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Study habits and attitudes are among the main factors influencing academic performance. Studies have shown that students with proper time management, concentration and positive learning attitudes performed better in academics (20,21,22). Socio-demographic factors especially gender, residence area, stable socio-economic status and family education background have positive associations with academic performance. The main objective of this study is to identify the influence of learning styles on academic performance among MMMC students.
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INTRODUCTION
Competency‐based education is the main objective of medical education (1). The curriculum and assessments of student’s academic performance are built on the foundation to produce clinicians who are competent in knowledge, skills and attitude (1,2). At most medical schools, various tools are implemented to assess students’ knowledge, understanding and clinical skills as a continuous medical education assessment (2,3,4,5). To achieve the standard requirements set by the institution and to qualify as a competent clinician, students are motivated to learn and perform well in all assessments (6).
Students’ potential can be tied to learning preference (7,8). Learning styles are defined by Kolb and Brown as the preference of one learning method over another to perceive and process new information including strategies that are consistently adopted to learn (7,9,10,11). By identifying the dominant learning style, one can potentiate their capabilities and strength followed by enhancing the effectiveness of learning experience (7,10). This will guide students to plan or to modify their learning methods parallel to the learning preference (12,13). Difficulties in learning are predominantly due to problems in cognitive process as in learning methods and not due to the subject itself (14).
Studies showed variable distribution of learning styles among students but there is lack of evidence to suggest impact of learning styles on academic performance among medical students in specific (4,15,16,17,18). A study done in Malaysia among secondary school students showed a strong association between learning styles and overall academic performance with predominantly visual and auditory learners (19). In another study in Trinidad, amongst highest performing undergraduate students, 67% were visual learners and the remaining were kinaesthetic learners (15).
Study habits and attitudes are among the main factors influencing academic performance. Studies have
shown that students with proper time management, concentration and positive learning attitudes performed
better in academics (20,21,22). Socio‐demographic factors especially gender, residence area, stable socio‐economic status and family education background have positive associations with academic performance (23,24,25). The main objective of this study is to identify the influence of learning styles on academic performance among MMMC students.
METHODOLOGY
Study design and study population
As a part of an accomplishment to explore the influence of learning style on academic performance among Melaka‐Manipal Medical College (MMMC) students specifically, and to study the learning preference among MMMC students, as well as other factors influencing academic performance generally, an analytical cross‐sectional study was conducted from July 2013 to August 2013. Cross‐sectional study is a class of research methods which involves observation of a certain population or representative subset at a specific point in time. The study was implemented among the MBBS students of MMMC. Melaka‐Manipal Medical College (MMMC) is a medical college established in 1997 by Dr.Ramdas Pai in collaboration with Datuk K Pathmanabam. MMMC has welcomed their first batch of MBBS students in 1997 and currently, it has 32 batches. Here in MMMC, the MBBS program is divided into 2 phases, where students will be completing the phase 1 in Manipal, India for 2.5 years and phase 2 in Melaka, Malaysia for another 2.5 years (26). These groups were pinpointed and used for this research as they represent various levels of education of students in a university.
THE INFLUENCE OF STUDY STYLES ON ACADEMIC PERFORMANCE AMONG MMMC STUDENTS: A CROSS SECTIONAL STUDY
Mohd Farhan bin Omar, Vithyalakshmi a/p Raja Balan, Mohd Ediamin bin Suhaimi, Muhammad Redzwan bin Abdullah, Nurfatin bt Hasanuddin (Melaka‐Manipal Medical College)
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Sample size calculation
According to a study done in Trinidad, it was found that the prevalence of students with Visual style of learning (V) having CGPA 3.60 and above was 67% (15). Thus, with this prevalence, and margin of error of 6%, a sample of 165 students was found to be the minimum number required in order to conduct this research. This minimum sample size was calculated based on the following formula;
n= Z2p(1‐p)
d2+ [Z2p(1‐p)]
N
Z is determined by the acceptable likelihood of error. The value of Z is set to 1.96, representing a margin of error of 6% (d). N is a total population that we take into consideration which is 550. Then, we confirmed the sample size calculation by using EpiStatcalc (31).
Diagnostic, inclusion and exclusion criteria
In this study, we evaluated and allocated the learning style of the students into 5 groups; Visual (V), Auditory (A), Read/Write (R), Kinesthetic (K) and Multimodal (more than one styles, M) based on the scoring system designed by Neil Fleming, the pioneer of VARK learning styles, on 1987, in New Zealand (28). The students involved in this study were those from fourth and fifth year MBBS students consisted of batch 24, 25 and 26. In addition, the inclusion criteria also comprised of those who have given their consent voluntarily and those who are fulltime students of MMMC. Albeit the consent given voluntarily, there were still some results that have to be excluded in this study, which were those that did not complete all the questions, and those who inappropriately answered the questionnaire by the continuous circling of one single option constantly. Moreover, the students who have not yet seated for the Sessional Examination, which was the guideline used for portraying the academic performance, were also excluded in this study. We obtained the consent from the Ethical Committee of MMMC prior to commencement of this study with assurance of confidentiality and privacy.
Sampling method and Data collection
We designed and distributed a set of questionnaire to these students at the MMMC campus during lecture hours. The questionnaire comprised of basic socio‐demographic data, VARK questionnaire (version 7.2) designed by Neil Fleming (29) and also additional series of questions on study skills and habits constituted of time management, attitude and concentration that was invented by Queens University (30). We applied the universal sampling in selecting the participants, where we selected the students from the above mentioned groups due to easy accessibility, availability and ease of their volunteering.
We established this questionnaire specifically to combine various socio‐demographic details, to ascertain the learning style of the students, to measure quantitatively the study skills and habits of each student, along with few other factors which were anticipated to reciprocally associate to the outcome of this study, which was the students’ academic performance. The questionnaire has 2 components, Section A; Socio‐demographic data and Section B; Assessment where the first part was VARK questionnaire and the second part was a set of questions for study skills and habits. Some of the spectrums covered in the socio‐demographic data were concerning the batch of the students, course, roll number, age, gender, ethnicity, religion, relationship status, residence area, current accommodation, current posting according to departments in medical course, scholarship, monthly allowance, household monthly income and parents’ level of education. The first part of Section B which was VARK questionnaire explored different individual styles of learning (question number 1‐16). This part was assessed into Visual (V), Auditory (A), Read/Write (R), Kinesthetic (K) and Multimodal (more than one styles, M), based on VARK questionnaire scoring chart where the highest score will be the dominant learning style of an individual. The VARK questionnaire scoring chart comprising of all the answers for all 16 questions according to each category, Visual (V), Auditory (A), Read/Write (R) and Kinaesthetic (K).
The second part of Section B, a series of questions on study skills and habits (question number 19‐31), was set up and the students were required to answer those questions on a Likert scale, ranging from (1) to (5), in which (1) signifies Strongly Disagree (SD), (2) signifies Disagree (D), (3) signifies Neutral (N), (4) signifies Agree
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(A) and (5) signifies Strongly Agree (SA). These scores were then summed up in 3 categories which were Time Management (question number 19, 22, 25, 28, 29, 31), Attitude (question number 20, 23, 26) and Concentration (question number 21, 24, 27, 30).
Data processing and analysis
For data processing, we gathered all the data and manually counted the total score of each questionnaire followed by each component. Later, we entered all of these data into and processed using Microsoft Excel 2010. Further statistical analysis was calculated and obtained from Epi‐Info7 version 3.5.1. We calculated descriptive statistics which comprises of measures of central tendency such as mean, median as well as measures of dispersion like standard deviation and quartile value.
We described the mean and standard deviation for age, monthly allowance and studying hours, while we used median as the cut of point in determining the quality of the study habits that comprised of time management, attitude and concentration. For categorizing the academic performance into upper and lower achievers, based on surgery marks, we used Quartile 3 at 67% as the benchmark. In illustrating the results, we used tables, bar and pie charts. All 5 tables that we composed were tables for descriptive statistics of basic variables, percentage of students with high and low academic achievements, comparison of different learning styles amongst high academic achievers and low academic achievers, and also the table for characteristics via quantitative as well as qualitative analysis amongst good academic performance and bad academic performance. We used bar charts to portray the distribution of learning styles on academic performance, the distribution of students’ accommodation on academic performance, the distribution of academic performers with different study methods and the achievements in academic performance amongst different ethnicities in MMMC, while we used pie chart to illustrate the distribution of learning style amongst MMMC students.
In terms of inferential statistics, we used T test, Chi square and Fisher’s exact. We used the T‐test to study the link between the other quantitative variables with academic performance. The qualitative variables were then categorized and we utilized the Chi‐Square test as
well as the Fisher Exact two‐tailed test to compare them to the academic results. Level of significance was set at 0.05; odds ratio with 95% confidence interval was described.
RESULTS
We calculated a minimum sample size of 165 subjects and distributed a total of 275 questionnaires out of which we obtained 182 respondents, resulting in a 66.2% respond rate.
Table I: Descriptive Statistics of Basic Variables (n=182)
Variables N (%)
Batch 24 25 26
46(25.3) 76(41.8) 60(33.0)
Age (mean ± SD)
23.47 ± 1.01 (22.46 ‐ 24.48)
Sex Female Male
102(56.0) 80(44.0)
Ethnicity Malay Chinese India Others
74(40.7) 59(32.4) 38(20.9) 11(6.0)
Religion Muslim Buddhist Christian Hindu Others
77(43.2) 43(23.6) 22(15.4) 27(14.8) 7(3.8)
Relationship status Single Married In a relationship
125(69.1) 6(3.3) 50(27.6)
Residency Urban Rural
149(81.9) 33(18.1)
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Accomodation Hostel Staying at home Staying with friends Staying with relatives
117(64.3) 9(4.9) 55(30.2) 1(0.5)
Current Posting A&E ENT Medicine ONG Ophthalmology Orthopaedics Paediatrics PCM Psychiatry Surgery Community Medicine
7(3.8) 10(5.5) 30(16.5) 7(3.8) 9(4.9) 31(17.0) 19(10.4) 6(3.3) 5(2.7) 22(12.1) 36(19.8)
Financial Support JPA MARA Parents PTPTN Others
81(44.5) 29(15.9) 49(26.9) 19(10.4) 4(2.2)
Allowance per month (mean ± SD)
771.62 ± 477.50 (294.12 ‐ 1249.12)
Household income (mean ± SD)
5895.60 ± 3834.96 (2060.64 ‐ 9730.56)
Parent’s education Father: Primary Secondary Pre‐university Diploma Degree Master PhD Mother: Primary Secondary Pre‐U Diploma Degree Master PhD
8(4.4) 47(25.8) 3(1.6) 31(17.0) 63(34.6) 24(13.2) 6(3.3) 16(8.8) 67(36.8) 5(2.7) 34(18.7) 45(24.7) 11(6.0) 4(2.2)
Learning Style Visual Audio Read Kinaesthetic Multimodal
27(14.8) 20(11.0) 37(20.3) 61(33.5) 37(20.3)
Time Management Good Poor
71(39.0) 111(61.0)
Attitude Good Poor
182(100) 0(0)
Concentration Good Poor
63(34.6) 119(65.4)
Study Hours (mean ± SD) 2.60 ± 1.34 (1.26 – 3.94)
Study Method Group studying Self‐ studying
56(30.8) 126(69.2)
From Table I, the mean age of participants was 23.47 years. Amongst the students who participated, 56.0% were females as compared to the 44.0% males. 41.8% of them were from Batch 25, 33.0% from Batch 26 and 25.3% from Batch 24. In regards to ethnicity, 40.7% were Malay, 32.4% were Chinese, and 20.9% were Indians while the remaining 6.0% were of other ethnicities. 69.1% of our respondents were single, 27.6% were in a relationship and the balances were married. Besides that, we could also conclude that 81.8% resides in urban area and the remaining 18.1% from rural area. Most of them are currently staying in hostel with 64.3% and other 35.7% are staying off campus. Of all the participants 37.3% were non‐scholarship while the remaining 62.6% were under scholarship. The mean monthly allowance for the students was RM771.62. With respect to parent's education level, 31.8% of fathers and 48.3% of mothers were of the lower education level (primary, secondary and pre‐university level). From our survey, 33.5% of the students are kinaesthetic learners followed by 20.3% of reading and multimodal learner each and visual learner with 14.8% and the least is audio
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learner with 11.0%.
Table II: Percentage of Students with High and Low Academic Achievements (n=182)
Academic Performance (67th percentile)
Number of students (%)
High 32.2
Low 67.8
The table above shows that 32.2% of students scored under high academic performance. 67.8% of students scored in low academic performance.
Table III: Characteristics via Quantitative Analysis amongst Good Academic Performance and Bad
Academic Performance (n=182)
Independent variables
High academic performance mean (SD)
Low academic performance mean (SD)
T test
P value
Age (years)
23.61(1.00) 23.41 (1.01) 1.27
0.205
Allowance (RM)
757.63(507.26)
778.33(464.55)
0.27
0.785
Studying hours
2.72(1.06) 2.55(1.46) 0.81
0.422
Household income
5362.71(2713.75)
6151.22(4256.16)
1.30
0.195
*Significance level set at 0.05
This table show that age, allowance, studying hours and household income are not significant (P value > 0.05).
Table IV: Comparison of Characteristics via Qualitative Analysis amongst High Academic Performance and Low
Academic Performance (n=182)
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Independent variables High academic performance (n=59) (%)
Low academic performance (n=123) (%)
OR (95% CI) Chi square P value
Gender Male Female
39.0 61.0
46.3 53.7
0.74 (0.37 ‐ 1.46)
0.88
0.349
Ethinicity Malay Chinese Indian Others
23.7 52.5 18.6 5.1
48.8 22.8 22.0 6.5
0.33 (0.15 ‐ 0.69) 3.76 (1.84 ‐ 7.70) 0.81 (0.35 ‐ 1.89) 0.77 (0.16 ‐ 3.36)
10.37 1.14 0.26
0.001*** 0.001*** 0.607 1.000
#
Religion Muslim
23.9
51.2
0.30 (0.14 ‐ 0.63)
12.35
0.0004***
Buddhist Hindu Christian Others Accomodation Hostel Staying with friends Staying with home
37.3 11.9 22.0 5.1 78.0 16.9 5.1
17.1 16.3 12.2 3.3 57.7 36.6 4.9
2.89 (1.35 ‐ 6.22) 0.69 (0.25 ‐ 1.88) 2.03 (0.83 ‐ 4.97) 1.59 (0.27 ‐ 8.80) 2.59 (1.21 ‐ 5.63) 0.35 (0.15 ‐ 0.81) 1.04 (0.20 ‐ 4.94)
9.03 0.61 2.97 7.12 7.29
0.0027*** 0.4349 0.0851 0.6834
#
0.0076*** 0.0069*** 1.0000
#
Parents Education level
Mother’s education level (High) Father’s Education Level (High) Study Method Group
Self
35.6 39.0 18.6 81.4
59.3 28.4 36.6 63.4
0.38 (0.19 ‐ 0.75) 0.62 (0.31 ‐ 1.26) 0.40 (0.17 ‐ 0.89)
9.01 2.04 6.03
0.0027*** 0.1536 0.0140***
Time Management Good Poor Concentration Level Good Poor
35.6 64.4 32.2 67.8
40.7 59.3 35.8 64.2
0.81(0.4 ‐ 1.61) 0.85 (0.42 ‐ 1.73)
0.43 0.22
0.5127 0.6357
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DISCUSSION
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students who may face problems such as transport and safety. In comparison, the off‐campus students have more distractions such as the television, having to settle utility bills and no curfew; whereas, staying in campus allow students to study at their own pace, time and place (36) conveniently.
From our research, we discovered that, the mother’s level of education is significantly associated with the child’s academic performance. In other words, if the mother’s level of education is low then the child’s academic performance would be higher. In our opinion, such coincidence could be due to circumstances where the low educated mother is a housewife or self‐employed. Thus, this category of parent spends more time with the child and is more likely to be actively involved in the child’s affairs (38,39), especially in education, such as attending parents’‐teachers’ meetings in school, giving parental guidance and support in completing the assignments given, and enhancing the child’s thinking skills by the mother herself. Hence, this promotes the child’s interest in his/her studies. Good mother‐child’s communication may help in nurturing positive attitude in a child. As a child grows up, he/she may have good motivational skills and high self‐esteem. Some students also portray low educated mothers who work hard to support the family as an inspiration to work even harder in their academic performances. This phenomena is one of the contributing factors in better academic performances amongst students.
In our next variable, we compared the marks scored between students who self‐study and those who do it in a group. Based on our study, we were able to demonstrate the positive association between students who self‐study and the marks they achieved in an examination are much higher than the once scored by students who study in groups. The different in the scores might be due to the flexibility of the individual students in determining the time, pace and arranging the study schedule as they do not have to be concerned about their group members (40). Besides, each student is weak in a certain topic and/or subject, and it is easier to overcome this weakness with the self‐adjusted study schedule as each individual is uniquely different from one and the other (41). Group studies require high discipline and cooperation from all the members in order to ensure smooth a learning process. However, this can be difficult to achieve. Hence, most students with good academic
performances choose to study on their own. Self‐study is believed to help maintain a student’s self‐esteem as there is no fear of criticism, thus improving the creativity in delivering the student’s ideas and intelligence. Likely, self‐study also encourages students to be more independent as one has to work hard in finding the learning materials and solving problems on their own. Independence in learning encourages students to put the best effort in their studies thus resulting in good academic performances (42). As time passes, they also become more self‐confident, able to address problems independently and through their own first‐hand experience, are knowledgeable and wiser.
Studies done in America and Pune proposed that students with good time management quality are more efficient and effective in their learning process thus positively influenced their academic performance (21, 22). In contrast to the studies done in America and Pune, we found out that the outcome of our study shows otherwise. We discovered that, surprisingly, good time management quality is negatively associated with good academic performance. This is due to the fact that medical students are attached to tight schedule designed by the respective faculties for both theoretical and clinical classes. Furthermore, students are obligated to follow strict regulations set by the college in order to complete the course successfully. Due to these reasons, it is difficult for the students to be faithful to their daily schedule including their studies; and if they are able to do so, most of them may face difficulties to follow it religiously. Therefore, most of the students will study at any time convenient to them and make full use of the holidays and during weekends and during their study leave to do their revision.
Previous studies claimed that concentration quality in the classroom positively affect the students’ academic performances (43, 44). However, our results contradict this fact as good concentration quality is less likely to give good academic performance. From our perspective, the different findings might be due to the reasons that students are not interested in classroom teaching where all the theory lessons take place. The long sessions spent for clinical classes in the hospital which require students to stand and the non‐conducive environment in the wards also influence the students’ ability to concentrate. In spite of this, students are able to pass their examination due to last minute studying
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merely to get through it but negatively this does not help them to acquire knowledge.
As for limitations, there are some really important methodological limitations that may have affected this study. First, our sample size was limited to only 182 students from only three batches from Melaka Manipal Medical College undertaking the MBBS course which means that this cannot be generalized beyond the sample. With a bigger sample size, the results may have been more conclusive. Besides that, this study enumerates only MBBS students and not BDS or FIS who may have different learning styles and quality of study habits that affect academic performances. Moreover, our study was based between the age groups of 22 to 26 year‐olds which limit the ranges of different learning styles with the academic performances that can be appreciated in the different age groups.
Other than this, our results were also based on the academic performances of our students during their Semester Six Surgery Sessional Examination. Sixty‐seven per cent was chosen as the high and low set point. This does not necessarily reflect their academic performances as some subjects may be relatively easier to pass than others. It can also be seen due to their preference in certain subjects, they perform better in these subjects as compared to others. This examination is also not an eligibility examination for the students to move on to the next semester; therefore, the students most likely have taken the particular examination for granted. Last but not least, as our study learning styles are limited to those of the VARK learning style which only has four domains. So, there is no consideration of the other various types of styles these students are exposed to.
CONCLUSION
In this study, we noticed that visual learners have scored best in their academic performances. This fact should encourage educators to prepare the appropriate learning tools by combining pictures and diagrams with different hues in the classroom. However, other students may have different learning styles such as kinaesthetic and reading. Hence, it would be best for the educators to incorporate different methods and tools in teaching like simple demonstrations to illustrate the theories, interactive sessions to encourage students to ensure
active participations in the classroom, and by giving simple examples using day to day activities in order to provide effective and efficient teaching‐learning experience. As for students, identifying and understanding learning styles is important as it sets a ground basis for each individual to plan or modify his/her learning strategy in order to sail smoothly in this competency‐based education and improve their academic performances. This also should encourage them to stretch their capabilities in searching knowledge by making use of their learning preferences. Thus, it is hope that through this study, students are able to have a more holistic approach in their studies making them great, competent doctors.
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