The assessment ofstudent nurse learning styles using the Kolb Learning Styles Inventory

The assessment of

the students. Nurse educators are urged to re-examine perceptions and assumptions about student learning needs.

student nurse

learning styles using the Kolb Learning

Styles Inventory Stephen J Cavanagh, Kevin Hogan and Terenlall Ramgopal

Stephen J Cavanagh RGN, PhD, Visiting Professor, Nene College, UK. Kevin Hogan PhD CPsych, School of Health Sciences, Universit), of Wolverharnpton, UK Terenlall Ramgopal RGN, MA, Shropshire and Staffordshire College of Nursing and Midwifery, UK (Requestsfor offprints to SJC, CEO, Birmingham & Solihull CoNM, Queen Elizabeth Medical Centre, Edgbaston, Birmingham B 15 2TH, UK) Manuscript accepted 15 June 1994

The learning styles of 192 Registered General Nursing/DipHE students was determined using the Kolb Learning Styles Inventory prior to the students having any formal contact with lecturing staff. The percentage of students having a predominantly concrete learning style was 53.7%, while 46.3% were predominantly reflective. This finding is in keeping with those of Laschinger & Boss (I 984), who suggest that they are supportive of Kolb's theoretical tenet that concrete learners tend to choose people-oriented professions. Chi-squared tests were used to determine if the respondent's learning styles varied with either age, sex or having been in employment prior to becoming a nursing student; no statistically significant associations were found. A further chisquared analysis was performed to see if there was a relationship between learning style and those students who possessed: I) only the DC test, 2) O-levels as highest qualifications, and 3) A-levels as highest qualifications - no statistically significant associations were found. There remain measurement problems with the Kolb inventory, and a discussion of some of these issues are presented. The findings have reinforced the need for using a variety of delivery styles with students, with an emphasis on participation and experiential learning. This need for variety is essential given the distribution of learning styles found with

Nurse Education Today (l ?95) 15, I77-183 © 1995PearsonProfessional/td

BACKGROUND There has been considerable researching into learning styles during the past few years, particularly in determining the learning styles of student nurses (Highfield 1988, Wells & Higgs 1990) and how students learn (Davis 1990, O'Kell 1988, Ramprogus 1988). Several reasons have been advanced for this including increased pressures to optimise learning opportunities offered to students (Fox 1984). Others include demographic and economic changes. These issues are important considering the prospect of a drop in the number of 18-yearold nursing recruits anticipated to take effect in the middle of this decade. Strategies to recruit mature and second career learners are proving effective as a countermeasure to date, yet in light of this non-traditional entrant pool, Hodges (1988) argues that it is important to identify 'types' of learners that are attracted to nursing to ensure their achievement, satisfaction, and retention. Thus, increasing knowledge about student learning styles is seen as important when considering success and dropout rates, as well as a student's overall performance. Research has also been conducted to determine the impact of matching student learning style to the delivery of learning materials; this has resulted in inconclusive findings (Cavanagh & Coffin 1994). Researchers and educationalists have developed a variety of methods to understand and assess the learning styles of students. Pre-eminent in this field has been Kolb (1976, 1985). This article ~ present a theoretical and methodological overview of the Kolb's Experiential Learning Model, and a review of our current knowledge about the learning style of nursing students. An account is presented of how the Kolb Learning Styles Inventory (K-LSI) was used with a sample of Registered General Nurse/DipHE students; methodological and practical issues are discussed for nurse educators.

KOLB'S EXPERIENTIAL LEARNING MODEL The Experiential Learning Model (Kolb 1976) views learning as a process involving a four stage cycle: 1) concrete experience, followed by 2) observation and reflection, which leads to

178 NurseEducationToday 3) formation of abstract concepts and generalisations, resulting in 4) hypotheses which will be tested by future actions leading to new experiences. In order to be an effective learner Kolb & Wolfe (1981) advocate that a learner needs some of all four abilities. This model is of particular interest because it reflects the nature of professional nursing with its blend of action, experience and cognition. Kolb's model, in addition to offering a useful approach to understanding how people learn, also postulates an important relationship between membership of a profession and learning styles; specifically learning styles are developed that reflect the special needs and learning demands of the discipline. Thus, the learning competencies of professions can act to shape the learning styles of members of that profession. Evidence for this is offered by Kolb & Wolfe (1981) with their findings that engineers had a predominantly convergent style, and that engineering environments had corresponding abstract and symbolic learning requirements for its members. Similarly social workers were found to have a divergent style and a work environment predominantly with a concrete and affective requirement. And in nursing, Laschinger & Boss (1989) established a link between predominant learning styles and perceptions of nursing learning environments. Those students with concrete learning styles had a significantly less positive attitude towards theory based learning than those with abstract learning styles. The implications of this finding for nursing is that 'the promotion of abstract competencies for nursing students may be useful in fostering more positive attitudes towards theory based practice' (Laschinger & Boss 1989, p221). This last finding can be considered as giving support to Kolb's assertions about the link between professional environments and practitioner learning styles. Kolb, in acknowledging links between characteristics of a discipline and the learning style of its members, recommends that professional learning attempts to develop all types of learning competencies. This is important for ensuring responsiveness to changes within the profession and for future career development. The wider significance of this, however, is that individuals with learning styles which are incongruent with those required by the profession may change style or leave.

KOLB'S LEARNING STYLE INVENTORY The components of the Experiential Learning Model can be assessed by using the Kolb

Learning Styles Inventory (L~LSI). Kolb advocates that there must be some involvement on the part of the learner (concrete experience (CE)), which is reflected upon (reflective observation (RO)), which in turn leads to concept formation (abstract conceptualisation (AC)), which is then used to make decisions and solve problems (active experimentation (AE)). The K-LSI assesses the scores of an individual on each of the four stages of the learning model, producing a measure of the extent to which an individual emphasises abstractness over concreteness is represented numerically by AC-CE, and that of action over reflection by AE-RO. These last two components of the K-LSI are often represented by a graph with AC-CE being the vertical axis and A E - R O the horizontal axis. Representing student scores in this way leads to the plotting o f A C - C E vs AIL-RO into one of four quadrants, each representing a prevalent learning style. The quadrants are labelled converger, diverger, assimilator and accomodator. The prevailing characteristics of each quadrant can be characterised in the following way:

Converger. Individuals appear to perform best in situations where there may be a single correct answer to a problem, and in these situations a hypothesis testing approach to reasoning is employed. Such individuals tend not to be peopleoriented. The greatest strength ofa converger is in the practical application of ideas. Diverger. Divergers are considered to possess opposite learning characteristics to convergers. Divergers have the abifity to look at problems from a variety of perspectives; to take ideas and organise them into a coherent whole. They like concrete experience and reflective observation, and are often people-oriented. The greatest strength of a diverger is in imaginative ability.

Assimilator. Assimilators are considered to have strengths in inductive reasoning and in producing coherent explanations from a variety of observations. They are less people-oriented and less practical than other learners. The greatest strength of an assimilator is in their ability to create abstract models for explaining phenomena.

Accomodator. Accomodators are considered to possess opposite learning characteristics to assimilators. These individuals perform well in situations where there is a need for adapting to new situations rapidly. The use of intuition and trial-and-error approaches are used to solve problems, and they rely on information being given by others rather than the collection of data by themselves. They are people-oriented and are active learners. The greatest strength of an accomodator is the ability to carry out plans of action that may be made by others.

KolbLearningStylesInventory 179

LEARNING STYLES OF NURSING STUDENTS Several studies have attempted to identify student nurses' learning styles and correlate such findings with other variables (Merritt, 1983). The K-LSI has been used with a variety of nursing students, and the predominant learning style in most studies has been found to be concrete (Marcinek 1983, Seiderman 1983, Staton-Cross 1988). Such findings are consistent with Kolb's view that individual's associated with human-related professions tend to adopt concrete learning styles and are personoriented. Other findings have also been reported by Hutch (1981), who identified in a study of 148 student nurses a primary learning style of accommodation, while King (1984) established that a group of 79 nursing students were accommodators or divergers. In a study using undergraduate nursing students, Rumfelt (1991) in a sample of 187 subjects, found learning styles to be predominantly assimilation and divergence. Thus, a wide range of findings have been reported, variations which are often accounted for by citing psychometric problems with the Kolb instrument (DeCoux 1990). Assessing student nurse learning styles is not always straightforward, and difficulties have been expressed by Ramprogus (1988) in classifying subjects into learning styles when scores on learning styles were similar. In such situations the idea of an 'all-rounder' has been suggested. Building on Kolb's idea that professional environments can influence learning styles, Ramprogus (1988, p 63) postulates that students start their careers as 'all-rounders' and learning styles are later influenced by socialisation and training. Researchers have also investigated the relationship between learning styles and other factors. Hutch (1981) found a statistically significant relationship between satisfaction with the learning programme and learning style, while King (1984) reported contrary findings. Merritt (1983) and Johanson (1987) four~d no statistically significant relationship between age and learning style, while Laschinger and Boss (1984) found no relationship between learning style and the specialty students were studying: Zematis (1987) found no statistically significant relationship between academic performance and learning style, which contradicts the findings of Johanson (1987). It has proven difficult to produce consistent findings when looking for associations between learning style and other factors. The majority of fmdings in the literature has involved North American or Canadian undergraduate nursing students; there has been

relatively little work using Kolb with students from the United Kingdom. Ramprogus (1988) found no relationship between learning style and the ability to solve problems in a sample of 54 students on a traditional Registered General Nurse programme. O'Kell (1988) found that the predominant learning styles of 158 traditional Registered General, Psychiatric and Mental Handicap Nurses were coverger or accomodator, and there was no relationship between learning specialty, age, or previous educational attainment. As part of a collaborative project between the Shropshire and Staffordshire College of Nursing and Midwifery, and the School of Health Sciences, University ofWolverhampton, a project was started aimed at investigating methods ofmaximising the learning potential for pre-registration nursing students. O f special interest was a greater understanding of how students learned within the classroom setting, and an important starting point for this work was considered to be an examination of student learning styles. It is acknowledged that there have been changes in the recruitment patterns of students entering DipHE/RN programmes which has encouraged the recruitment of students with a wide range of ages and academic attainments, and that students may have different learning styles based upon these factors. A filrther dimension of this situation is Kolb's belief that professions can influence the learning styles of its members. It therefore becomes an important theoretical issue to consider a student's learning style before they have had any contact with lecturing staff. Such measures of learning styles would serve as a baseline for further studies with these students during their education.

~

-

#

RESEARCH QUESTIONS The following questions are addressed in this study: 1. What are the learning preferences of D i p H E / R N students at the commencement of their studies? 2. Is there a relationship between learning styles and age, gender, educational attainment, and previous work experience?

METHODOLOGY A total of 192 D i p H E / R N students were administered the K-LSI (II) (described later) and a questionnaire to gain information about a variety of demographic and biographic details.

180

Nurse Education Today

Both instruments had been prepared on a form which could be optically scanned to quicken and improve data analysis. Students were administered the questionnaires within the first week of their training before any formal teaching had commenced. All participants were informed that the questionnaire was part of an investigation and were advised of their rights as human subjects. The K-LSI (II) consists o f 12 questions in which respondents try to describe their learning styles. Subjects rank-order four sentence endings that correspond to the four learning styles o f the Experiential Learning Model. Students were given detailed instructions on how to complete the questionnaire and how to accurately record their responses on the scoring sheets.

Instrumentation T w o forms of the K-LSI have been developed. The original (K-LSI (I)), as described by Kolb (1976), had diffÉculties associated with it. Freedman & Stumpf (1978, 1980) were concerned with the relatively low percentage of total variance explained by the two dimensions of the K-LSI (I), and the relatively low testretest results. Such criticisms led to the development o f the K-LSI (II) (Kolb 1985, Smith & Kolb 1985). The new form of the instrument has a changed format, is easier to read and score, and has clearer administration instructions: this form was used in the study. W o r k by Sims et al (1986) found that the internal reliability o f the K-LSI (II) sub-scales ranged from 0.76 and 0.85 and test-restest indices of 0.24 to 0.66 using 438 undergraduate and postgraduate business students. The internal reliability coefficients of the K-LSI (II) are an improvement on those of the K-LSI (I). These coefficients provide an important measure of the internal reliability of the instrument, in particular, the extent to which performance on one item is a good predictor o f performance of any other item in the same instrument. Under conditions of perfect prediction the coefficient would be 1.0. The results o f these studies suggest that there is, in some cases, a high degree of internal reliability o f scales, and that there is some evidence for the construct validity o f the dimensions of the K-LSI, which is supportive o f the theoretical underpinnings advanced by Kolb. This appears to be the case for a wide range o f undergraduate students including those studying nursing. However, the lack o f stability over time, as reflected in the low test-retest reliability figures, is problematic. Theoretically it is a problem as the Experiential Learning Model postulates that learning styles are relatively stable. Thus, any instrument seeking to identify learning styles should produce reasonable test-

retest reliability coefficients. Sims et al (1986) suggests that there remain measurement problems with the K-LSI (II), in particular that there may be a response set which leads to good internal consistency coefficients but poor testretest findings. This may be because of the ordering of the questions; the first deals with feelings, the second with watching and listening, the third with thinking and logic, and the last with activity and getting things done. The implication o f this are that a respondent's score could be influenced by the ordering of questions and not solely on the questions themselves. A tendency to respond in a certain numerical way would lead to inflated internal consistencies.

FINDINGS

Data were collected and optically scanned. O f the 192 returned forms, only 166 students completed the gender question, this included 139 (83.7%) women and 27 (16.3%) men. Fewer respondents (158) completed the age question, results of which are summarised in Table 1. Participants also possessed a wide range of academic backgrounds, with 39 (22.3%) o f the sample having taken the D C test for entry to the programme, and 42 (21.8%) had A-levels. Ten students had already studied for a degree. Despite the missing data on biographical data there was a much higher return rate o f usable responses (186) to the K-LSI (II) items. Table 2 shows the scores of subjects on the four learning style dimensions of the Kolb inventory. The ratings in the last two columns (ACCE and A E - R O ) identify the degree to which an individual emphasises abstractness over concreteness and action over reflection. Respondent scores on A C - C E and AE-1KO dimensions were plotted. Table 3 shows the distribution of student scores classified by learning style. The percentage o f students having a predominantly concrete learning style (accomodator+diverger scores) was 53.7% while 46.3% were predominantly reflective (assimilator + converger scores). To explore any differences in student learning style preferences associated with demo-

:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::~:~:::::::::::::::~:::::~:::::::::::::::~:::::::::::::::::::::::::::::

iiiiii iiiiiiii iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiil i! ! Age range

Number

% age range

17-19 20-25 26~0 41+

53 51 49 5

33.5 32.3 31.0 3.2

Kolb Learning Styles Inventory

181

!ii{{iiNi{iiiiN i iNiiNiN{}iiiNiiNN!iNNiii{ii{!i{{!i!!i{iiii{ii{!!!ii!!{{!iiii!iiiiii{ii{ii{iiiiiiiii!i{ii{iiiii!iiiiii!ii{iiiiiiiiii!iii{iiiiiiii!i{i!iiiii{iii!i}i!{ii{

Mean Std Dev

Concrete experience

Reflective observation

Abstract conceptualisation

Active experimentation

(CE)

(RO)

(AC)

(AE)

AC-CE

AE-RO

I 0.00 3.33

I I. 13 4.27

I 1.02 3.34

9.55 3.07

1.47 3.36

- I. 13 5.38

graphic or educational backgrounds, a series of analyses were performed. Chi-squared tests were used to see if learning styles varied with either age, sex or having been in employment prior to becoming a nursing student; no statistically significant associations were found. A further series of chi-squared analyses were performed to see if there was a relationship between learning style and those students who possessed, 1) only the D C test, 2) O-levels as highest qualifications, and 3) A-levels as highest qualification: no statistically significant associations were found. An additional post-hoc analyses was performed. The knowledge that a convergent learning style was prominent for this group of students raised the question of whether a relationship existed between learning style and the possession of a mathematics qualification. (The reason for this analysis was Kolb's belief that convergent individuals perform best when hypothetico-deductive approaches to reasoning is used, as in mathematics.) A chi-squared analysis was performed to see if there was a statistically significant association between learning style and the possession of a pass at mathematics at O - or A-level or as a component o f a B T E C qualification: no association was found. This suggests for this group of students that there is no relationship between possession o f a mathematics qualification and being a converger.

DISCUSSION

Students in this sample were found to have fairly evenly distributed learning styles: there was not an obvious predominance for any one, although the divergent style occurred the most. Yet looking at student scores in the concrete area of learning, 53.7% favoured this approach.

Accommodator I n=

%

Diverger

Assimilator

Converger

48

52

35

51

25.8

27.9

18.8

27.4

In terms of the predominance of students who were classified as concrete learners, these findings are in keeping with that of Laschinger and Boss (1984). These authors have suggested that their findings are supportive of Kolb's theoretical tenet that concrete learners tend to choose people-oriented professions. It is difficult with the results of this study to be confident of supporting this position because of the small percentage of respondents who were classified as being concrete in preference to being reflective. The relationship between preferences for people-oriented professions and learning style warrants further investigation. This finding also has important theoretical ramifications for teaching, learning, and the environment in which such activities take place, because concrete learners are considered by Kolb (1976) to favour learning with experiential components. Laschinger & Boss (1984) advance classroom ramifications of these findings which are appropriate for this study. They stress the importance of using discussion, roleplay, simulation and other activities to be considered alongside formal lectures and presentations, arguing that this will enhance the learning of those students favouring an experiential approach to learning. This is problematic however, because group scores are presented here and in other studies, whereas it is ultimately the individual who must be assisted to develop their learning abilities to the maximum potential facilitated by the teaching and learning environment. Kolb stresses that it is equally important to develop non-dominant modes of lean-ring ai~d to ensure that teaching activities permit all students to learn. Non-significant findings with indices such as gender, age and educational level suggest that these measures may not be important in influencing learning styles for those individuals who enter nursing. Similar findings have been reported by other authors (Merritt 1983, Johanson 1987) and it is likely with the increasing amount of evidence that factors such as gender or age have little or no impact upon learning styles. Kolb's notion that professions can influence individual member learning styles is an important one. When a relationship was looked for between those who had commenced their

182

Nurse Education Today

nurse training immediately upon leaving school and those who had prior paid employment, no relationship was found. In all likelihood, the methodological approach of creating a simple binary division o f employment/no employment was not sensitive enough to identify all the possible combinations of an individuals experience. From this study at least, it has not been possible to make any inferences about the impact of employment on learning styles. These findings have reinforced the need for using a variety o f learning styles. These findings have reinforced the need for using a variety of delivery styles with students, with an emphasis on participation and experiential learning. This need for variety is essential given the distribution o f learning styles found with the students. The lack of an obvious predominant learning style will require, as Ramprogus (1988) rightly suggests, nurse educators to re-examine perceptions and assumptions about student learning needs.

Methodological issues There remain a number of problems with the K-LSI (II). As a research instrument it does not allow for differentiation between various elements in the target population in any consistent manner. For example there is no definitive statement as to the relationship between nursing specialty and preferred learning style, and there is little evidence of a clear match between learning preferences and overall performance on a course. The learning styles as identified by the KLSI (II) are almost certainly not stable, enduring traits along the lines of personality traits; but instead may be determined, in part, by the respondents self-knowledge and experience. These two variables are not independent o f one another; it could be the case that only after having been taught using a particular method, and succeeded in the assessment does a clear view o f relative preferences emerge. Similarly there is a tendency in the literature for respondents to view their job and learning needs to evolve over time - particularly as people begin to question the delivery and content of formal learning experiences in the light o f their experiences in clinical settings. There could also be a significant attitudinal component to the instrument. If this were the case a higher correlation between the KLSI (II) and a satisfaction scale could be predicted which taps more directly into the underlying variables than the correlations between the K-LSI (II) and a performance scale (such as final scores on a test). It must also be recognised that experiences of learning and training can colour the perceptions formed; the personality of the trainer, the room, timetabling, as well as the balance o f theoretical and practical material

presented. Consequently the overall importance o f the factors tapped by the K-LSI (II) can vary dramatically insofar as they drive students underlying attitudes towards what they are experiencing. Thus the relative importance o f the views expressed in responding to the KLSI (II) may vary over time, in terms o f their salience in determining attitudes, work levels and work efficiency. This being the case, reliability and validity of the K-LSI (II) could be dramatically affected to the extent that it measures attitudes rather than the fundamental underlying traits. Thus, using the K-LSI (II) could amount to being snap-shot research. If nothing else there is an obvious need for a longitudinal study employing this technique. The systems model of training evaluation and training itself would suggest that an instrument such as Kolb's LSI would have low predictive validity and test re-test reliability - insofar as it is influenced by attitudes and experience. With these concerns about the psychometric properties of the K-LSI (II) and the relative inconsistency o f findings, it is important to appraise the importance o f this instrument for nurse education. D e C o u x (1990, p207) is scathing in her condemnation of the Kolb instrument and concludes: 'The use o f the Kolb SLI in nursing education is not recommended due to the documented instrument weaknesses and the general lack of correlation between learning style.., and other variables...'. Such criticisms are levelled primarily at the K-LSI, and on balance appear justified. The Experiential Learning Model however, remains a useful framework for understanding learning, particularly professional learning. Despite these well considered approaches for rejecting Kolb's inventory, there nevertheless remains the imperative to ensure that students are given the optimum environment for learning and to ensure that students complete courses. To this end, educators will continue to explore avenues to understand more fully h o w students learn. REFERENCES

Cavanagh SJ, CoffinD A 1994 Matchinginstructional preference and teaching styles: a review of the literature. Nurse Education Today 14:106--110 Davis B D 1990 How nurses learn and how to improve the learning environment. Nurse Education Today 10:405-409 DeCoux V 1990 Kolb's learning style inventory: a review o£its applications in nursing research.Journal of Nursing Education 29 (5): 202-207 Fox R D 1984 Learningstylesand instructional preferences in continuing educationfor health professionals: a validitystudy of the LSI.Adult Education Quarterly 35 (2): 72-85 Freedman R D, Stump£S A 1978What can one learn from the Learning StylesInventory?Academyof ManagementJournal 21:275-282 Freedman R D, StumpfS A 1980 Learningstyletheory:

Kolb Learning Styles Inventory

less than meets the eye. Academy of Management Review 5:445-447 Highfield M E 1988 Learning styles. Nurse Educator 13 (6): 30-33 Hodges S A 1988 Individual learning styles of student nurses, their teachers and ward sisters. Journal of Advanced Nursing 13:341-344 Hutch M 1981 Adult students' locus of control, learning styles and satisfaction with the baccalaureate nursing programme. Unpublished doctoral dissertation, University of Mississippi Johnason L S 1987 An investigation of learning styles of baccalaureate student nurses. Unpublished doctoral dissertation. University of Northern Illinois KingJ E 1984 A comparative study of adult development patterns of generic students and R N students in a baccalaureate nursing programme and the correlation of impact of the education experience on the development pattern. Unpublished doctoral dissertation, Vanderbilt University Kotb D A 1976 Learning style inventory. Technical manual. Mcber, Boston Kolb D A 1985 Learning style inventory: technical manual McBer, Boston Kolb D A, Wolfe D 1981 Professional education and career development: a cross-sectional study of adaptive competencies in experiential learning. Case Western Reserve University, Dept of Organisational Behavior, Cleveland, Ohio Laschinger H K, Boss M W 1984 Learning styles of nursing students and career choices. Journal of Advanced Nursing 9:375-380 Laschinger H K, Boss N W 1989 Learning styles of baccalaureate nursing students and attitudes towards theory-based nursing. Journal of Professional Nursing 5 (4): 215-223 Marcinek M A 1983 An analysis of learning styles of R N students. BSN students and nurse educators in a

18]

baccalaureate nursing program. Unpublished doctoral thesis, West Virginia University Merritt S L 1983 Learning style preferences of baccalaureate nursing students. Nursing Research 32: 367-372 O'Kell S P 1988 A study of the relationship between learning style, readiness for self-directed learning and teaching preferences of learner nurses in one health district. Nurse Education Today 8:197-204 Ramprogus V K 1988 Learning how to learn. Nurse Education Today 8:59-67 Rumfelt J J 1991 The relationship of learning style and type of instruction about AIDS with achievement and attitudes of college nursing students. Unpublished doctoral dissertation, Southern Illinois University Sims R R, Veres J G, Watson P, Buckner K E 1986 The refiability and classification stability of the learning style inventory. Educational and Psychological Measurement 46:753-760 Seiderman M N 1983 Student nurse learning styles based on experiential learning theory from three types of nursing programs. Unpublished doctoral thesis, University of Southern California Smith D, Kolb D A 1985 User guide for the learning style inventory. McBer, Boston Staton-Cross D L 1988 Relationship of learning styles, learning preferences, and learning autonomy among learners in two associate degree nursing programs: traditional and non-traditional. Unpublished doctoral dissertation, Boston College Wells D, Higgs Z R 1990 Learning styles and learning preferences of first and fourth semester baccalaureate degree nursing students. Journal of Nursing Education 29 (9): 385-390 Zematis M L 1987 Learning styles, learning preference, and registered nurse students in baccalaureate programs. Dissertation Abstracts International 47: 4304A