Results of a study assessing teaching methods of faculty after measuring student learning style preference

    Results of a study assessing teaching methods of faculty after measuring student learning style preference Bridget V. Stirling PII: DOI: Reference:

S0260-6917(17)30115-6 doi:10.1016/j.nedt.2017.05.012 YNEDT 3553

To appear in:

Nurse Education Today

Received date: Revised date: Accepted date:

23 November 2016 20 April 2017 10 May 2017

Please cite this article as: Stirling, Bridget V., Results of a study assessing teaching methods of faculty after measuring student learning style preference, Nurse Education Today (2017), doi:10.1016/j.nedt.2017.05.012

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ACCEPTED MANUSCRIPT Results of a Study Assessing Teaching Methods of Faculty after Measuring Student Learning Style Preference

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Bridget V Stirling RN, BScN, MPH, PhD (Assistant Professor) University of Calgary in Qatar

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Corresponding Author P.O. Box 3 Saanichton BC, Canada, [email protected] , Phone: +974 4406 5397

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Keywords: teaching method; learning styles; nursing student; VARK learning styles; Saudi Arabia; nurse education

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Word Count: 4393

ACCEPTED MANUSCRIPT ABSTRACT Background: Learning style preference impacts how well groups of students respond to

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their curricula. Faculty have many choices in the methods for delivering nursing content,

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as well as assessing students. Objectives: The purpose was to develop knowledge around how faculty delivered curricula content, and then considering these findings in the

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context of the students learning style preference. Design: Following an in-service on

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teaching and learning styles, faculty completed surveys on their methods of teaching and the proportion of time teaching, using each learning style (visual, aural, read/write and

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kinesthetic). Setting: This study took place at the College of Nursing a large all-female university in Saudi Arabia. Participants: 24 female nursing faculty volunteered to

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participate in the project. Methods: A cross-sectional design was used. Results: Faculty reported teaching using mostly methods that were kinesthetic and visual, although lecture

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was also popular (aural). Students preferred kinesthetic and aural learning methods. Read/write was the least preferred by students and the least used method of teaching by faculty. Conclusions: Faculty used visual methods about one third of the time, although they were not preferred by the students. Students’ preferred learning style (kinesthetic) was the method most used by faculty.

INTRODUCTION Teaching, like nursing, is both an art and a science. When it comes to the health professions, making sure that students have both the core content and the ability and skills to be life-long learners is imperative. The art of nursing is demonstrated by faculty through the finesse and passion with which clinical stories are told. Nursing instructors

ACCEPTED MANUSCRIPT captivate their students while sharing stories of care and compassion towards sick and dying patients. There is an art to ably to confidently perform tactile skills and simulate

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real-world conditions in the clinical nursing lab. Faculty use their creativity as they

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develop scenarios to prepare students and measure their success in the simulation lab. Nursing faculty are also scientists in their ability to observe and measure student

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performance. They experiment with new ways of teaching and delivering curricula to a

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diverse and ever-changing body of students. Faculty also go on to diagnose student strengths and weaknesses and prescribe activities in order for them to be successful in

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students’ development as nurses. As a science, faculty can also use evidence through surveys, tools, and interviews to better understand the learning style preference that each

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cohort of students hold, and adapt how they deliver their content accordingly. This paper is a description of how the teaching faculty at one College of Nursing described their

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teaching styles and the time that they spent in different modalities of teaching and learning, having just found out about their students’ learning style preferences.

Throughout time, every culture and generation differs in how it prefers to learn. In Saudi Arabia and all through the world, nursing faculty want to support their students to become the kind of nurses who practice with competence and confidence. It is the goal of nursing faculty to creatively develop education techniques that are companionable with the preferred learning styles of students. Therefore our faculty strove to understand the student learning preferences in order to effectively develop methods that will result in educating well-prepared, nursing professionals.

ACCEPTED MANUSCRIPT BACKGROUND Professional nursing in Saudi Arabia has its roots in a collaborative project that was

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jointly lead by the Ministry of Health and the World Health Organization, starting in

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1958 (Almalki, Fitzgerald, & Clark 2011). This educational project was first initiated in Riyadh, and was known as the Health Institute for Boys. Over the past decades, the way

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in which Saudi national nurses are educated has changed. Nurses used to attend nursing

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two-year diploma programmes that were apprentice-based and augmented with didactic, class-based learning. Nursing programmes used to be designed to train nurses in clinical

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skills and basic sciences. Students were assessed both by their mentors and also by multiple choice questions that measured their rote learning. Rote learning relies on

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understood.

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memorization and parroting answers, which the nursing student may or may not have

While previously, nursing in the region was not viewed as a highly respected profession, over time, more Saudi nationals have been entering the nursing profession (Clerehan et al., 2012). Students are encouraged to pursue nursing and are well supported. The students’ tuition and books are provided free of charge, and students are given a stipend to attend government universities. The Princess Nourah University (PNU), College of Nursing offers a Bachelor’s Degree in Nursing. As more Saudi nationals enter the profession, achieving higher levels of education, there will eventually be more Saudi faculty. Currently, however the majority of faculty are foreigners and many Saudi nurse faculty are in the early stages of their careers. During this overlapping period, as more Saudi faculty are educated, there is an opportunity for all faculty to consider the teaching-

ACCEPTED MANUSCRIPT learning experience of their students. This could set the stage for how nurses are educated

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in Saudi for decades to come.

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Educating nurses is becoming more complex. Nursing is a dynamic field, requiring its practitioners to be highly educated, life-long learners. Nurses are expected to read,

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understand, interpret, apply and generate evidence in their daily practice. Nursing work

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has become more specialized and technical. In order to keep pace with the volume of new information and the increasing nursing responsibility, a greater emphasis has been put on

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critical thinking and evidence-based nursing skills. As a result of an increase in educational technology, nurses now are also able to practice clinical skills in a simulated

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environment. This opens up new venues for nursing faculty to use their creativity to

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bring content that must be learned into a simulated hospital environment.

The nursing program at PNU has been moving away from a didactic curriculum towards one that is more interactive. Instructors are using case studies, practical activities in smaller seminar groups, and an excellent, well-equipped simulation laboratory. Traditional methods of nursing students’ learning such as in reading and writing have been met with resistance and trivial effort on the part of the students. Although reading and writing are clearly important and necessary abilities to develop, they are not the only methods through which nursing students must learn.

Nursing faculty often think of themselves as coordinators of the learning environment. In their role as the students’ guides, they aim to be caring, nurturing mentors, leading

ACCEPTED MANUSCRIPT students into growth in their shared profession. They do so by presenting evidence-based theory, exploring and experimenting in the lab, synthesizing and discussing in the

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seminars, and practicing in the clinical area. While these venues and times are set aside

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and labelled as such, the faculty have a large range of teaching and assessment methods

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that they can draw upon in order to build the skills and knowledge of students.

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TEACHING STYLES

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Faculty members are themselves learners we also have developed their individual preferred teaching styles. Like all other educators, faculty at health sciences universities

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tend to have favored teaching styles that are based on their training, experience and personality. For decades, researchers have examined how teaching styles have looked at

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the teaching styles used to pass information from teacher to student (Grasha, 1981 and Dember, 1965). These researchers suggest that optimal learning occurs when there is some amount of tension in the learning environment so that learners feel challenged while learning. What is less clear within this debate is whether combining certain teaching styles and learning styles affects the teaching–learning relationship, and if so in what way.

Whatever the unique teaching style of the nursing instructor, it is clear that the different methods of teaching influence student outcomes. Instructors can be encouraged to change the method of delivering information and developing nursing student skills. For example, an experimental study prospectively measured the difference between communication

ACCEPTED MANUSCRIPT and problem solving ability in a large group of Korean nursing students (Yoo and Park, 2015). The students were exposed to two different styles of teaching the same material.

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One group was taught using in class didactic methods. The other group was taught using

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case-based interactive small group learning. Students in the case-based group improved their ability to communicate with patients (p < 0.001) as well as to solve problems (p <

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0.001).

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Another study from Korea (Lee et al., 2016) looked at the impact of presenting curriculum using high-fidelity simulation on nursing core competencies, problem solving

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and academic self-efficacy. While this curriculum included all 4 learning styles (VARK) in part, it was highly kinesthetic. The study reported a significant improvement in nursing core

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competencies in those nursing students who were exposed to simulation experience in

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comparison to classroom-based learning (P = 0.008).

LEARNING STYLES

There are a number of tools designed to assess learning styles. Some tools focus on the personality of the participant or their current strengths. Two of the most popular learning style tools are the VARK (Visual, Aural, Read/Write and Kinesthetic) Learning Styles Inventory (Fleming, 2016) and Kolb’s Learning Style Inventory (Kolb, 1984). Other models of learning styles used in nursing populations include the following: Learning Styles Inventory (Honey and Mumford 1986); Myers-Briggs Type Indicator (Myers, 1975); Felder-Silverman Learning Style Model (Felder and Silverman 1988); GrashaReichmann Student Learning Style Scale (Grasha, 1996); and the Theory Of Multiple Intelligences (Gardner, 1993). These learning style models were outlined and reviewed in an article by Anderson (2016).

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For the current study, the two tools that were seriously considered were the Learning

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Styles Inventory (Fleming, 2016) and Kolb’s Learning Style Inventory (Kolb, 1984). The

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decision was made to use VARK for several reasons. The VARK tool has been welltested in Saudi populations of medical and dental students (Abidia et al., 2016; Al-Saud,

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2013; Abdullah, 2013; Asiry, 2015; Nuzhut et al., 2011) and it is a simple, straight

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forward tool. It is easy to both complete as a student and interpret as a faculty member. Other tools have also been used to look at learning styles in Saudi health professionals

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(Al-Qathani and Algatani, El-Gilany & Abusaad, 2013, and Suliman 2010).

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The purpose of using the VARK Learning Styles Inventory was to assist in helping students to understand their learning style, and for faculty to consider the overall

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preferences for the cohort of nursing students. The 16 VARK questions are multiple choice with four possible answers. The questions are intuitively understood and the results are simple to calculate. The results are easy for students to understand. The program includes information sheets that both explain the student’s preferred learning style and includes strategies for improving in all ways of receiving information. This information is available on-line and students were also provided print-outs to read and consider. VARK learning style inventory was tested for reliability coefficients, which were found to be adequate (Leite, et al. 2010).

METHODS

ACCEPTED MANUSCRIPT This study took place at the College of Nursing, in a large, all-female university in Riyadh, Saudi Arabia. The aim of the current study was to understand what methods were

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being used to deliver the nursing curricula, in light of the results of the students’ preferred

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learning styles. Just prior to informing the nursing instructors of the students’ results, the researcher aimed to understand the current teaching practice of the faculty. The

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researcher’s hypothesis was that the instructors’ dedicated teaching time and chosen

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methods would have some relationship with the students learning style preference.

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This inventory-based, descriptive study examined the perceived use of classroom time, the teaching methods that they engaged and their overall perceptions of satisfaction with

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their current classes. Ethics approval was obtained from the College of Nursing Ethics Committee at PNU. Faculty completed a consent form outlining the project and

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informing them that their participation was voluntary.

All faculty were invited to participate in the study, and all but two, one of whom was on maternity leave chose to participate (24/26, 92%). This was an adequate sample size, as our original calculation for such a small group required that we get at least 24 in order to reach a 5% margin of error and a 90% confidence level. The sample was obtained during a staff meeting that was called for the purpose of discussing student learning styles. All participants in the study were female and were active faculty members in the College of Nursing.

ACCEPTED MANUSCRIPT The inventory was developed by the researchers to record demographic characteristics of the faculty (4 questions) and a self-assessment of the proportion of their class time that

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they devoted to each of the major categories of learning (visual, aural, read/write, and

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kinesthetic). They were then asked to choose all of the activities from a list of specific activities that they had used in their classes in the past semester. The list was generated

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during a two-day seminar on interactive teaching, where faculty from all of the health

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Colleges listed the types of teaching methods they used or might use in their classes.

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Nursing faculty were also asked to rate how satisfied they were with their classes. Each participant indicated on a five-point Likert scale whether they were anywhere from

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RESULTS

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dissatisfied to extremely satisfied with the classes that they teach.

The population

Ten of the faculty members were Saudi Nationals, and 14 were from foreign countries. Foreign faculty had been in Saudi Arabia on average 3.3 years (range of 0.33 to 9). The mean number of years of teaching experience in the faculty was 8.8. Saudi faculty members had a mean number of years of teaching experience of 2.2 years, while nonSaudi faculty had taught, on average for 13.5. The highest educational degrees of the respondents were as follows: four had Bachelors’ Degrees (of which, three were Saudi nationals), ten had Masters’ Degrees (of which six were Saudi Nationals) and nine held PhDs (all non-Saudi nationals), as is illustrated in Figure 1.

ACCEPTED MANUSCRIPT Figure 1: Education levels, by nationality

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Faculty

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While all of the non-Saudi nationals taught theory courses, only two of the 10 Saudi

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faculty did. Half of all faculty taught seminars (5/10 Saudis and 7/14 non-Saudis). The

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majority of faculty members taught in the clinical lab setting.

Less than half (43.5%) of the faculty were either satisfied or extremely satisfied with the

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classes that they teach. While non-Saudi faculty were more satisfied than national, Saudi

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faculty, the difference was not statistically significant (p = 0.5).

Reasons given for being satisfied included, “because I use many different styles of

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teaching”. Another faculty member who reported that she was satisfied with the classes she teaches because she was “I had the opportunity to plan and develop the course”. One faculty member who responded as neutral to the question on satisfaction remarked, “I’m trying to apply different learning styles but have not been able to because there are some barriers.” It was unclear what those barriers were. Another faculty member who responded neutrally to the satisfaction question commented that they were not fully satisfied “Because students don’t read”. Another faculty member who responded neutrally to the question on satisfaction reported,” because I’ve already used visual and aural but never in kinesthetic”. A faculty member that responded that she was dissatisfied with the classes that she taught explained, “because I am kind of under stress when I teach two different courses and both of them need a lot of preparation, time and effort”.

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Table 1: Inventory of teaching methods used, by area of teaching (theory, seminar,

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lab, or clinical)

Table 1 outlines each of the types of classes that faculty taught. Most faculty taught more

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than one type of course. For example most of the instructors who taught lab also taught

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clinical, along with the learning style methods of teaching. Of those 18 instructors teaching in the clinical nursing lab, 9 (50%) used the SimLab. Pictures, videos, and

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PowerPoint were the most frequently used methods of teaching. No one in the group used MP3 audio platform for delivering educational material. Only six of the 18 (33%)

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method of teaching.

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teachers who taught theory classes claimed to use the assigning of textbook readings as a

When faculty were asked about the proportion of their time spent engaging in different activities, the following results were found: lectures 31%; videos and demonstration 26%; reading writing and papers 14%; and activities including group work and during clinical skills 32%. This finding was interesting as the nursing students in this group were predominantly kinesthetic learners, followed by aural preference learners.

Figure 2 represents the proportion of time that faculty spends in each of the major methods of learning. The second part of the figure refers to the VARK learning styles inventory results for students who had a strong unimodal preference. Very few students preferred to learn by reading, writing, or watching. 38.2% had a strong preference for

ACCEPTED MANUSCRIPT kinesthetic learning, while 10.6% 4.9% and 2.4% had a dominant preference for aural, reading/writing, and visual learning, respectively. The study of the results from the PNU

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nursing student learning style preferences was published previously (Stirling and

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Alquraini, 2016).

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Figure 2: Faculty self-reported time spent and VARK strong learning (unimodal)

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preference of their students

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DISCUSSION

At the time of the survey, the VARK learning style inventory results for the group of

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students that the faculty were teaching was intentionally not revealed to them. The faculty had received a 30 minute in-service on learning styles and many had attended a two-day

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workshop on interactive teaching methodologies in the month previous to this study. Not revealing what was reported by the students’ VARK survey before the faculty survey served to reduce bias as information was gathered on the perception of the faculty’s current teaching methods.

Despite not knowing the results of the VARK for our group of students, the faculty naturally tended to teach using a variety of different kinesthetic methods. The faculty reported that they were teaching the kinesthetic learning mode most of the time, closely followed by methods that were visual. Faculty at this institution also tended not to do as much teaching using read/write methods. This was in line with student preferences for kinesthetic and lack of student preference for reading/writing. Of the total cohort of PNU

ACCEPTED MANUSCRIPT nursing students, 80.5% had at least some preference for kinesthetic learning (Stirling and

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Alquraini, 2016). Only about 30% had any preference for reading and writing.

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While it would be inconceivable in a Western nursing school for only a third of the instructors to assign textbook readings, this is not surprising in the Saudi Arabian context.

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Students were not used to completing readings, and in some cases students lacked basic

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literacy skills such as the ability to use and index. Less than 5% of students had a strong preference for reading and writing. Although all course specifications included textbook

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readings, when asked in class of nearly 90 students, all students admitted to not having read the assigned material. Therefore, lack of assigning readings may be due to the

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extreme resistance on the part of students to complete assigned readings and a high

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preference for other styles of learning such as aural and kinesthetic.

Visual teaching and learning was one area that faculty dedicated a high percentage of their teaching, while the students had a low preference or learning. The nursing students in this university scored visual methods as the lowest preference for any learning style. And yet, faculty responded that visual methods were those most often used in theory, clinical, seminar, and lab. These included the use of pictures, videos, and PowerPoint. Faculty also spent about as much time using visual methods as they did kinesthetic, and far more time having the students watch than listen and speak.

While PNU has one of the most sophisticated and well-equipped simulation labs in the world, less than half of all instructors who led Lab and clinical courses used the SimLab.

ACCEPTED MANUSCRIPT This may have been due to the fact that some of the software for the Sim manikins expired and many of the instructors were not trained on how to use the high fidelity

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manikins.

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CONCLUSIONS

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This study showed that many of the faculty of the College of Nursing at this university are interested in using a variety of styles of teaching. Faculty spent a large portion of time

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teaching with kinesthetic methods. This is in line with the learning style preference of the students at the College of Nursing. However, the amount of time that they spent using

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visual teaching methods such as watching videos and demonstrations was not congruent

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with the learning style preference of the students that they taught.

Overall, the faculty were satisfied with the classes that they taught. Some faculty expressed their satisfaction with being able to plan and develop the courses, as well as being able to use a variety of teaching styles. There was no significant difference in the level of satisfaction between Saudi and International staff. Was interesting to note that only half of the instructors who were leading classes in lab and clinical, had invited the students to the simulation lab. With the availability of high fidelity dolls and well simulated hospital environments at the University, this seems like a missed opportunity.

Nursing educators recognize their setting up their students to be lifelong learners. Nurses need to be able to learn about their patients in practice in a variety of different ways. They need to read charts, observe and assess, listen to oral reports and to the patients, as

ACCEPTED MANUSCRIPT well as perform many clinical skills. The way that nurses learn in their college years will set them up to become lifelong learners. Faculty find satisfaction in teaching in a way that

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will help students to engage in a variety of ways of learning all of what is needed in order

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to practice the profession of nursing.

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A proficient instructor will be able to adapt their approach to how course objectives are

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met as they use a variety of activities, technologies, and experiences. This is where the balance between what the instructor chooses to present based on science and evidence

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and their own intuitive creativity takes place. With that said, responsibility for the learning experience is shared between the nursing student and faculty member. Only

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learning take place.

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when both are engaged in the experience of and are prepared and organized can in-depth

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Almalki M, Fitzgerald G, & Clark M. (2011). Health care system in Saudi Arabia: an overview. Eastern Mediterranean Health Care Journal Oct;17(10):784-93.

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Anderson, I. (2016). Identifying different learning styles to the learning experience. Nursing Standard, 31(7), 53-61.

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Clerehan, R., McCall, L., McKenna, L., & Alshahrani, K. (2012). Saudi Arabian nurses' experiences of studying Masters degrees in Australia. International Nursing Review, 59(2), 215-221.

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Dember, W. (1965). The New Look in motivation. American Scientist, 53, 409–27.

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El-Gilany A.H., Abusaad F. S. (2013). Self-directed learning readiness and learning styles among Saudi undergraduate nursing students. Nurse Education Today. Sep;33(9):1040-4. doi: 10.1016/j.nedt.2012.05.003. Epub 2012 May 27.

Felder R.M. and Silverman, L.K. (1988). Learning and teaching styles in engineering education. Engineering Education, 78 (7), 674–681. Fleming, N. D., VARK: a guide to learning styles (online). < http://varkLearn.com/english/indexasp> (Accessed 2016). Gardner, H. (1993). Multiple Intelligences: The Theory in Practice. A reader. Basic books, New York, NY. Grasha A. F. (1996). Teaching with style: a practical guide to enhancing learning my understanding teaching and learning styles. Pittsburgh, PA: alliance publishers; 1996. Grasha, A. (1981). Learning style: The journey from Greenwich Observatory (1796) to Dalhouise University (1981). Dalhouise Conference, Dalhouise University. 1981, Halifax, Nova Scotia. Honey P. and Mumford A. (1986). Manual of Learning Styles. Peter Honey Publications, Maidenhead. Kolb, D. A. (1984). Experiential learning: Experience as the source of learning and development. New Jersey: Prentice-Hall.

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Leite WL, Svinicki M, Shi Y. (2010). Attempted validation of the scores of the VARK: learning styles inventory with multitrait-multimethod confirmatory factor analysis models. Educational and Psychological Measurement 70:323–339.

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Myers, I. (1975). Myers-Briggs Type Indicator. Manual. Consulting Psychologist Press, Palo Alto, CA.

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Nuzhat A., Salem RO, Quadri M. S. A., & Al-Hamdan N. (2011). Learning style preferences of medical students: a single-institute experience from Saudi Arabia. International Journal of Medical Education, 2, 70-73.

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ACCEPTED MANUSCRIPT Figure 1: Education levels, by nationality

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Educations Level, by Nationality 10 9

Saudi national

Non-Saudi

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8 7

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6 5 4 3

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Masters

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Bachelor

PhD

ACCEPTED MANUSCRIPT Figure 2: Faculty self-reported time spent and VARK strong learning (unimodal) preference of their students

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80

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70 60

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50

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40 30

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20 10 0

Aurel

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Visual

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Faculty Time

Read/Write

Reported students preference Kinesthetic

ACCEPTED MANUSCRIPT Table 1: Inventory of teaching methods used, by area of teaching (theory, seminar, lab, or clinical) SEMINAR

LAB

CLINICAL

(n= 16)

(n=12)

(n=18)

(n=15)

Pictures

13

11

17

Videos

15

11

PowerPoint

15

11

Symbols

4

4

Drawings

4

2

Demonstration

9

9

Term papers

10

Multiple choice

13

17

14

5

4

3

3

13

13

9

10

11

6

8

7

6

6

6

6

8

8

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13

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9

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Lecture notes

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7

14

17

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Read/write Lists

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Visual

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THEORY

Reading and writing in medical charts

3

2

3

3

Textbook readings

6

6

7

7

Lectures

11

10

14

10

Discussions

12

9

13

10

Tutorials

8

7

8

8

MP3

0

0

0

0

Practicing verbal orders

5

5

6

6

Summarizing

8

8

11

10

Aural

Kinesthetic

ACCEPTED MANUSCRIPT 8

8

13

12

SimLab

5

4

7

8

Role-play

6

5

8

7

Case studies

12

9

14

Acting

3

3

6

Movement

5

4

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7

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Clinical skills

11 6 8

ACCEPTED MANUSCRIPT Research Highlights The hypothesis was that nurse faculty teaching methods may line up with student learning style preference

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This article addresses the current practices and proportions of time spent on different teaching modalities in a single nursing college in Saudi Arabia

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Visual and Kinesthetic were the most used teaching styles, the students reported a preference for Kinesthetic and Aural (listening and speaking)

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