Association between Academic Learning Strategies and Annual Examination Results among Medical Students of King Edward Medical University

Learning style is the composite of cognitive, affective, and physiological characteristics that serve as relatively stable indicators of how a learner perceives, interacts and responds to the learning environment. Felder – Solomon Index of Learning Style (ILS) includes Sensitive/Intuitive, Visual/Verbal and Sequential/ Global, Active/reflective. The learning strategies are a major indicator of exam performance of students. Objective: To find the association between academic learning strategies and annual examination results among medical students of King Edward Medical University. Date of Submission 1-2-2016 Date of Acceptance for Publication 3-5-2016 Conflict of Interest: None Funding Source: None Tariq S. Assistant Professor, Department of Community Medicine King Edward Medical University, Lahore Khan M.A. APMO, Department of Community Medicine King Edward Medical University, Lahore Afzal S. Chairperson and Head of Community Medicine King Edward Medical University, Lahore Shahzad S.R. MBBS Student, King Edward Medical University, Lahore Hamza M. MBBS Student, King Edward Medical University, Lahore Khan H.A. MBBS Student, King Edward Medical University, Lahore Qamar F. MBBS Student, King Edward Medical University, Lahore Javed M. MBBS Student, King Edward Medical University, Lahore Ashraf M.F. MBBS Student, King Edward Medical University, Lahore Mubarak F. MBBS Student, King Edward Medical University, Lahore Puri B.I. MBBS Student, King Edward Medical University, Lahore Masood T. MBBS Student, King Edward Medical University, Lahore Kazim F. MBBS Student, King Edward Medical University, Lahore Shaukat T. MBBS Student, King Edward Medical University, Lahore Shaikh S. MBBS Student, King Edward Medical University, Lahore Original Article SAIRA TARIQ, MUHAMMAD ARIF KHAN, SAIRA AFZAL, et al 125 ANNALS VOL 22, ISSUE 2, APR. – JUN. 2016 Study Design: Cross – sectional study design. Study Setting and Duration: King Edward Medical University and 3 months. Materials and Methods: The study was conducted among the 3, 4, and 5 year medical students of KEMU Lahore. Informed consent was taken. A total of 300 students, 100 each from 3, 4 and 5 year were taken. 132 males (44%) and 168 females (56%) were part of the study. Simple Random sampling (non-probability sampling) was used. Results: The overall dominant learning strategies among students of King Edward Medical University were sensing/SNS (64.3%), visual/VIS (80.7%), sequential/SEQ (63.7%) and Active/ACT (50.3%). Chi squared test for individual learning combinations against achiever types showed no significant association between academic learning strategies and annual exam performance (p value > 0.05). Results also showed that females performed better academically than their male counterparts.


Introduction
"Learning style is the composite of cognitive, affective, and physiological characteristics that serve as relatively stable indicators of how a learner perceives, interacts and responds to the learning environment". 1tudent oriented learning has taken precedence over teacher oriented one.This has resulted in adoption of new teaching methods that allow students to employ their own methodology. 2The learning style of a student is a major indicator of his performance in examinations.Students with different learning styles perform differently on different exam questions. 3 Various studies have been conducted in the past in order to establish the spectrum of learning styles adopted by students.Till date there has been no study carried out to establish the relationship between exam performance and learning styles employed by students.
Different researchers have developed different methods to qualify and quantify different learning strategies.VARK developed by Fleming 4 describes students" preference for Visual (V), Aural (A), Read/ Write (R) and Kinesthetic (K); it tells us which teaching style is the most conducive to a student's learning in a particular setting.Index Learning Style (ILS) is an instrument developed by Felder and Silverman 5 which is used to assess preferences on four dimensions 6 of a learning style model.These four dimensions are: Processing: Active/Reflective, Perception: Sensing/Intuitive, Input: Visual/Verbal, Understanding: Sequential/ Global.Vermunt 7 developed a method spanning four dimensions of cognitive processing, metacognitive regulation, mental learning models and learning orientations.Based on these characteristics, he classified student learning styles as undirected, reproductiondirected, meaningdirected and applicationdirected.We shall use ILS model in our study because VARK has little to say about personality, motivation, social preferences, physical environment or intraversionextraversion and also because it inclines more towards teaching directed than selfdirected learning.ILS identifies Vermont"s four learning styles and is a more practical in use.An individual learning style is subject to variation with time, learning environment and course enrollment.The learning preponderance of an engineering major may not be the same as that of a medical student.A student"s inclination towards a particular learning dimension provides an insight into his strengths, habits and tendencies which might affect his performance in academic set up.ILS is designed to assess preference on the four dimension of Felder -Silverman learning style.Based on ILS model, a study conducted in 2003 on 493 first year engineering students of Aalborg University, Denmark revealed that the majority was active, visual and sensing type while sequential and global learners were relatively equal. 8urthermore, among 129 Materials engineering majors at Iowa State university, 63% were active, 67% sensing type, 85% visual and 58% sequential learners.Undergraduates totaling 2506 from various engineering disciplines and from across different universities were tested for the preponderance of learning strategies.Active (64%); Sensing (63%); visual (82%) and sequential (60%) were the dominant preferences.A relative mismatch was observed between the engineering undergraduates" learning preferences and the teaching styles.Teaching methodology was more inclined towards reflective, intuitive and global learning.
In the past, the predominant learning style in medical students has been found. 9However, to date, no research of sorts has been conducted regarding correlation of exam scores and learning styles of medical students particularly in the context of Pakistan.The rationale of this study is to establish the preponderance of learning strategies according to the ILS questionnaire amongst the students of King Edward Medical University and its association with exam performance.
This research aims to investigate the preponde-rance of learning strategies among underachievers, achievers, high achievers and overachievers.It will help form a comparison between the different strategies adopted and establish the superiority of the learning strategies of highachievers, which shall lead to the establishment of a successful pattern of academic learning styles that could revolutionize the exam results and curb the social problems arising due to failure.Additionally, this could call for a more uniform questionwriting in exams and for instructors to have a better match between their teaching styles and students' needs.

Materials and Methods
The study was conducted among the 3 rd , 4 th , and 5 th year medical students of KEMU Lahore.Informed consent was taken.A total of 300 students, 100 each from 3 rd , 4 th and 5 th year were taken.

Study Design
Cross sectional study.

Study Setting and Duration
King Edward Medical University and 3 month duration.

Data Collection Procedure
Data is pretested.A total of 300 3 rd , 4 th and final year MBBS students were asked to fill out the biodata pro forma and Felder -Solomon Index of Learning Style (ILS) questionnaire manually.Data was collected by all our team members.According to ILS questionnaire, each participant is given 44 questions, 11 from each dimension of learning style with a possible "a" or "b" answer.The scores of "b" in each dimension are subtracted from scores of "a" in the same dimen-sion to reach an integer between -11 to +11 which indicates both the learning strategy and its strength.
The inclination towards a particular style maybe mild, moderate or strong.

Exam Performance
Underachievers: Scoring less than 65% in their exams (mean of all professional exam scores).Achievers: Scoring 65% or above and less than 70% in their exams (mean of all professional scores).
Highachievers: Scoring 70% or above and less than 75% in their exams (mean of all professional scores).Overachievers: Scoring 75% or above (mean of all professional scores).

Learning Strategies
There were 4 pairs of learning strategies in total which are as follows: 1. Sensing/Intuitive: Sensing (SNS): Concrete thinker, practical, oriented towards facts and procedures.

Visual/Verbal Visual (VIS):
Prefer visual representation of presented material such as pictures, diagrams and flow charts Verbal (VRB): Prefer written or spoken explanation.

Active/Reflective Active (ACT):
Learn by trying things out, enjoy working in groups.

Reflective (REF):
Learn by thinking things through; prefer working alone or with a single familial partner.

Sequential/Global
Sequential: Liner thinking process, learn in small increment steps.
Global: Holistic thinking process, learn in large leaps.

Hypothesis
There exists an association between academic learning strategies and annual examination results among medical students of King Edward Medical University.

Null Hypothesis
There is no association between academic learning strategies and annual examination results among medical students of King Edward Medical University.

Data Analysis
All

Examination Results and Academic Learning Strategies
The overall dominant learning strategies among stu-dents of King Edward Medical University were sensing/SNS (64.3%), visual/VIS (80.7%), sequential/SEQ (63.7%) and Active/ACT (50.3%).Majority of the overachievers were Reflective (REF), Visual (VIS) and Sequential (SEQ).The number of Sensing (SNS) and Intuitive (INT) learners among overachievers was the same.High achievers had the greatest proportion of Active learners compared to the other three achiever types.High achievers showed preponderance for active, sensing, visual and sequential learning strategies.While majority of high achievers were of the Active type, the greatest proportion of overachievers was of the Reflective type.Achievers were mainly reflective, sensing, visual and sequential.As far as the underachievers are concerned, majority were of the Reflective, Sensing, Visual and Sequential types.The most common learning strategy from the four learning combinations in all achiever types was Visual.Chi squared test for individual learning combinations against achiever types showed no significant association between academic learning strategies and annual exam performance (p value > 0.05).

Gender Preponderance
An analysis drawn between gender and learning types revealed that more males were Reflective, Sensing, Visual and Sequential while females only differed from their male counterparts in being more Active.
Furthermore, our study shows that significant statistical difference exists between exam performances of females and males.Females outperform their male counterparts.

Discussion
Preponderance of learning strategies among Engineering majors and Medical students was found in the past but no such study of this type has ever been conducted in the context of Pakistan.Our study goes a step further in order to find the association between exam per-formance and academic learning strategies.However, no statistical significance was found between exam performance and academic learning strategies.Exam performance is multifactorial.Probable reasons explaining the results of our study coming out negative could be difference in intellectual capacity of students, different approach towards examination, poor grading system, difference in dedication towards studies, peer pressure, diversity in strength of foundation in basic sciences and varying attitude of students towards teachers.Certain policy measures to boost academic performance would involve uniform exam writing, replacement of pass/fail criteria by Grade Point Average (GPA) and opting channels for proper counseling of students.However, some factors were not accounted for -IQ being one of them.Further limitations include our study being conducted only on students from King Edward Medical University.Moreover, only Index Learning of Styles (ILS) was used to determine learning strategies.Other models were not followed.For further studies, other models can also be followed to evaluate learning strategies.Medical students hailing from different institutions can be researched upon.
Factors like IQ should be controlled in other studies.An ILS model for teaching strategies should be conducted among teachers and compatibility established with predominant learning strategies shown by our research.

Conclusion
The Null Hypothesis that states that there is no association between academic learning strategies and annual examination results among medical students of King Edward Medical University cannot be rejected.Our research establishes that females outperform their male counterparts in academic performance.

05; X 2 crit =7.81. If X 2 calc is more than 7.81, result becomes significant.
collected data was entered and analyzed in computer program SPSS version 22. Frequency and percentage of dominant learning strategies among overachievers, high achievers, achievers and underachievers was calculated.Intergender and interclass comparison was also a part of the study.The p value ≤ 0.05 was considered significant.At df = 3 and p ≤ 0.

calc is more than 7.81 so result is statistically significant Class Preponderance
A greater number of 4 th year students were Reflective as opposed to relatively higher Active learning style seen in 3 rd and final year.All three years inclined more towards Sensing, Visual and Sequential learning types.