Medical Teacher

ISSN: 0142-159X (Print) 1466-187X (Online) Journal homepage: http://www.tandfonline.com/loi/imte20

A cross-sectional study of learning styles among

continuing medical education participants

C. Scott Collins, Sanjeev Nanda, Brian A. Palmer, Arya B. Mohabbat, Cathy D.

Schleck, Jayawant N. Mandrekar, Saswati Mahapatra, Thomas J. Beckman &
Christopher M. Wittich

To cite this article: C. Scott Collins, Sanjeev Nanda, Brian A. Palmer, Arya B. Mohabbat, Cathy
D. Schleck, Jayawant N. Mandrekar, Saswati Mahapatra, Thomas J. Beckman & Christopher M.
Wittich (2018): A cross-sectional study of learning styles among continuing medical education
participants, Medical Teacher, DOI: 10.1080/0142159X.2018.1464134

To link to this article: https://doi.org/10.1080/0142159X.2018.1464134

Published online: 27 Apr 2018.

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MEDICAL TEACHER
https://doi.org/10.1080/0142159X.2018.1464134

A cross-sectional study of learning styles among continuing medical

education participants
C. Scott Collinsa, Sanjeev Nandaa, Brian A. Palmerb, Arya B. Mohabbata, Cathy D. Schleckc,
Jayawant N. Mandrekarc, Saswati Mahapatraa, Thomas J. Beckmana and Christopher M. Witticha
a
Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA; bDepartment of Psychiatry and Psychology, Mayo Clinic,
Rochester, MN, USA; cDivision of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA

ABSTRACT
Purpose: Experiential learning has been suggested as a framework for planning continuing medical education (CME). We
aimed to (1) determine participants’ learning styles at traditional CME courses and (2) explore associations between learning
styles and participant characteristics.
Materials and methods: Cross-sectional study of all participants (n ¼ 393) at two Mayo Clinic CME courses who completed
the Kolb Learning Style Inventory and provided demographic data.
Results: A total of 393 participants returned 241 surveys (response rate, 61.3%). Among the 143 participants (36.4%) who
supplied complete demographic and Kolb data, Kolb learning styles included diverging (45; 31.5%), assimilating (56; 39.2%),
converging (8; 5.6%), and accommodating (34; 23.8%). Associations existed between learning style and gender (p ¼ 0.02).
For most men, learning styles were diverging (23 of 63; 36.5%) and assimilating (30 of 63; 47.6%); for most women, diverg-
ing (22 of 80; 27.5%), assimilating (26 of 80; 32.5%), and accommodating (26 of 80; 32.5%).
Conclusions: Internal medicine and psychiatry CME participants had diverse learning styles. Female participants had more
variation in their learning styles than men. Teaching techniques must vary to appeal to all learners. The experiential learning
theory sequentially moves a learner from Why? to What? to How? to If? to accommodate learning styles.

Introduction
Continuing medical education (CME) is essential for regulat-
ing physician knowledge during this era of exponential
information growth (Segall 2014; Thompson 2014; Cervero
and Gaines 2015; McMahon 2015). Lectures are the most
common method for CME delivery (Copeland et al. 2000;
Armstrong and Parsa-Parsi 2005; Yee et al. 2014); nonethe-
less, studies have demonstrated that this traditional
approach to CME produces only modest improvements in
physician behaviors and patient outcomes (Bellande et al.
2010; Cervero and Gaines 2015). The Institute of Medicine
(2010) and others have emphasized the need to reimagine
CME (Campbell and Rosenthal 2009; Lowe et al. 2009; Davis
et al. 2011; Davis et al. 2013; Gorrindo and Stock 2014;
Nissen 2015). With research showing better educational
outcomes from self-directed (Mazmanian and Davis 2002)
and interactive CME (Davis et al. 1999), authors have pro-
posed incorporating experiential learning methods
(Armstrong and Parsa-Parsi 2005).
The Kolb learning styles (Figure 1), which are grounded
in experiential learning, have been suggested as a frame-
work for planning CME (Armstrong and Parsa-Parsi 2005).
Learning styles are the individualized and preferred ways
that students perceive, comprehend, and retain information
(Hauer et al. 2005; Engels and de Gara 2010; Caulley et al.
2012). The Kolb model emphasizes learners’ differences
and experiences and how learners process and perceive
their experiences (Kolb 1984; Armstrong and Parsa-Parsi
2005). Kolb (1984) separates learners into 4 styles:
diverging, assimilating, converging, and accommodating.
Practice points
 Experiential learning has been suggested as a
framework for planning continuing medical edu-
cation (CME).
 Most CME participants had diverging or assimilat-
ing styles, fewer had an accommodating style,
and very few had a converging style.
 Female participants had more variation in their
preferred learning styles than men.
 These findings should alert CME planners and pre-
senters that variation in teaching techniques is
necessary to appeal to all learners.
 The experiential learning theory supports curricu-
lum planning for CME by sequentially moving a
learner from Why? to What? to How? to If? to
ensure that learning styles are accommodated.
Diverging students learn by feeling and watching; assimilat-
ing students by thinking and watching; converging stu-
dents by thinking and doing; and accommodating students
by feeling and doing (Robinson 2002; Armstrong and Parsa-
Parsi 2005; Engels and de Gara 2010). Building on this the-
ory, McCarthy expanded the Kolb framework into a curricu-
lum planning model that suggested a sequential process
from concrete to abstract for all educational experiences
(Guild and Garger 1988; Armstrong and Parsa-Parsi 2005)
(Figure 1). In this model, students progress through the

CONTACT Christopher M. Wittich wittich.christopher@mayo.edu Division of General Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN
55905 USA
ß 2018 Informa UK Limited, trading as Taylor & Francis Group
2 C. S. COLLINS ET AL.
Figure 1. The four Kolb learning styles: Diverging, Assimilating, Converging, and Accommodating. The horizontal axis is the range of transformation from an
experience (from doing to reflecting), and the vertical axis is the range of perception (from experiencing to thinking). The concrete curriculum planning frame-
work suggests that learning should progress from quadrant Q1 to Q4 sequentially and focus on the 4 associated questions (Why? What? How? and If?) adapted
from: Kolb 1984). Used with permission.
learning process by asking four questions: (1) Why? (motiv-
ation for learning); (2) What? (seek new knowledge); (3)
How? (apply knowledge); and (4) If? (create new experien-
ces) (Guild and Garger 1988; Armstrong and Parsa-Parsi
2005). Teaching that moves sequentially through the styles
allows students (especially in groups with diverse styles
represented) to experience their preferred modality and
encourages interest by using less familiar approaches (Guild
and Garger 1988; Vaughn and Baker 2001; Armstrong and
Parsa-Parsi 2005).
Within CME, specific teaching techniques might align
with certain Kolb styles. For example, participants with a
diverging style (Why?) may respond to a wide choice of
topics or data from their own practice to personalize their
learning experiences. Assimilating (What?) participants may
thrive in a lecture or journal club format that focuses on
knowledge acquisition. Converging (How?) learners may
need practical application through cases, discussions,
debates, or flipped classrooms. Accommodating (If?) stu-
dents may benefit from reflective exercises or commitment
to change statements that facilitate synthesis of new con-
cepts. Providing eclectic CME activities that use teaching
approaches adapted to all learning styles may be a prudent
means for engaging diverse audiences (Armstrong and
Parsa-Parsi 2005).
Kolb learning styles have been studied at multiple levels
of medical education (Chapman and Calhoun 2006; Cook
and Smith 2006; Lujan and DiCarlo 2006). Prior work has
suggested that students’ learning styles may be associated
with their level of training (Adesunloye et al. 2008; Engels
and de Gara 2010; Caulley et al. 2012), specialty (Robinson
2002; Richard et al. 2014; Modi et al. 2015; Quillin et al.
2016), and gender (Slater et al. 2007; Wehrwein et al. 2007;
Quillin et al. 2016). Studies have shown that learning styles
affect preferences for, and outcomes from, delivery meth-
ods in medical education (Cook 2005; Cook and Smith
2006; Cook et al. 2006; Pashler et al. 2008; Tuli et al. 2011).
Student satisfaction with learning and examination scores
was higher when the presentation and learning style
matched (Miller 1998). In undergraduate medical education,
student learning style predicted preferred teaching strategy
and success in end-of-rotation examinations (McParland
et al. 2004; Kharb et al. 2013). Also, the knowledge that
medical students gained from clinical experiences was
related to their learning style preference (McManus et al.
1998; Martin et al. 2000). For practicing physicians, differen-
ces in approach to work and perceived workplace climate
were related to learning styles (McManus et al. 2004).
Despite this research, little is known about applying these
concepts to a diverse population of CME learners.
Therefore, we sought to determine (1) the preferred
learning styles of participants at traditional internal medi-
cine and psychiatry CME courses and (2) the potential asso-
ciations between preferred learning styles and
characteristics of CME course participants. From the results
of previous research, we hypothesized that most partici-
pants would be classified in the accommodating and con-
verging learning style categories and that associations
would exist between preferred learning styles and partici-
pant gender, specialty, primary degree, and years in clinical
practice (Slater et al. 2007; Wehrwein et al. 2007; Engels
and de Gara 2010; Jiraporncharoen et al. 2015; Kim and
Gilbert 2015; Quillin et al. 2016).
Methods
Participants and setting
This was a cross-sectional study of all participants (n ¼ 393)
at 2 CME courses: the 2016 Mayo Clinic updates in internal
medicine (n ¼ 175) and the 2016 Mayo Clinic psychiatry
clinical reviews (n ¼ 218). Both courses were accredited by
 MEDICAL TEACHER 3

Mayo School of Continuous and Professional Development. Table 1. Characteristics of participants at the 2016 Mayo Clinic updates in
internal medicine and psychiatry clinical reviews continuing medical educa-
Updates in Internal Medicine were a 3-day course consist-
tion courses.
ing of 26 podium presentations that qualified for 18.0 CME
Participants, no. (%)
credits. The intended audience was general internists, fam-
Updates in Psychiatry
ily practice physicians, subspecialists, and advanced practice
internal clinical
providers. Psychiatry clinical reviews was a 3-day course medicine reviews
consisting of 19 podium presentations and 13 workshops Characteristic (n ¼ 64) (n ¼ 79)
that qualified for 20.75 CME credits. The intended audience Gender
Male 29 (45.3) 34 (43.0)
was psychiatrists, neurologists, primary care physicians, and Female 35 (54.7) 45 (57.0)
advanced practice providers. For both courses, faculty Age, years
members were selected by the course directors for expert- 20–40 14 (21.9) 18 (22.8)
41–50 17 (26.6) 19 (24.0)
ise in their specialties. This study was deemed exempt by 51–60 21 (32.8) 27 (34.2)
the Mayo Clinic Institutional Review Board. 61 12 (18.8) 15 (19.0)
Practice type
Academic 4 (6.2) 12 (15.2)
Data collection Group/solo 56 (87.5) 57 (72.2)
Government or military 4 (6.2) 10 (12.7)
Practice location
All participants at each course received a packet that US Northeast 7 (10.9) 5 (6.3)
included a survey about demographic characteristics and US South 25 (39.1) 2 (2.5)
version 3.1 of the Kolb Learning Style Inventory (KLSI) (Hay US Midwest 25 (39.1) 53 (67.1)
US West 7 (10.9) 8 (10.1)
Group). Participants’ demographic characteristics included Other 0 (0) 11 (13.9)
gender; age (in years); practice type (academic, group/solo, Primary degree
or government/military); practice location (US Northeast, US MD/DO 53 (82.8) 64 (81.0)
NP/PA 11 (17.2) 15 (19.0)
South, US Midwest, US West, or other); professional degree Specialty
(doctor of medicine, doctor of osteopathy, nurse practi- Internal medicine 35 (54.7) 1 (1.3)
tioner, or physician assistant); specialty (internal medicine, Family medicine 18 (28.1) 18 (22.8)
Psychiatry 2 (3.1) 56 (70.9)
family medicine, psychiatry, or other); clinical care time per Other 9 (14.1) 4 (5.1)
week; and years of clinical practice. These characteristics Clinical care, hours/week
were chosen from previous research showing relationships 0–20 4 (6.2) 8 (10.1)
21–40 20 (31.2) 40 (50.6)
between preferred learning styles and learner age, level of 41 40 (62.5) 31 (39.2)
training, educational background, and amount of time Clinical practice duration, years
spent in clinical care (de Saintonge and Dunn 2001; Mattick 0–10 21 (32.8) 30 (38.0)
11–20 17 (26.6) 14 (17.7)
et al. 2004; Dobson 2010; Kulac et al. 2015). The KLSI 21–30 12 (18.8) 19 (24.0)
(ALQahtani and Al-Gahtani 2014; Cervero and Gaines 2015) 31 14 (21.9) 16 (20.2)
was administered free of charge through an experiential DO: doctor of osteopathy; MD: doctor of medicine; NP: nurse practitioner;
learning grant from the Hay Group. The KLSI 3.1 is a revised PA: physician assistant.
version of the original inventory whose content was based
on the experiential learning theory developed by David A.
Kolb (Kolb and Kolb 2005). Validation of the KLSI, based on Responses to the KLSI items were summed to create
a sample of 6977 KLSI users, included factor analysis and scores for concrete experience (CE), active experimentation
excellent internal consistency and test–retest reliability. (AE), reflective observation (RO), and abstract conceptual-
External validity evidence was established through relation- ization (AC). The preferred learning styles, calculated by
ships with demographic variables and other experiential subtracting CE from AE and RO from AE, were as follows:
learning assessment inventories. diverging (AC  CE  6 and AE  RO  6); assimilating
Survey packets were distributed at the start of the con- (AC  CE  7 and AE  RO  6); converging (AC  CE  7
ference, and the completed packets were collected at the and AE  RO  7); and accommodating (AC  CE  6 and
end. A participant code was assigned to each packet with- AE  RO  7). Given the sample size and non-normally dis-
out identifying information to ensure that the survey tributed data, associations between participants’ learning
responses were anonymous. A pen with the Mayo Clinic styles and demographic characteristics were determined
logo was given to study participants who returned com- with the Kruskal–Wallis test. The threshold for statistical
pleted packets. Survey responses were transcribed by the significance was set at p less than 0.05. Statistical analyses
Mayo Clinic Survey Research Center with double data entry were conducted with SAS software, version 9.4 (SAS
(i.e. responses were entered by two people, and discrepan- Institute Inc., Cary, NC).
cies were resolved by referring back to source documents)
to ensure data quality and accuracy.
Results
Data analysis Participant characteristics

Categorical variables were presented as numbers and per-
centages. Continuous variables were presented as means
and SDs. The preferred learning style for each participant
was determined from the KLSI responses by following the
exact KLSI calculation methods (Kolb and Kolb 2005).
A total of 393 participants returned 241 surveys (response
rate, 61.3%). Of those who returned the survey, 143 (36.4%)
completed the demographic information and the KLSI, pro-
viding the data for this study. Participant characteristics
were similar for the two courses (Table 1).
4 C. S. COLLINS ET AL.

Table 2. Associations between learning style and characteristics of participants at the 2016 Mayo Clinic updates in internal medicine and psychiatry clinical
reviews continuing medical education courses.
Kolb learning style preference of participants, no. (%)
Participants, Diverging Assimilating Converging Accommodating
Characteristic no. (%) (n ¼ 143) (n ¼ 45) (n ¼ 56) (n ¼ 8) (n ¼ 34) p Valuea
Gender 0.02
Male 63 (44.0) 23 (36.5) 30 (47.6) 2 (3.2) 8 (12.7)
Female 80 (55.9) 22 (27.5) 26 (32.5) 6 (7.5) 26 (32.5)
Age, years 0.95
20–40 32 (22.4) 11 (34.4) 12 (37.5) 2 (6.2) 7 (21.9)
41–50 36 (25.2) 9 (25.0) 14 (38.9) 3 (8.3) 10 (27.8)
51–60 48 (33.6) 16 (33.3) 19 (39.6) 3 (6.2) 10 (20.8)
61 27 (18.9) 9 (33.3) 11 (40.7) 0 (0.0) 7 (25.9)
Practice type 0.72
Academic 16 (11.2) 3 (18.8) 6 (37.5) 1 (6.2) 6 (37.5)
Group/solo 113 (79.0) 38 (33.6) 45 (39.8) 6 (5.3) 24 (21.2)
Government or military 14 (9.8) 4 (28.6) 5 (35.7) 1 (7.1) 4 (28.6)
Primary degree 0.09
MD/DO 117 (81.8) 39 (33.3) 47 (40.2) 8 (6.8) 23 (19.7)
NP/PA 26 (18.2) 6 (23.1) 9 (34.6) 0 (0.0) 11 (42.3)
Specialty 0.60
Internal medicine/family medicine 72 (50.3) 23 (31.9) 30 (41.7) 3 (4.2) 16 (22.2)
Psychiatry 58 (40.6) 19 (32.8) 22 (37.9) 5 (8.6) 12 (20.7)
Other 13 (9.1) 3 (23.1) 4 (30.8) 0 (0.0) 6 (46.2)
Course 0.42
Updates in internal medicine 64 (44.8) 20 (31.2) 29 (45.3) 2 (3.1) 13 (20.3)
Psychiatry clinical reviews 79 (55.2) 25 (31.6) 27 (34.2) 6 (7.6) 21 (26.6)
Clinical care, hours/week 0.49
0–20 12 (8.4) 3 (25.0) 3 (25.0) 0 (0.0) 6 (50.0)
21–40 60 (42.0) 21 (35.0) 22 (36.7) 3 (5.0) 14 (23.3)
41 71 (49.6) 21 (29.6) 31 (43.7) 5 (7.0) 14 (19.7)
Clinical practice duration, years 0.92
0–10 51 (35.7) 16 (31.4) 18 (35.3) 2 (3.9) 15 (29.4)
11–20 31 (21.7) 8 (25.8) 14 (45.2) 3 (9.7) 6 (19.4)
21–30 31 (21.7) 11 (35.5) 11 (35.5) 2 (6.4) 7 (22.6)
31 30 (21.0) 10 (33.3) 13 (43.3) 1 (3.3) 6 (20.0)
DO: doctor of osteopathy; MD: doctor of medicine; NP: nurse practitioner; PA: physician assistant.
a
Kruskal–Wallis test.

Significant associations were not detected between partic-

Figure 2. Kolb learning styles by gender of participants at the 2016 Mayo
Clinic updates in internal medicine and psychiatry clinical reviews continuing
medical education courses. The association between Kolb learning style and
gender was significant (p ¼ 0.02; Kruskal–Wallis test).
Relationships between Kolb learning style and
participant characteristics
Of the 143 participants, 45 had a diverging style (31.5%);
56, assimilating (39.2%); 8, converging (5.6%); and 34,
accommodating (23.8%) (Table 2). The association between
participants’ learning styles and gender was significant
(p ¼ 0.017) (Figure 2). Among the 63 male participants, the
most common learning styles were diverging (23; 36.5%)
and assimilating (30; 47.6%). Fewer male participants had
converging (2; 3.2%) or accommodating (8; 12.7%) styles.
Among the 80 female participants, the most common
learning styles were diverging (22; 27.5%), assimilating (26;
32.5%), and accommodating (26; 32.5%), and only a few
female participants had converging styles (6; 7.5%).
ipants’ learning style and age, practice type, primary
degree, specialty, course, weekly clinical care time, or years
in clinical practice.
In our study, the converging learning style group was
the smallest (n ¼ 8). With our sample sizes, pairwise com-
parisons between the learning style groups would have
detected effect sizes ranging from 0.566 (diverging versus
assimilating learning style groups) to 1.128 (converging ver-
sus accommodating learning style groups). These effect
sizes are medium and large, respectively (where 0.2 repre-
sents a small effect size; 0.5, medium; and 0.8, large)
(Cohen 1988).
Discussion
To the best of our knowledge, this is the first study of pre-
ferred learning styles among CME course participants. Most
CME participants had diverging or assimilating styles, fewer
had an accommodating style, and very few had a converg-
ing style. Furthermore, male participants tended to have a
diverging or assimilating style, while female participants
had more variation in learning styles, including diverging,
assimilating, and accommodating. We did not find associa-
tions between participants’ learning styles and medical spe-
cialty as had been hypothesized from previous research.
Integration with previous research
The association between learning style and gender identi-
fied in the current study is concordant with previous
 MEDICAL TEACHER 5

investigations. In a prior work, most men had the assimilat- Implications

ing style and women were more evenly distributed across
This study has important implications for those who
all styles (Philbin et al. 1995). Additionally, that study found
develop CME. First, differences and variation between male
that more men than women identified a match between
and female participants’ learning style preferences aid cur-
their education and their learning styles. Among first-year
riculum planning that supports diverse learning styles
medical students, women had more learning style diversity
(Armstrong and Parsa-Parsi 2005). For example, podium-
than men, especially concerning sensory modality preferen-
based CME presentations to large groups promote diverg-
ces (Slater et al. 2007). The VARK (Visual, Aural, Read/Write,
ing (Why?) and assimilating (What?) styles, whereas CME
and Kinesthetic; VARK Learn Limited) is an alternative learn-
that incorporates small group discussions may best facili-
ing style inventory that has been studied in medical set-
tate converging (How?) and accommodating (If?) styles.
tings. Studies of medical students using the VARK showed
Second, CME directors should be mindful to select diverse
significant variation in gender preferences (Choudhary et al.
presenters to ensure that various backgrounds and prefer-
2011): male participants preferred the kinesthetic learning
ences are represented. Third, CME directors should advise
style, and female participants preferred the aural style
presenters to use presentation techniques that use multiple
(Sarabi-Asiabar et al. 2014). These findings are important
teaching modalities. Fourth, awareness by the presenters
because traditional classroom settings, where abstract and
and participants of their own learning styles may optimize
reflective techniques predominate, favor men’s preferred
learning through insight and openness to new modes of
learning styles and neglect the hands-on experiences pre- knowledge acquisition. Finally, future research should
ferred by women (Philbin et al. 1995). More research is attempt to link learning styles-based curricula to outcomes
needed to determine whether a relationship exists between in CME. Future research should compare participants’ per-
gender and preferred learning style across the continuum ceptions of how they like to learn and their Kolb learning
of medical education. style and then determine whether interventions that match
We found no associations between participants’ learning or mismatch learning techniques to learning style affect
styles and medical specialty. Research has shown that satisfaction or knowledge acquisition.
learning styles change as physicians progress through train-
ing (Adesunloye et al. 2008; Engels and de Gara 2010;
Caulley et al. 2012; Richard et al. 2014; Modi et al. 2015; Conclusions
Quillin et al. 2016). Medical students usually have assimilat-
In a population of internal medicine and psychiatry CME
ing learning styles (Engels and de Gara 2010). When learn-
course participants, learning styles were diverse.
ers begin training in specialties, they often transition to
Additionally, female participants had more variation in their
specialty-specific learning styles: Physicians in surgical spe-
preferred learning styles than men. These findings should
cialties usually have converging and accommodating styles
alert CME planners and presenters that variation in teach-
(Engels and de Gara 2010; Caulley et al. 2012; Richard et al.
ing techniques will be necessary to appeal to all learners.
2014; Modi et al. 2015; Quillin et al. 2016), while those in The experiential learning theory supports curriculum plan-
medical specialties often have assimilating styles ning for CME by sequentially moving a learner from Why?
(Adesunloye et al. 2008). In our study, most participants to What? to How? to If? to ensure that learning styles are
were internists or psychiatrists. Although both internal accommodated.
medicine and psychiatry are cognitive specialties and the
physicians may be presumed to share learning style prefer-
ences, previous CME research has suggested differences in Ethical approval
preferred CME teaching techniques between internists and This study was deemed exempt by the Mayo Clinic Institutional
psychiatrists (Palmer et al. 2017). Future research should Review Board.
better clarify preferred learning styles among cognitive spe-
cialties, especially those that are more procedur-
ally focused. Acknowledgements
The authors acknowledge Ms Debra Blomberg and Ms Valerie
Fernandez for their administrative support.
Limitations and strengths
First, this study is a cross-sectional study at a single institu- Disclosure statement
tion, which may limit generalizability. However, course par-
ticipants had diverse ages, geographic locations, and The authors report no conflicts of interest. The authors alone are
responsible for the content and writing of this article.
specialties. Second, it is not known whether participant
learning styles influence participation and survey comple-
tion. Third, participants self-identified their specialty classifi- Funding
cation, and those who selected the “other” category may
The Kolb Learning Style Inventory was administered through an experi-
include procedurally focused subspecialists who may have ential learning research grant from the Hay Group.
learning preferences that vary from those of the generalists.
Strengths of the study include a priori selection of demo-
graphic variables based on previous research, use of a Notes on contributors
widely used and validated learning style inventory, and C. Scott Collins, MD, is a consultant, Division of General Internal
support from a dedicated survey research center to ensure Medicine, Mayo Clinic, Rochester, Minnesota, and assistant professor of
data integrity. medicine, Mayo Clinic College of Medicine and Science.
6 C. S. COLLINS ET AL.
Sanjeev Nanda, MD, is a consultant, Division of General Internal
Medicine, Mayo Clinic, Rochester, Minnesota, and assistant professor of
medicine, Mayo Clinic College of Medicine and Science.
Brian A. Palmer, MD, MPH, is a consultant, Department of Psychiatry
and Psychology, Mayo Clinic, Rochester, Minnesota, and assistant pro-
fessor of psychiatry, Mayo Clinic College of Medicine and Science.
Arya B. Mohabbat, MD, is a consultant, Division of General Internal
Medicine, Mayo Clinic, Rochester, Minnesota, and assistant professor of
medicine, Mayo Clinic College of Medicine and Science.
Cathy D. Schleck is a statistician, Division of Biomedical Statistics and
Informatics, Mayo Clinic, Rochester, MN.
Jayawant N. Mandrekar, PhD, is a consultant, Division of Biomedical
Statistics and Informatics, Mayo Clinic, Rochester, MN, and professor of
biostatistics and neurology, Mayo Clinic College of Medicine
and Science.
Saswati Mahapatra, MS, is a research coordinator, Division of General
Internal Medicine, Mayo Clinic, Rochester, MN.
Thomas J. Beckman, MD, is a consultant, Division of General Internal
Medicine, Mayo Clinic, Rochester, MN, and professor of medical educa-
tion and medicine, Mayo Clinic College of Medicine and Science.
Christopher M. Wittich, MD, PharmD, is a consultant, Division of
General Internal Medicine, Mayo Clinic, Rochester, MN, and associate
professor of medicine, Mayo Clinic College of Medicine and Science.
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