Medical Education, 1985, 19, 3-8

The learning style of medical students

D. I. NEWBLE

AND

MARG ARET I. G O R D O N

Department of Medicine, University of Adelaide, Australia

Summary. Recent research indicates that

students learning styles and approaches to
study may have a significant bearing on
their academic success. A study was undertaken on first-, third- and final-year medical
students to analyse their preferred learning
styles and approaches to study, using the
Lancaster Approaches to Learning Inventory. The results showed that students
entering the medical school had preferences
which were more similar to science students
than arts students. The medical students
had high scores on reproducing orientation
(surface approach) in all years tested. The
first-year students had low scores on meaning orientation (deep approach) but the
scores from students in later years showed a
progressive rise.
The implications of these results with
regard to selection, teaching and assessment
are explored. However, this preliminary
study does not allow us to differentiate
between the effect of student preference and
that of the context and the environment in
which they study.

aminadons have on the learning of medical

students (Newble & Jaeger, 1983). The
effect was so considerable as to indicate that
it may be the major factor influencing
student learning in a medical school with a
traditional curriculum. However, the higher education literature suggests that other
factors have a significant bearing on the
students approach to learning. One of these
factors, which seems to be central, is the
students learning style and approach to
study. O u r own experience interviewing
students who fail the final examinations in
medicine and surgery has revealed that
some do not appear to have failed because of
lack of effort or for overt psychological
problems but because of an inappropriate,
and often bizarre, approach to their study
and preparation for the examinations. The
concern must be that a far greater proportion of the students may not be reaching
their full potential for the same reasons. It is
therefore important to investigate ways in
which students learning styles and study
habits can be identified and modified if
found to be inappropriate.
The literature in the area of student
learning is complex and confusing and is
poorly represented in the medical education
literature. Any attempt a t summarization
risks oversimplification. However, it seems
reasonable to conclude that students have a
tendency to adopt one of two distinct
approaches to learning which might most
easily be referred to as deep or surface
(Marton & Saljo, 1976a, b). The student
adopting the deep approach sets out to
understand the meaning of what is to be
learnt while the student adopting the surface

Key words: Students, medical/*psychol;

*Learning; *Education, medical, undergraduate; Personality inventory; Australia

Introduction

In a recent article we demonstrated the

marked effect that assessments and exCorrespondence: D r D. I. Newble, Department of
Medicine, T h e Queen Elizabeth Hospital, Woodville,
South Australia 5 0 1 I , Australia.

D . I . Newble and Margaret I . G o r d o n

approach sets out to memorize the information likely to be required in any subsequent
test. In one study, students w h o consistently
used a deep approach were more successful
in their university examinations than those
who used a surface approach (Svensson,
1977). These concepts, which were largely
developed from experimental studies, have
been supported by work using questionnaires based on what students felt about
their own approach and attitude to study
(Entwistle et al., 1979; Biggs, 1979). It is
important to recognize that the preferred
learning style may be modified depending
on the students perception of the taskand
motivation towards it (Fransson, 1977;
Laurillard, 1979). Generally speaking, it
appears that the most successful learners
will be those w h o habitually have a preference for the deep approach but who also
demonstrate a versatility of strategy compatible with the task in hand.
This paper describes the results obtained
from administering Entwistles Lancaster
Approaches to Learning Inventory (LI) to
students at the University of Adelaide. The
main aim of this study was to obtain
preliminary information about the approach

Subscale
Meaning orientation
Peep approach
Interrelating ideas
Use of evidence
Intrinsic motivation

to learning of medical students in a traditional medical school environment a t different stages of their course.

Methods
The Lancaster Inventory is a self-report
questionnaire containing sixty-four items
to be answered o n a scale from 4
(definitely agree) to o (definitely disagree).
These items are grouped into sixteen
subscales which are themselves combined
to form four major factors: meaning
orientation (deep approach, relating ideas,
use of evidence and logic, and intrinsic
motivation);
reproducing
orientation
(surface approach, syllabus bound, fear of
failure and extrinsic motivation); achieving
orientation
(disorganized
approach,
negative attitudes, strategic approach and
achievement motivation) and holistic
orientation or styles and pathologies
(comprehension learning, globetrotting,
operation learning and improvidence). The
meaning of each of these subscales is
briefly outlined in Fig. I (Ramsden &
Entwistle, 1981). At this point it is
important to remember that the concept of

Meaning

,Active questioning in learning

Relating to other parts of the course
Relating evidence to conclusions
Interest in learning for learnings sake

Reproducing orientation
Surface approach
Syllabus-boundness
Fear of failure
Extrinsic motivation

Preoccupation with memorization

Relying on staff to define learning tasks
Pessimism and anxiety about academic outcomes
Interest in courses for the qualifications they offer

Achieving orientation
Strategic approach
Disorganized study methods
Negative attitudes to studying
Achievement motivation

Awareness of implications of academic demands made by staff

Unable to work regularly and effectively
Lack of interest and application
Competitive and confident

Styles and pathologies

Comprehension learning
Globetrotting
Operation learning
Improvidence

Readiness to map out subject area and think divergently

Over-ready to jump to conclusions
Emphasis on facts and logical analysis
Over-cautious reliance on details

FIG. I . Meanings of the subscales in the Lancaster Approaches to Learning Inventory (from Ramsden
& Entwistle, 1981).

Medical students learning style

Meaning orientation
Item 5 : I usually set out to understand thoroughly the meaning of what I am asked to read (deep
approach)
Item 34: When I am tackling a new topic I often test my understanding of the new information by asking
myself questions about it (deep approach)
Item 29: In trying to understand new ideas I often try to relate them to real life situations to which they
might apply (relating ideas)
Item 54: Problems fascinate me, particularly those you have to work through to reach a logical
conclusion (use of evidence and logic)
Item 39: My main reason for being here is to learn howto help peoplewith social and medical problems
(intrinsic motivation)
Item 47: I often find that studying can be really exciting and gripping (intrinsic motivation)
Reproducing orientation
Item 19: When I am reading I try to memorize important facts which may come in useful later (surface
approach)
Item 36: Often I find I have to read things without having a chance really to understand them (surface
approach)
Item 25: I prefer courses to be clearly structured and highly organized (syllabus bound)
Item 12: The continued pressure of work assignments, deadlines and competition often makes me
tense and depressed (fear of failure)
Item 35: I suppose I am more interested in the qualifications I shall get than in the course I am taking
(extrinsic motivation)
FIG. 2. Examples of items from subscales in the Meaning orientation and Reproducing orientation
factors in the Lancaster Approaches t o Learning Inventory.

deep approach outlined in the introduction

is broadly represented in the LI by the
meaning orientation factor and the surface
approach by the reproducing orientation
factor. The subscales in the LI bearing the
same names have a more limited
definition. Examples of items from the
two factors with which we are primarily
concerned are shown in Fig. 2 . Scores for
each factor and subscale are obtained by
summation of the item scores.
The LI was administered to groups of
first-, third- and final-year students during
1983. They were distributed at the
conclusion of a lecture and students were
asked to complete them on the spot. The
few not present were sent the inventories
by post. Students were encouraged to put
their names on the response sheet to assist
follow-up and to allow later correlation
with academic performance. However,
they were reassured that only the research
assistant would have access to their
responses. All responses were obtained at
the beginning of the third term. For the
first- and final-year students, this was
approximately 8 weeks before their endof-term examinations. For the third-year

students it was the time in the curriculum

at which they commenced their clinical
studies. All first- and third-year students
were available for testing but the
investigators only had access to half the
class of final-year students, who were at
the time undertaking internships in
medicine and surgery. Students in all
groups who failed to respond were
contacted by the research assistant initially
by letter and subsequently personally.

Results
The inventory was completed by 87% of
first-year students, 98% of third-year
students and 91% of the final-year
student group.
Table I shows the mean scores obtained
by Entwistle and his colleagues from large
numbers of arts and science students
attending universities in the United
Kingdom. These results can be compared
with those obtained from our three
medical student groups. Unfortunately,
the data provided by Entwistle do not
allow us to make statistical comparisons
between these main orientations. Despite

D . I . Newble and Margaret I . Gordon

TABLEI . Mean major orientation scores or three medical student groups, and for
university science and arts student groups, using the Lancaster Approaches to Learning
Inventory
Medicine
(University of Adelaide)

Arts
(Entwistle)
___

First year

Third year

Sixth year

n=865

n=491

n=98

n= I02

n=43

Meaning

3 7.6

40.2

3 8.0

40'5

42.4

Reproducing

3 4.9

28.6

33.8

30.6

3 2.2

Achieving

3 7'4

3 6.4

37'5

3 8.0

36.0

Holistic

29'2

33'5

28.6

30'6

Science
(Entwistle)
~

Orientation

this it would appear that the medical

students compare more closely to the
science students than to the arts students.
Table I also allows us to compare and
contrast any changes in orientation that
may occur during the undergraduate
course. A one-way analysis of variance
followed by Duncan's post koc multiple
range tests showed that both third- and
sixth-year medical student groups had
significantly higher scores on meaning
orientation than the first-year student
group. O n the other hand, there was no
difference in reproducing orientation
between the first- and sixth-year groups
with
the
third-year
group
being
significantly lower than both other
groups. No changes were evident in the
scores on achieving and holistic orientations.
Discussion

The University of Adelaide, like most

Australian medical schools, selects almost
all students entirely on the basis of school
matriculation results. Nearly all students
come from the science stream, where the
examinations are predominantly objective
in type, a form of assessment particularly
likely to induce surface-type learning
strategies. The results of our study seem
to support this possibility. O u r first-year
students, as a group, were similar to the
U . K . science students, being relatively
high on reproducing orientation (surface
approach), and relatively low on meaning

- ..

30.0

orientation (deep approach), in relation to

U.K. arts students. In other studies, to be
reported separately, our students showed
scores on surface approach which were
higher than all other tested groups of
Australian university and college students.
It seems unlikely that many of us would
be happy to admit to medical school a
cadre of potential doctors whose major
approach to study was through the surface
approach strategy of rote learning.
at
this
stage
of
our
However,
investigations it is impossible to say how
much of this stated preference is an
inherent one and how much is dependent
on the context of the secondary school
science stream environment and the
matriculation examination format.
Given the limitations of a cross-sectional
study rather than a longitudinal study, it
was still rather disturbing to find that
group scores on reproducing orientation
did not differ significantly between the
first- and final-year groups. Again, it
is impossible to apportion the influence
of preference and context but it is probably reasonable to say that the format
of the traditional curriculum and the
predominance of objective-type
tests
throughout the whole medical course
would not be likely to induce a decpcr
approach to learning, particularly in those
whose preference was for the surface
approach. One might even say that we
were more likely to support the habit
rather than help our students kick it.
The significantly lower group score on

Medical students learning style

reproducing orientation for the third-year
group might be an indication that context
is indeed the more powerful factor. This
group of students had just completed their
major pre-clinical examinations and were
participating in a course which was
primarily
concerned
with
teaching
introductory clinical skills. There was no
immediate threat of formal assessment and
much of the teaching was being
undertaken in small groups in a ward
setting.
An encouraging feature arising from the
cross-sectional study was the sequential
rise in the scores for meaning orientation,
with final-year students producing the
highest value for all groups for whom we
have comparable data. One would like to
believe that this was the result of the
nature of the curriculum and the quality of
the teaching. However, it must be
remembered that the comparison groups
of arts and science students were in the
early years of their courses. Thus a
developmental component relating to
increasing maturity cannot be excluded as
a reason for the improvement in meaning
orientation scores. Such a development
has previously been shown in longitudinal
interview studies (Heath, 1964; Perry,
1970).

It would be possible to discuss and

attempt to rationalize many of the other
results obtained in this study, particularly
those arising from analyses of subscale
scores. In our opinion, to do so at this
early stage in our investigations of medical
student learning might be more likely to
confuse than to clarify. It is our intention
to analyse the value of the major factors,
the subscales and individual items in
predicting academic performance and
particularly in identifying those students
whose
performance
is
consistently
unsatisfactory.
These
preliminary
studies
have
produced results which fit in well with
those of other workers and are largely
consistent with our predictions. However,
considerably more research is required if
we are to unravel the extent to which

these patterns of learning behaviour reflect

the natural tendencies and preferences of
individual students or the context in which
they have to study. We intend to pursue
this particular issue with more detailed
longitudinal studies and by collaborative
studies with other medical schools. We are
particularly interested in comparing our
students with those from medical schools
with different selection, curriculum and
assessment policies. We are also interested
to see if we can use this inventory, or a
modified version, as a reliable screening
device to identify individual students who
are likely to get into academic strife and at
a time which might allow successful
remedial action to be undertaken.
Until now, most educational research
into the effectiveness of student learning
has concentrated on the design of the
curriculum, the format and effectiveness
of the teaching and the impact of assessments and examinations. If we wish students to learn effectively in our courses,
and if we really do wish them to become
the effective problem-solvers and life-long
self-learners so frequently espoused in the
aims of the modern medical school, we
must become much more concerned with
the way in which they approach their
study and the way in which we might
influence their approach by the activities
which we impose. The student who has,
o r who develops, a preference for a deep
approach to study would appear to be
more likely to become a successful selflearner. If this turns out to be the case, a
knowledge of students learning preferences and approaches to study clearly has
important implications for the way w e
select our students and for the way in
which we teach them during their undergraduate career.

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D . I . N e w b l e and Margaret I . Gordon

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Received I 7 February 1984; editorial cornrnerits

to authors I 3 April 1984; accepted fov publicatiorz 20 J u n e 1984