Teaching mode efficiency and learning preferences of first year nursing students

Science education in nursing 

A strong, foundational science knowledge base is important for contemporary nursing practice, however, human physiology and anatomy are perceived by many nursing students to be more difficult than other subjects and is often a source of student ‘anxiety and great difficulty’ (Jordan et al., 1999). Identifying the causal factors for student anxiety and dissatisfaction with human physiology and anatomy has been the focus of a number of studies (McKee, 2002). The diverse educational background of students enrolled in nursing (Jordan et al., 1999, Mckee, 2002), students perception of the importance of human physiology and anatomy to their course and subsequent careers (Jordan et al., 1999), work or family related commitments (Glackin and Glackin, 1998, Lee et al., 1999) and the depth of material and course structure (Jordan et al., 1999) all have been identified as contributing to student anxiety. The majority of students feel that insufficient time is allocated to the human physiology and anatomy considering how much subject content is required.

Common teaching strategies in science education 

Teaching human physiology and anatomy generally involves different teaching strategies. Lectures have traditionally been viewed as a very inexpensive way of presenting new ideas and concepts to a large group of students, identifying the relevance of human physiology and anatomy to student’s courses and profession, and to promote an interest in the subject. However, lectures rarely stimulate student thinking and get information beyond short term memory of students (Ramsden, 2003, Cannon, 1992). Tutorials, or small group learning, traditionally provide students with the opportunity to engage with course material at levels which have personal meaning for them (Lublin, 1987). The tutorial experience can support and encourage a deep approach to learning in the subject as students are encouraged to participate in class activities and discussion. However, tutorials can pose real problems with student ‘passivity, anxiety, repetitive activity and silence’ (Ramsden, 2003). Practicals, or lab based learning, require students to follow instruction to perform experiments, record observations, analyse and interpret data (Hazel and Baillie, 1998). Most practical experiments have been designed to reiterate themes introduced in lectures. The use of practical classes is constantly being reviewed due to increasing cost and reduced availability of resources (Ramsden, 2003). Increasingly, contemporary methods of science teaching include web based interfaces.

Developing an approach to science teaching in one university 

The design of the human physiology and anatomy units has been strongly influenced by consideration of the different learning styles of students. In any student population student diversity is apparent in their preferred style of learning, or the mode in which they take in information (Miller, 2001). Learners preferred mode of learning is related to the sensory modality or the neural system by which they prefer to take in the new information. Although learners can use all sensory modes of learning, one mode is often dominant and preferred. The types of learning have been classified into four categories: visual (diagrams, pictures, symbols and other image rich teaching tools), aural (lectures, tutorials, tapes and exploring material further through discussions), read/write (interaction with textual materials, text books or keynotes) and kinesthetic (learn by touching and experiences) (Fleming, 1995). In developing effective curricula and teaching strategies that promote learning, consideration of the preferred learning styles of students has been viewed as fundamental.

Aim 

The aim of this study was to:

The development of the questionnaire and data collection 

To meet the aims of the study a quantitative study design was deemed appropriate with a questionnaire designed for data collection. The questionnaire consisted of two sections. The first section aimed to obtain student feedback on their experiences of lectures, tutorials and practical classes and to determine if the objectives of these teaching strategies was achieved. The statements used in the study were mostly a closed format where the students were given a Likert scale, to select one of five options. The second section consists of a test to determine the preferred learning style of individuals, devised by Neil Fleming, Lincoln University, New Zealand (Fleming, 1995). The VARK test, visual, aural, reading/writing, kinesthetic sensory modalities determines the different ways of receiving information. It consists of thirteen questions which identifies the preferences of individuals for particular modes of information presentation. The links to the questionnaire and background information is available on the internet from the VARK homepage, http://www.vark-learn.com/english/index.asp. The questionnaire also provided students with the opportunity for any additional comments.

The questionnaire was handed out to students during a timetabled lecture by an administrative assistant unknown to the students. They were informed that the completion of the questionnaire was voluntary and anonymous. Students were given 15min to complete the questionnaire and completed questionnaires were collected by the administrative assistant.

Data analysis 

The survey data were analysed using Statistical Package for Social Sciences (SPSS) Version 12.0.1, initially using frequencies followed by cross-tabulations to generate descriptive statistics. Analysis for the VARK component was performed online, at the VARK home page. Student responses to the questionnaire were entered into the system and their preferred mode of information presentation was returned. The VARK homepage provides the results of over 65,000 individuals and enabled this study result to be compared against the VARK database. Results are presented as a percentage of the total number of completed questionnaires.

Statistical analysis was conducted using the Chi Square distribution test, significance has been noted when the P value was less than 0.05.

Ethics 

Ethics approval for this study was obtained from the Human Ethics Committee of La Trobe University.

Learning styles of first year students 

Student preferences for how they receive information can be singular, two modes, three modes or all four modes of presentation. Table 1 represents the results obtained for this study, revealing that the majority of students, 54%, prefer a single mode of information presentation. Two modes of presentation were preferred by 20% of students, 10% preferred three modes and 16% preferred to receive information using all four sensory modes.

Table 1. Comparison of the learning mode preferences of first year health science students

	Unimodal 54% (46)		Bimodal 20% (17)		Trimodal 10% (9)		Quadmodal 16% (14)
	Visual	11 (5)	Aural/kinesthetic	12 (3)	Visual/read/ kinesthetic	45 (4)
	Aural	4 (2)	Read/kinesthetic	26 (7)	Aural/read/kinesthetic	11 (1)
	Read	17 (8)	Kinesthetic/visual	23 (6)	Visual/aural/read	33 (3)
	Kinesthetic	68 (31)	Visual/read	4 (1)	Visual/aural/kinesthetic	11 (1)

Percentages of first year students who preferred unimodal (visual, aural, read, or kinesthetic modes), or combinations of different modes: bimodal, trimodal or quadmodal information presentation. Data represent percentage of respondents, with the number of respondents in brackets. NT=true none of the time, LT=true little of the time, HT=true half of the time, MT=true most of the time, AT=true all of the time.

Of the students that preferred a single mode of information presentation, more than two thirds, 68%, preferred kinesthetic methods, 17% preferred the read/write approach, 11% preferred visual, while only 4% of students preferred the aural or lecturing presentation mode. Of the students that preferred multiple modes of information presentation, 84% included kinesthetic modes. Of the students that preferred two types of information presentation or bimodal learners, 26% preferred both read/write and kinesthetic, 23% preferred visual and kinesthetic, 4% preferred visual and read/write, while 12% preferred aural and kinesthetic. For those students that preferred three modes of information presentation, 15% preferred the combination of visual, read/write and kinesthetic, 4% preferred aural, read/write and kinesthetic, 12% preferred visual, aural and read/write, while 4% preferred visual, aural and kinesthetic.

Comparison between the results obtained in this study and those from medical students in the USA (postgraduate programme; (Lujan and DiCarlo, 2005)) and the VARK website, which includes almost 65,000 individual responses, reveals interesting differences. Table 2 (http://www.vark-learn.com/english/index.asp) indicates that nursing students at this university have a preference for kinaesthetic information presentation, 37% of students preferred this mode from first year, compared to 18% and 21% for medical students and the VARK website respectively. Twice as many nursing students prefer visual modes (6%), compared to the VARK website (3%). This result is more comparable with the medical students (5%). Half as many nursing students prefer aural modes (2%), compared to the VARK website (4%). Only 10% of nursing students at this university preferred trimodal presentation, compared to 21% of medical students. There was a difference between the percentages of nursing students that preferred all four modes of presentation, (16%), compared with the VARK website which reported 32% of responses.

Table 2. Comparison of learning mode preferences between first year health science students, post graduate medical students in USA and general public responses from VARK website

		Visual	Aural	Read/write	Kinesthetic	Bimodal	Trimodal	VARK
	Nursing (N=86)	6	2	9	37	20	10	16
	Medical students (N=166)	5	5	8	18	16	21	27
	VARK website (N=65,358)	3	4	13	21	15	12	32

Data represent percentage of respondents in each category, with the number of respondents in brackets.

Useful learning experience 

The majority of students found all three teaching strategies, lectures, tutorials and practicals, to be useful. As indicated in Table 3, practical classes were perceived as being of most benefit. The majority of students (85.8%) felt practical classes were a useful learning experience at least most of the time (37%), if not all the time (48.8%). Lectures were the next most useful teaching method, with 70.9% of students responding favourably, although more students responded ‘true most of the time (44.2%) as opposed to all of the time (26.7%). Responses to the ‘usefulness’ of tutorials was more diverse compared to lectures and practicals; 61.6% of students found this method useful. Almost twenty percent (19.7%) of students felt that tutorials were useful ‘little’ or ‘none’ of the time.

Table 3. Student responses to listed questions regarding lectures, tutorials and practical sessions, the benefits of each, the purpose of each teaching strategy and the benefits of integrating lectures with tutorials and practical

	Question	NT	LT	HT	MT	AT
	Lectures were a useful learning experience∗	0	2.3 (2)	26.7 (23)	44.2 (38)	26.7(23)
	Tutorials were a useful learning experience	801 (7)	11.6 (10)	18.6 (16)	31.4 (27)	30.2 (26)
	Practicals were a useful learning experience∗	0	5.8 (5)	8.1 (7)	37.2 (32)	48.8 (42)
	Lectures
	New ideas were introduced in lectures	0	3.5 (3)	10.5 (9)	47.7 (41)	38.4 (33)
	Tutorials
	I get feedback which helps me learn in tutorials	9.3 (8)	11.6 (10)	22.1 (19)	33.7 (29)	23.3 (20)
	Tutorials allow me to verbally demonstrate my understanding of this topic in my own words∗	9.3 (8)	14 (12)	31.4 (27)	24.4 (21)	20.9 (18)
	Tutorials allow me to interact and socialise with other students	7 (6)	13 (11)	24.4 (21)	29.1 (25)	26.7 (23)
	Practicals
	Practicals gave me the confidence to carry out instructions∗	2.3 (2)	2.3 (2)	18.6 (16)	41.9 (36)	34.9 (30)
	Practicals gave me the confidence to observe and document information∗	0	0	20.9 (18)	47.7 (41)	31.4 (27)
	Practicals gave me the confidence to analyse and interpret information∗	0	5.8 (5)	20.9 (18)	46.5 (40)	26.7 (23)
	Practicals have given me good work practice, that will be relevant to my chosen profession∗	8.1 (7)	11.6 (10)	31.4 (27)	30.2 (26)	18.6 (16)
	Practicals allow me to develop relevant professional values, attitudes and interests∗	1.2 (1)	10.5 (9)	34.9 (30)	38.4 (33)	15.1 (13)
	Integration
	Tutorial sessions helped me understand the lecture material∗	5.8 (5)	11.6 (10)	26.7 (23)	36.0 (31)	19.8 (17)
	Practical sessions helped me understand the lecture material∗	2.3 (2)	5.8 (5)	15.1 (13)	34.9 (30)	41.9 (36)
	I have learned to make connections between this subject and others∗	1.2 (1)	8.1 (7)	40.7 (35)	38.4 (33)	11.6 (10)
	I have developed skills needed by my profession∗	5.8 (5)	18.6 (16)	34.9 (30)	29.1 (25)	11.6 (10)

NT=true none of the time, LT=true little of the time, HT=true half of the time, MT=true most of the time, AT=true all of the time. Data represent the percentage of respondents in each category, with the number of respondents in brackets. Statistically significant results are denoted with an asterisk, P>0.05.

Students were asked if they felt lectures were a means of receiving new ideas and information (Table 3). More than 70% of responses were in agreement with this concept, with only 2.3% of responses not viewing lectures as a means of presenting students with new information. Students were asked if they get feedback during tutorials; 31.4% of responses found this statement to be true at least most of the time (Table 3). One third (34.9%) of students’ felt tutorial sessions gave them feedback little or none of the time, 10.5% none of the time and 24.4% less than half of the time. Students were asked if tutorials allowed them to verbally demonstrate their understanding of the topic in their own words. Forty five percent of students believed this occurred most or all of the time (Table 3). More than 23% of students suggested they were unable to verbally demonstrate understanding in the tutorial setting. The majority of students (55.8% true most or all the time) found they interacted and socialized with other students during tutorial sessions (Table 3), however, 20% of students felt they did not socialise or interact with their peers during tutorial sessions.

Students expressed an increase in confidence to initiate and complete a variety of tasks during practical sessions (Table 3). When asked if practical sessions gave students confidence to carry out instructions, to observe and document information and to analyse and interpret information, the majority of students responded favourably. The majority of students (95.4%) felt they had increased confidence to carry out instructions more than half the time during practical classes. All students responded that practicals gave them the confidence to observe and document information more than half of the time. The majority of students (94.2%) felt practicals increased confidence to analyse and interpret data with only 5.8% of students felt this occurred little of the time.

More than 80% of students indicated they had developed good work habits more than half the time during practical sessions (Table 3). Almost twenty percent of students indicated that practicals did not give them good work practice. When asked whether practical sessions develop professional values, attitudes and interests, student responses were that this occurred at least half the time or more (88.4%). However, 8.1% of students reported professional development did not occur during practical classes.

Integration of teaching approaches 

To determine how well the current strategies link concepts, in lectures, tutorials and practicals sessions, students were asked if different teaching approaches to the same subject matter aided in their understanding of human physiology and anatomy (Table 3). In relation to the link between concepts introduced in lectures and follow up discussions in tutorials, 82.5% of students indicated tutorials helped them to understand the lecture material. However, 17.4% of students did not feel tutorials helped them understand concepts introduced in lectures.

In relation to the link between concepts introduced during lectures and then further explored during practical sessions, the benefits of the practical sessions in helping students understand the lecture material was very favourable. The majority of students (91.9%) responded that practical sessions helped them understand lecture material. Only 8.1% of students indicated that practical sessions did not help them further their understanding.

Usefulness of lectures, tutorials and practical sessions 

The majority of students participating in this study found all three teaching strategies, lectures, tutorials and practicals, useful for their learning. The most favoured strategy was practical sessions, which enable students to visualize the difficult concepts relating to human physiology and anatomy. Tutorials were seen as least useful by most students. Questions about the usefulness of tutorials have also been identified in a study conducted in the UK in a pre-registered nursing course (Davies et al., 2000). The benefits students gain from tutorials is dependent on a number of variables; student participation, group dynamics and interactions between students and the tutor.

Tutorials are a very effective way of providing students with feedback or question time sessions. They can be structured, group work or problem based, or relaxed where students can ask any question on any topic. The benefits of these sessions rely heavily on the students, and how they interact or participate in the session. The skill and experience of the tutor and other group dynamics can also influence the effectiveness of the session. The number of students in each tutorial session can impact on their effectiveness. Although more than two decades old, research by Mahler et al. (1986) is useful when designing tutorials. This research indicates that student’s contributions to tutorials decline if groups are larger than sixteen (Mahler et al., 1986).

The dynamics of tutorial groups and the tutor/student interaction has been the focus of a number of studies. One important aspect of tutorials is that students and tutors spend a lot of time together and this fosters an informal atmosphere (Bowman and Hughes, 2005). It is important to be aware that ‘emotional and psychological’ interactions during tutorials impacts on student learning, whether this has a good or bad effect is dependent on the tutor and student. The availability of quality tutors may be an limiting factor.

Group dynamics impacts on student learning. A tutorial method where this may have a greater impact is student-led tutorials. Promoting student participation and leadership has been shown to improve tutorial atmosphere, decision-making and support for students, compared to tutor led session (Kassab et al., 2005b). Understanding the gender issue in group behaviour is important (Kassab et al., 2005a). Male students tend not to participate as effectively as female students.

Practical sessions were seen as the most useful learning experience by the majority of students. The aims and objectives of these sessions were overwhelmingly met in this context, highlighting the benefits of practical sessions in reiterating and emphasizing the human physiology and anatomy concepts, encouraging interest in the subject and promoting good professional habits. Other studies have found practical sessions to have less of an impact on student learning (Davies et al., 2000).

At this university, there are several additions to the practical sessions that aid student learning and preparation for the sessions. The practical experiments are clearly outlined in a practical manual, with exact detail and easy to follow instructions. Pre-practical questions, which must be attempted prior to beginning the experiments, complement the session’s topic. These questions were designed by the subject coordinator and require students to do the pre-reading exercises before the session. Finally, the ratio of students to demonstrators is kept relatively low. One demonstrator to every 10–12 students is desired, and in many cases the ratio or lower is preferable. The lead demonstrator is usually a lecturer or academic, while the remaining auxiliary demonstrators are mostly postgraduate students or sessional staff, who have been participating in the practical sessions for a number of years. In the current economic climate, practical sessions are increasingly becoming more of a financial burden, but the benefits of these sessions to encourage active learning and critical thinking needs to be taken into consideration.

Limitations of the study 

The study is limited to a single university (regional campus), with a limited, yet diverse student population. It is unlikely that the results of statistical analysis could be attributed to chance, but this does not necessarily imply that they are valid outside this university or that they can be generalized to other settings. The results do highlight the importance of practical sessions for student learning of human physiology and anatomy, and the pitfalls of tutorial sessions.

As with all surveys the results presented here are only a ‘snapshot’ of the attitudes and preoccupations of respondents. In this study it was not possible to explore the full complexities of the learning triad; students, teachers and curriculum. It would be unethical and impractical to determine the exact nature of student/lecturer or student/tutor interactions, or to ask students to directly comment on the knowledge base and presentation of lecturers and tutors. This does make it hard to draw firm conclusions from the data collected in this study.