both identifying LSs and applying them instructionally [17]. According to Newton & Miah, learning preferences, teaching methods, and students’ reflections on how they learn are irrelevant for determining each LS using particular classifications [34]. Another criticism is about the “meshing/matching hypothesis,” which refers to matching teaching to LSs or designing teaching methods according to LSs [1, 17, 33, 34] in healthcare education. Critics claim that determining students’ LSs and planning instruction accordingly does not benefit students [17, 26, 34, 35].

However, teaching methodology is not the only variable that affects LS, and many factors affecting learning make selecting an appropriate LS complex [13, 24]. Continued use may lead to misclassification, wasted resources, and unrealistic expectations [30, 33, 34]. Despite these criticisms, some researchers maintain that style awareness may still positively influence learning outcomes [22], and the topic remains under active investigation.

Study skills and approaches

Study approaches refer to students’ intentions to study and learn and the learning processes they apply to achieve their goals [7, 11]. Marton and Saljo’s (1984) deep and surface approaches were replaced with “approaches to learning” or “learning approaches” in later studies. Entwistle’s approaches and study skills inventory for students [11] avoids ‘styles’ in favor of ‘strategies,’ ‘approaches,’ and ‘orientation to studying’ [7, 24, 36]. In the remainder of this article, the abbreviated use of “study approaches” is preferred instead of “study skills and approaches.”

Entwistle [11] does not suggest that these approaches are innate. Hence, these approaches are neither constant nor biological; instead, they are dynamic, and learners choose one in accordance with the situation [26, 32] and their motivation [25]. In this multifaceted view of instruction [29], contextual factors (the topic, the course design, the assessment, the teacher) and situations affect learning behaviors [21, 31, 37]. Entwistle defines contexts as the range from the broadest (the overall educational setting within the institution) to the narrowest (the content of a specific task) [7]. In brief, learning happens differently in different learning environments (regular campus-based or distance education) [24]. The learner can prefer a deep or surface-apathetic approach, and it is possible to combine several strategies [24, 32].

The “deep approach” refers to the learning process focused on understanding and internalizing a subject’s underlying concepts and principles [31]. It is characterized by the ability to think critically, apply knowledge in new situations, and connect different pieces of information [38]. This type of learning typically involves active engagement with the material and focusing on understanding the “big picture” rather than just memorizing facts [36, 39]. On the other hand, the “surface-apathetic approach” focuses on memorizing facts and information without a deep understanding of the underlying concepts or principles [38]. It is a more passive form of learning that relies on rote memorization and repetition to retain information [36]. The “strategic approach” focuses on achieving and improving grades [28]. Depending on the tasks, a strategic approach can involve deep and surface-apathetic approaches [31]. The learner aims to succeed and uses various strategies to achieve this [36]. This approach, called “organized studying,” pertains to students’ everyday study habits regarding how they structure their studies and manage their time. It is thus regarded as more of a study approach than a learning approach [40]. While categorizing types of learners, Boland & Amonoo [25] put this tripartite model [17, 25] under metacognitive approaches, which consider the role of learners’ motivations and strategies in the learning process.

Vermunt [8] have adressed strong interrelations among the learning components. The mutual coherence of LSs and study approaches is as follows: The meaning-directed and reproduction-directed styles encompass Entwistle’s [7] meaning and reproducing orientation, and Biggs’ [6] and Tait & Entwistle’s [10] deep and surface-apathetic approaches. The undirected style is similar to Tait & Entwistle’s [10] surface-apathetic approach. While Vermunt [8, 24] focuses on LSs, Entwistle’s work primarily deals with the approaches students take toward learning [7, 10]. Vermunt’s framework, focuses on cognitive, metacognitive, and affective dimensions [8, 24], is much broader than Entwistle’s approach. Entwistle’s study approaches emphasize the depth and nature of engagement with learning material [7, 10], whereas Vermunt’s LSs framework provides a more comprehensive model that accounts for a wider range of learner characteristics, including emotional and metacognitive dimensions.

A modest contribution with potential ripple effects

Research on the interrelation between learning styles (LSs) and study approaches serves key purposes across three domains: teaching and instruction, academic performance, and cognitive and educational psychology. Understanding how LSs interact with study approaches can help optimize teaching strategies, encouraging educators to act as facilitators rather than mere transmitters of knowledge.

Such insights inform the design of inclusive curricula and instructional materials that accommodate diverse LSs, thereby promoting equity in education. Furthermore, investigating LS- study approach interactions can advance personalized learning, improve student outcomes, and align with 21st-century educational models, including adaptive learning systems and smart environments. Person-oriented approach [39], evident in adaptive learning technologies, emphasize supporting students as autonomous learners.

Promoting lifelong, self-directed learning [19] requires enabling students to recognize and apply their own LSs and study strategies. Developing metacognitive awareness and self-regulated learning, —both critical to educational success —should therefore be a priority for targeted interventions [13]. This may help students develop flexible, individualized learning pathways [41]. From a psychological perspective, these interrelations offer valuable insights into cognitive processes and learning behaviors. As learners gain awareness of their own patterns, they foster adaptability and resilience across varied contexts [42].

In sum, this line of research is essential for developing responsive and effective educational practices. This study aims to make a modest yet purposeful contribution—much like a pebble cast into still water—with the expectation that its ripple effects will extend into future research, pedagogical innovation, and the broader pursuit of adaptive, learner-centered medical education.

The present study

Given the criticisms of LSs and the evidence supporting study approaches, our research examines whether study approaches significantly differ across LS categories. Using instruments widely employed in medical education, this study addresses the following research questions:

1. (1)

   How are medical students distributed according to (a) their preferred learning styles and (b) the study approaches they adopt?

2. (2)

   Is there a significant association between medical students’ preferred learning styles and their study approaches?

By addressing these questions, this study seeks to contribute to the broader understanding of individualized learning in medical education and its implications for effective educational practices.