Abstract
Introduction
The approach of matching teaching practice to individual student “Learning Styles” has been repeatedly shown to be ineffective, even harmful. Yet, it appears a majority of educators believe it to be an effective approach. The status of Learning Styles theory in health professions education is unclear.
Method
We surveyed health professions educators to determine whether they believed that Learning Styles theory is effective and whether this belief translates to action. We also test knowledge of Learning Styles theory.
Results
87.4% of participants are familiar with Learning Styles, but knowledge about specific models varies. 69.9% of participants believed that Learning Styles theory is effective, but only one-third of them were actually using it.
Discussion
More effort is required to emphasise the importance of evidence-based educational awareness and practice in the healthcare community. As is the case with clinical practice, a culture of promoting pedagogy validated by the scientific method should be the norm.
Supplementary Information
The online version contains supplementary material available at 10.1007/s40670-023-01849-1.
Keywords: Learning styles, VARK, Pedagogy, Postgraduate, Neuromyths
Introduction
The principle of evidence-based practice is fundamental to all health professions and has been for longer than most of us can remember. The model is not perfect, for example, there are concerns about an over-reliance on evidence over judgement and experience and concerns that there is too much evidence and synthesis, and because so much progress has been made, we are now reduced to only making incremental gains for significant cost [1].
The idea of evidence-based practice is not the norm in the area of education. Many common educational practices are not supported by evidence [2]. One of the most common of these, used across education, is the theory of “Learning Styles”, which was the most commonly used teaching technique in a recent survey study of health professions educators in the USA [3].
In this perspective article, we will explore the similarities and differences between evidence-based practice in education vs clinical practice, using Learning Styles as a case study. We include primary data from a study where we examined the views of clinical educators around their belief in Learning Styles and, crucially, whether they actually used this theory in their teaching practice.
The basic principle of Learning Styles is that students can be classified into various different types of learners (e.g. visual learner, active learner, auditory learner) and that tailoring teaching methods to account for these individual “styles” will result in improved educational outcomes. There is no evidence to support the matching of Learning Styles to instruction [4–7], and scepticism about the effectiveness of the method has existed for decades [8, 9], and yet almost 90% of educators around the world report that they believe it to be effective [10].
There are even proposals that attempting match instruction to Learning Styles may actually be harmful to learners. For example, Kirschner and van Merriënboer [11] tell us that attempting to “pigeon-hole” learners can be inaccurate, as differences between people are more “gradual” rather than “nominal”. Kirschner and van Merrienoer argue that those who advocate Learning Styles tend to ignore these fluctuating human nuances, instead opting to use arbitrary predefined criteria to categorise people. Other proposed problems, supported by educators, are that the diagnosis of supposed Learning Styles risks creating unrealistic expectations that educators should create multiple versions of a teaching session in order to match multiple Learning Styles and that the advocating of a method that is not evidence-based risks undermining the credibility of educational practice and research [12].
Another problem is the low reliability and validity of Learning Styles. For example, the self-reported test–retest reliability of many Learning Styles instruments is low, which could lead to learners being classified differently on different occasions [4]. This could lead to students misdiagnosing themselves and amending their study habits accordingly — another potential harm of Learning Styles.
There are still many research papers published on Learning Styles in health professions education despite the lack of evidence. It is not uncommon to see research papers that encourage individual medical students to acknowledge personal learning styles in order to improve their academic performance [13] or propose that professional workplace-based education programmes account for learning styles preferences in practicing nurses [14]. The wealth of available publications on Learning Styles patterns in healthcare professionals and students makes it extremely important to establish whether our educators are actually acting on these findings.
Despite the lack of evidence to support the use of Learning Styles, almost 90% of recent studies on the subject present Learning Styles as a positive, useful approach [15], with some articles directly suggesting the use of their data to guide medical education [16]. These reflect the aforementioned widespread belief in the effectiveness of matching instruction to Learning Styles, which is also at almost 90% according to a recent review [10]. However, this review raised several questions for further study, including a question of whether educators fully understand what Learning Styles theory actually is (compared to, for example, simple individual differences), along with a question about whether educators are actually using Learning Styles theory. This study tested these questions in a sample of educators from the Health Professions in the UK and Ireland.
In this study, we focus on five of the most popular models of Learning Styles – VARK, Kolb, Honey and Mumford, Dunn and Dunn and Felder. These have been described in further detail in Coffield’s review [4]. The VARK and Felder models focus on sensory preference of learners. VARK includes visual learning, auditory, reading, kinaesthetic, or tactile learning [4, 10]. Felder includes active/reflective, visual/verbal, sensing/intuitive and global/sequential [12]. Kolb’s Learning Style Inventory (LSI) focuses on experiential learning that forms a cycle, comprised of learning from concrete experience, reflective observation, abstract conceptualisation and active experimentation. From these types of learning, Kolb derives four learning styles — the converging style (abstract, active), the diverging style (concrete, reflective), the assimilating style (abstract, reflective) and the accommodating style (concrete, active). Honey and Mumford’s Learning Styles Questionnaire (LSQ) encourages the idea that Learning Styles should only be for personal use and not for assessment, so that learners can be truthful about their preferences. It also states that Learning Styles are fluid and can change depending on the situation. There are flexible activists, careful and conscientious reflectors, reasoning and questioning theorists and the realist pragmatists. It outlines strengths and weaknesses for each, in almost horoscopic fashion. Dunn and Dunn describe five contributors to learning called stimuli — environmental, emotional, sociological, psychological and physiological. Like Kolb’s LSI, Dunn and Dunn derive their learning styles from these, each type of learner requiring a different balance of these factors. There are environmental, emotional, physical and sociological learners. Different Learning Styles classifications have different levels of stability — their dynamism and how likely they are to change. Coffield categorises different models of Learning Styles into five families, one of which is flexibly stable models. These state that previous and current experiences, as well as other situational factors, can influence learning type. Honey and Mumford, Felder and Kolb fit into this [4].
Materials and Methods
Ethics
Ethical approval (reference number 2020–0024) was obtained from the Research Ethics Sub-Committee at Swansea University Medical School.
Participants
Participants were health professions educators, with a role in teaching undergraduate students or postgraduate trainees. We primarily contacted participants at three tertiary institutions in the UK and Ireland. However, with the help of contacts at these three institutions, we used snowballing to reach out to other participants. Therefore, it is difficult to determine how many institutions or individuals were ultimately invited to participate.
Survey Design
The research instrument from a previous study that surveyed academics in higher education [12] was used as the basis for the instrument used here. We incorporated some of the qualitative feedback from that study, specifically electing not to allude to the lack of evidence for Learning Styles until the respondent has already completed the survey. A pilot study was undertaken with 10 people possessing varying degrees of prior familiarity with Learning Styles. Based on the feedback received from the pilot study, we made modifications to the final version. This primarily centred around making the survey’s language less ambiguous and improving the order of the questions.
In the final survey, all respondents were asked to confirm that they hold (or have previously held) a healthcare-related teaching role at either an educational institution or hospital. It involved teachers of undergraduate students (e.g. medical or nursing students) and/or qualified trainees (e.g. junior doctors or physician associates).
There were 12 questions asked. Six of these were mandatory and six were optional. Two were on 5-point Likert scales, five were multiple-choice fields, four were free text fields, and one was a simple yes/no question.
First, we asked participants to rate their familiarity with the Learning Styles concept. Then, we asked them to rate their agreement with the statement “The approach of matching teaching design/approach to the diagnosed Learning Styles of individual students will result in enhanced learning”. This question in our survey is worded differently to the question used in the majority of recent studies which survey belief in Learning Styles. We did this because a recent review [10] concluded that the question used in these studies could be misunderstood as referring to other, broader interpretations of the phrase “Learning Styles” rather than the specific approach of matching instruction to Learning Styles as identified using a specific questionnaire. Both these questions were 5-point Likert scales.
We then asked respondents to select which model(s) of Learning Styles they have used in their educational practice before and with which groups of learners (participants could pick one or more of; undergraduate students, postgraduate students and qualified trainees). We included a multiple-choice question with the five most common Learning Styles instruments identified in reviews of education research [15, 17] along with an option to state any others that participants had used. Following this, we asked educators who have used Learning Styles before to state how they have applied it and asking those who have not used it to state why not. This qualitative section was optional.
Participants are then asked to state which models of Learning Styles they have heard of before, followed by an optional knowledge test of the different Learning Styles. Participants were given a “mix-and-match” list of Learning Styles (e.g. activists, reflectors, pragmatists, theorists) and were then asked to match these to the model that they come from (e.g. Honey and Mumford). There was an option to select “Don’t know”. This is the 7th question of the survey included in the supplementary material.
Finally, some additional demographic information was collected optionally, as well as a free-text box for further qualitative comments.
The full set of survey questions is included in the supplementary material, along with the consent statement and debrief.
Procedure
We used convenience sampling, with snowballing, to invite participants from medical providers and tertiary education institutions in Ireland and Wales. The survey was online with an email invitation. It was distributed initially within healthcare education departments at three tertiary institutions, but eventually to others due to snowballing. No reference to “Learning Styles” was made in the invitation or briefing text. Recipients were instead asked to participate in a study exploring a well-known “teaching method”. The survey was published on 9th September 2020. Responses were collected until 5th October 2020.
Participants were both briefed and debriefed about the study and the usage of their survey responses, including informing them about their anonymity and the right to withdraw. A statement of informed consent was taken from all participants. Contact details were also provided for those who wished to ask further questions about the research.
Data Analysis
Quantitative data were analysed using frequency distributions. Qualitative data were analysed using six-phase inductive thematic analysis [18]. Both authors did this separately. The two authors then compared their themes and came to a common agreement on the themes.
Results
One hundred sixty-two participants started the survey. Sixteen participants did not progress beyond the first two questions, which were to confirm their consent and that they held a teaching role in health professions education. These 16 responses were not analysed. Thirty-five partial responses were analysed; thus, the sample size varies between questions. The total number of people who completed the survey in its entirety was 103.
The participants taught in healthcare fields listed in Table 1. Many participants taught more than one group of learners, so they were allowed to choose more than one option here. Hence, the total number of 198 responses in Table 1 exceeds the 162 individuals who took part in the survey.
Table 1.
Disciplines of healthcare education taught by participants
| Discipline | % | Count |
|---|---|---|
| Medicine | 40.9% | 81 |
| Nursing | 13.6% | 27 |
| Physician associates | 12.6% | 25 |
| Pharmacy | 8.1% | 16 |
| Physiotherapy | 7.1% | 14 |
| Paramedic | 3.5% | 7 |
| Speech and language therapy | 3.5% | 7 |
| Dentistry | 1.5% | 3 |
| Midwifery | 2% | 4 |
| Biomedical scientist/chemist/physiologist | 2% | 4 |
| Radiography | 1% | 2 |
| Dieticians | 1% | 2 |
| Others* | 3% | 6 |
| Total | 100% | 198 |
*Each of the following had one respondent each: addiction services, allied health, audiology, healthcare leadership and management, healthcare-related PhD, occupational therapy
Demographic Data
The demographic section of the survey was optional. Participants were first asked to select which healthcare students they have taught. As many educators are involved with different courses, we allowed more than one option to be selected. Therefore, a total of 198 options were selected by 102 respondents. The disciplines selected are shown in Table 1.
Participants were then asked to state whether they had a formal teaching qualification (e.g. PGCert or Academy of Medical Educators Fellowship). One hundred two out of 103 people answered this question, of whom 41 (40.2%) stated that they had a qualification.
All 103 participants chose to state how many years they had been involved in medical education. These participants had an average of 15.6 years’ teaching experience (SD = 8.5).
Ninety-nine of our 103 participants elected to tell us the country in which they have done most of their teaching activities. Due to how we distributed the survey, the most-commonly selected countries were UK (67) and Ireland (26). Other chosen countries were Bahrain, Cuba, the Netherlands, Nigeria, Portugal and USA (all one respondent each).
Belief in and Use of Learning Styles (N = 146)
The majority of participants (87.4%) stated that they were at least somewhat familiar with the concept of Learning Styles, while 12.6% were not familiar at all. A full breakdown of these responses is shown in Table 2. 69.9% agreed that Learning Styles enhances learning. 12.6% of participants disagreed, while 17.5% neither agreed nor disagreed. Thirty-four participants (33%) stated that they have used at least one Learning Styles model in their teaching practice. Within this cohort, the most commonly employed questionnaires were Honey and Mumford and Kolb. This is demonstrated in Table 3.
Table 2.
Familiarity of participants with Learning Styles approach (n = 103)
| Answer | % | Count |
|---|---|---|
| Extremely familiar | 8.7% | 9 |
| Very familiar | 14.6% | 15 |
| Moderately familiar | 40.8% | 42 |
| Slightly familiar | 23.3% | 24 |
| Not familiar at all | 12.6% | 13 |
| Total | 100% | 103 |
Table 3.
Most commonly used Learning Styles models among those who have used it (n = 34)
| Learning Styles model | Count | % |
|---|---|---|
| Honey and Mumford | 19 | 55.9% |
| Kolb | 19 | 55.9% |
| VARK | 10 | 29.4% |
| Felder | 2 | 5.9% |
| Dunn and Dunn | 1 | 2.9% |
| Others | 1 | 2.9% |
There was also variability within educators’ use of Learning Styles in different levels of training. Among the 34 participants who have used it, 61.8% reported using it with undergraduate students, 55.9% used it with qualified trainees, and 47.1% have used it with postgraduate students. Honey and Mumford and Kolb were the most commonly used models across all levels of education, i.e. there was no variation in Learning Styles model preference at different training levels (Table 4).
Table 4.
Models of Learning Styles used by educators at different levels of training
| Model | Use with qualified trainees (n = 19) | % of 19 |
Use with undergraduate students (n = 21) | % of 21 |
Use with postgraduate students (n = 16) | % of 16 |
|---|---|---|---|---|---|---|
| Dunn and Dunn | 1 | 5.3% | 0 | 0% | 0 | 0% |
| Felder | 0 | 0% | 2 | 9.5% | 0 | 0% |
| Honey and Mumford | 11 | 57.9% | 7 | 33.3% | 9 | 56.3% |
| Kolb | 11 | 57.9% | 10 | 47.6% | 8 | 50% |
| VARK | 3 | 15.8% | 5 | 23.8% | 6 | 37.5% |
| Others | 1 | 5.3% | 0 | 0% | 0 | 0% |
Among those who hold professional teaching qualifications, less people believed in Learning Styles than those who don’t have a qualification. However, interestingly far more participants who hold a qualification have actually used Learning Styles compared to those who do not have a qualification. Of those who hold a qualification (n = 41), 58.5% of participants believe in Learning Styles, and 53.7% have used it in their teaching practice. Of those who don’t hold a qualification (n = 61), 77.1% of participants believe in Learning Styles, but only 27.9% have used it.
Knowledge of Learning Styles
While 33% of participants in our study stated that they had used Learning Styles in their teaching practice, 87.4% of them had heard of it (Table 2). However, even though the majority were familiar with the concept as a whole, many of them were not aware of any specific models of Learning Styles. In contrast to the 12.6% of people who said that they were not familiar with Learning Styles at all, 37.9% stated that they did not know any specific model. In keeping with the overarching trends of this study, the most commonly known classifications among participants were Kolb (known by 49.5%) and Honey and Mumford (41.8%). This is further detailed in Table 5.
Table 5.
Correctly identified Learning Styles classifications among those who attempted to identify them, and among the total sample, in the mix-and-match question
| Correct answers among those who attempted the question (n = 41) |
Correct answers among the total sample of completed surveys (n = 103) | |
|---|---|---|
| Honey and Mumford | 28 (78.6%) | 21.4% |
| VARK | 25 (88%) | 21.4% |
| Kolb | 17 (88.2%) | 14.6% |
| Dunn and Dunn | 15 (73.3%) | 10.7% |
| Felder | 11 (54.5%) | 5.8% |
We included an optional exercise to test knowledge of, rather than just belief in, Learning Styles. We did this in the form of a “mix and match” question. We listed five statements, each describing a certain model of Learning Styles, and respondents were asked to match each statement to the model that it best describes (7th question of the survey — see supplemental material). Only 41 participants attempted this question. Of this cohort, however, it should be noted that those who have an understanding, of Learning Styles, or have previously used them, were more likely to attempt this question. Therefore, we should be careful with how we generalise this result. For this reason, we have expressed the responses as percentages of those who attempted the question as well as the total number of participants who completed the survey (n = 103) in Table 6. Twenty-two (53.7%) correctly identified Honey and Mumford, 22 (53.7%) correctly identified VARK, 15 (36.5%) correctly identified Kolb, 11 (27.8%) correctly identified Dunn and Dunn, and 6 (14.6%) correctly identified Felder. The most correctly identified classifications were Honey and Mumford and VARK (Table 6).
Table 6.
Which model(s) of Learning Styles have you heard of? Select all that apply (n = 103)
| Answer | % of participants | Count |
|---|---|---|
| VARK | 22.3% | 23 |
| Kolb | 49.5% | 51 |
| Honey and Mumford | 41.8% | 43 |
| Dunn and Dunn | 11.7% | 12 |
| Felder | 5.8% | 6 |
| Others | 2.9% | 3 |
| None of the above | 37.9% | 39 |
We were interested to analyse whether those who were using various models of Learning Styles were able to correctly identify the models that they said they were using. For each set of participants who stated that they were using a particular Learning Styles model, we analysed their answers to the mix-and-match question. We found that under half of those who were using a particular model correctly identified that model. The majority of the remainder chose not to attempt this question (Table 7).
Table 7.
Correctly identified Learning Styles classifications by those who attempted to identify them in the mix-and-match question
| MODEL | Used this model | Used this model and correctly identified it | Used this model and incorrectly identified it | Used this model, and did not attempt to identify it |
|---|---|---|---|---|
| Honey and Mumford | 28 | 13 | 3 | 12 |
| VARK | 21 | 10 | 2 | 9 |
| Dunn and Dunn | 8 | 0 | 3 | 5 |
| Kolb | 22 | 6 | 3 | 18 |
| Felder | 8 | 1 | 2 | 5 |
Qualitative Data
Twenty-four participants left comments regarding the content of the survey, which were coded into three categories:
How/why Learning Styles is used
Why Learning Styles is not used
Other commentary
We have grouped a number of subthemes alongside each theme, based on the underlying ideas that were mentioned by participants (Tables 8 and 9).
Table 8.
How/why Learning Styles is used
| Theme | Ideas mentioned | Example |
|---|---|---|
| Insight into students | For educators to understand their students’ better | “I have used it with students who have been on a 4 month placement where there would be 1–1 teaching and mentorship” |
| Increase self-understanding | To help students understand themselves better in order to enhance their own personal study; identify strengths and weaknesses in themselves | “I have requested students complete Honey & Mumford prior to attending education, so that they are familiar with their own preferred learning styles. When preparing the education, I then ensure that the students have options in relation to how they approach their learning” |
| Individualise teaching approach | For educators adapt their teaching approach to the needs of the individual student | “Students are asked to complete the VAK questionnaire at the beginning of their placement in order for their educator to tailor the learning experience to the students preferred style—as far as is practically possible within a clinical setting” |
| Educational programme guidance | To guide the development of the teaching programme for learners; to assist other educators | “Every academic and student should be exposed to training on Learning Styles. How will our learning styles be affected by the new normal of Virtual Asynchronous and Synchronous teaching and learning” |
Table 9.
Why Learning Styles is not used
| Theme | Ideas mentioned | Example |
|---|---|---|
| Lack of awareness | Educators simply don’t know about Learning Styles | “not aware of Learning Styles. 20 years’ experience of teaching” |
| Lack of evidence | Unwillingness to incorporate a teaching method with a poor evidence base | “I thought the literature suggests Learning Styles has not been validated with evidence…just talked about a lot so many people believe it” |
| Logistics | Time constraints and clinical commitments; inability to apply individualistic methods in clinical setting; large class sizes | “service commitments eclipse any time to take this sort of approach. Combination of methods naturally used in clinical teaching” |
| Targeted curriculum | Healthcare education is based on fixed learning outcomes and pre-set curricula, Learning Styles not part of this curriculum | “I usually have an hour max and a curriculum point to hit in that time…..Format of the teaching I deliver—very curriculum / target based” |
| Not the educator’s responsibility | It is a learner’s job to identify and understand their own learning preferences, not the teacher’s | “I would also argue that, dealing with adult learners, it is the learner's responsibility to know their own learning style rather than mine to spoon feed them” |
How/Why Learning Styles Is Used
Table 8
Why Learning Styles is Not Used
Table 9
Other Commentary
In our survey, we chose not to present the lack of evidence for Learning Styles to participants until their responses had already been submitted, in order to avoid influencing the way in which they answer their questions. This led to the development of a number of interesting comments. On one hand, many people initially worried that our study was designed to promote Learning Styles and expressed concern that we were propagating a debunked teaching method.
“I’m sorry to say that learning styles is a completely debunked academic myth and I hope that your project is not dependent on/intending to promote their use in medical education. I’m wondering if your project is aiming to capture poor educational practices.”
On the other hand, many people hadn’t heard about Learning Styles before and wanted to know more.
“I would be interested in being informed of the outcomes of this survey and also any useful links for further study”
“I am deeply interested in knowing more”
With these responses, we had a number of people stating that they have learned a new teaching method through this survey and that they would now consider incorporating Learning Styles into their practice. We anticipated that this would happen, and we were keen to mitigate against this and so included an online resource explaining the lack of evidence for Learning Styles at the end of the survey [19].
Two respondents also talked about how clinical educators often only have transient time with their learners. For example, a small batch of medical students that pass through a hospital on rotation will generally only stay for a few weeks. It also tends to be the case that junior doctors rotate around different posts quite frequently. Therefore, educators may not always get enough time with a specific learner to build a sufficient rapport that is conducive to an individualised teaching approach.
“My teaching comprises one off sessions. Some of these are clinical and involve one or two students shadowing me in a clinic. The rest are lectures delivered to groups of students but I will deliver only one lecture to them on their course. Because I have no ongoing relationship with students I'm not in a position to assess the individual learning styles”
“I do not spend enough time with one group of learners to make it worth my while to interrogate their learning style formally—I tend to have responsibility for short and intense blocks rather than prolonged periods of time”
Finally, we noticed that many participants mentioned that the survey was very technical and focused on a niche topic. Some of them stated that without having done a qualification or formal study in education, there would be no way for them to know about Learning Styles.
Discussion
Our study aimed primarily to gauge the prevalence of Learning Styles belief and usage among educators of healthcare professionals and to compare it to trends in other academic populations. Our findings show that a 69.9% of healthcare educators believe that Learning Styles works, and a third of them have used it in their teaching practice. We have also found that the level of belief and usage in healthcare is roughly in keeping with the levels seen across higher education as a whole. Thirty-three percent of university educators across a range of academic fields reported using Learning Styles in Newton and Miah [12], which is the same as the percentage seen among healthcare educators in our study. A recent systematic review of survey studies found that belief in Learning Styles by educators was high across education, with an average of 89.1% across all types of educator, and no sign that this is decreasing [10]. However, in the small number of studies that sampled the views of teachers in higher education, the reported levels of belief were lower; belief in Learning Styles was 64% of academics in a sample of US liberal arts university academics [20] and 58% in a sample of UK academics [12].
A multitude of reasons why Learning Styles is/isn’t used in healthcare have been reflected in our study. The most common reason for using it seemed to be the ability to tailor learning needs to the individual, while the most cited reason not to use it was lack of awareness about it. On a positive note, the lack of evidence for Learning Styles was also mentioned in 16 comments, demonstrating that this is a prevalently known fact among some participants.
Among those who have used Learning Styles, we have identified a number of themes that are driving their use of it. We can use this data to approach how we bring about a change to this.
Most people who attempted our “mix-and-match” test on Learning Styles models managed to correctly answer the questions (Table 6). Interestingly, we did not find that those who reported using Learning Styles in their teaching practice correctly identified the models at a higher rate than those who don’t use them. The majority did not attempt to answer these questions. This would suggest (but does not conclude) that they would have got it wrong. Therefore, we should exercise caution in how we interpret this, i.e. we should not immediately conclude that knowledge about Learning Styles is high among the wider healthcare education community. Those who attempted to answer this question are more likely to be familiar with Learning Styles, so there is a risk of bias here.
Our study has some limitations. We had an unexpected dropout rate (27.8%) for a short survey, though this is slightly better than the average online survey dropout rate of 30% [21]. On examination of the unfinished responses, we found that many people dropped out after the first two questions about Learning Styles. We postulate that this may be because many people who were unfamiliar with Learning Styles were put off by the survey topic.
We are also limited by our use of convenience sampling and the modest size of our sample. These limitations are very common in research on belief in Learning Styles [10], but they do limit confidence in the generalisability of our findings. A larger survey using a representative sample would help address this in future work and could develop our approach of attempting to look for relationships, or not, between stated belief in Learning Styles, and actual use of the method.
Stahl proposes a “fortune teller” analogy to explain belief in Learning Styles. He argues that the classifying choices are written in such a way that they are both specific enough to seem true, but vague enough to apply to most people. This is similar to how a fortune-teller operates (with ambiguous statements such as “you will be successful soon”), and Stahl postulates that this may be driving the popularity of Learning Styles [9]. Both Stahl and Pashler et al. [5] highlight the commercial aspect of Learning Styles, showing that companies claim to be able to measure various individual learner patterns whilst often charging very high fees to do so, for little benefit. The lack of evidence for this methodology is compounded by the absence of universal agreement on what Learning Styles actually is, as well as the multitude of distinct ways in which educators are applying them [22].
The inculcation of evidence-based educational practices in healthcare is especially important, given that the ultimate aim of our education is to provide patient care. It is an unquestioned norm that our medical assessment and therapeutics for our patients are grounded in solid evidence and research. We would seldom prescribe a new medication that did not withstand its due scrutiny under the scientific method. We tend not to employ the same scrutiny for our teaching practices. For example, an American study showed that 22.4% of participants had previously changed their teaching practice due to boredom [23]. This would clearly be considered a dangerous reason for someone to change their healthcare practice. There are many possible explanations for this, with lack of awareness likely to be a factor. Arslan Yurumezoglu and Gokce Isbir found that nurse educators sometimes confused evidence-based nursing and evidence-based education. Many of them reported only using evidence for nursing practices to design educational courses, as opposed to including some evidence in pedagogy. This was partially attributed to not knowing about education-related literature [24]. Despite this, these studies have demonstrated that there is a strong will among healthcare academics to build evidence-based education into their teaching practice. This should be seen as a positive sign, as it means that there is always scope for healthcare educational programmes to promote awareness of evidence-based education among their faculties.
However, our ability to deliver evidence-based practice depends on the quality and nature of the evidence. We found that 89% of recent research papers about learning styles present a misleadingly positive view of the theory, suggesting that it is a useful approach to learning and teaching, despite the lack of evidence [15]. A similar situation was found in the wider Higher Education Literature [17]. This suggests that, even were an educator to attempt to take an evidence-based approach to the use of Learning Styles, they may be misled by the evidence. This is perhaps a contrast with evidence-based clinical practice, where clear guidelines and established national protocols exist for common situations, with training often available, even required for those guidelines. There are very few such protocols and guidelines in educational practice [2], although the BEME collaboration offers a “best evidence” synthesis on a wide variety of educational topics, aimed at clinical educators [25].
There are circumstances where clinicians use treatments that are demonstrably ineffective. For example, there is evidence of widespread use of placebo treatments by clinicians, including approaches such as homoeopathy where there is clear and conclusive evidence that they do not have a meaningful clinical effect beyond a placebo [26]. It has been suggested then that Learning Styles are the homoeopathy of educational practice [25]. The reasons why clinicians prescribe such medicines may provide some valuable insight into why educators continue to believe in, and use, Learning Styles theory. A common assumption is that placebos, including homoeopathy, are prescribed in order to take advantage of the placebo effect [27]. This raises the intriguing possibility of educationalists taking a similar approach. The existence, or not, of a placebo effect in education has not been extensively researched [28], although a recent study found evidence for a placebo effect associated with branding [29]. However, Linde et al. argue that placebo use by doctors is, more likely, driven by more complex reasons such as wishing to avoid conflict with, or preserve unstable relationships with, patients, along with time pressures and diagnostic uncertainty [26].
A potentially important difference here though is that clinicians most likely are fully aware of the lack of evidence to support the use of approaches such as homoeopathy, whereas our findings and others suggest that educators believe Learning Styles to be effective.
There is evidence that the concerns we have are not just limited to Learning Styles. For example, the use of, and research on, the “Cone of Learning” appears to be common in health professions education [30], with no signs of decline [31]. Further study in this area could examine the use of other pedagogic approaches in healthcare education, including those that are backed by evidence, to help us understand whether health professions education is truly evidence-based.
Conclusion
Belief in Learning Styles is common in healthcare education. One-third of healthcare educators have used Learning Styles in their practice, with Honey and Mumford and Kolb being the most used classifications. There is Learning Styles usage across many levels of training (undergraduate, postgraduate and qualified trainees). Learning Styles’ prevalence in healthcare is similar to that in other fields of higher education reported in previous studies. Further work is needed to encourage awareness of evidence-based education in the healthcare world and to highlight the use of those practices which are not evidence-based.
Supplementary Information
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Acknowledgements
We would like to thank Professor Marc Devocelle (Dublin, Ireland) for sparing no effort to support this research. We would also like to thank the staff at the Royal College of Surgeons (Dublin, Ireland) and Sligo University Hospital (Sligo, Ireland), who were instrumental in our sampling efforts in Ireland.
Data Availability
The authors confirm that the data supporting the findings of this study are included within the article and its supplementary materials.
Declarations
Conflict of Interest
The authors declare no conflict of interests.
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Data Availability Statement
The authors confirm that the data supporting the findings of this study are included within the article and its supplementary materials.