Annotated Bibliography and Outline

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MAKING CONNECTIONS BETWEEN LEARNING STYLES AND EFFECTIVE LEADERSHIP n By Lacey Shreve, MS4; John Fardell, MPH, MS4; Helen See, MPH; and Anthony D. Slonim, MD, DrPH, FAAPL

In this article … An understanding of the role learning styles play in physician education can be an impor tant component of leadership development.

SEE ONE, DO ONE, TEACH ONE HAS BEEN the prevailing teaching model in medicine for de cades. The model, attributed to William Halsted, the first professor of surgery at Johns Hopkins Hospital, follows the premise that the replication of good clinical practice under the supervision of medical experts will provide sufficient training for future generations of clinicians.1 In addition, the concept of 10,000 hours of training has been considered a mandatory threshold to create an expert in a professional discipline.1

Changes in healthcare delivery, an increase in the global burden of disease, and the diversity of roles available to physi- cian leaders, however, require that we reassess how tomor- row’s physicians should be educated to achieve and maintain competence and evolve as leaders.2 Here, we explore how learning style models can be effectively applied in the educa- tion and work environments to create and maintain competent physician leaders.

EXAMINING LEARNING STYLES

Individuals have dif fer ent strengths and preferences in the way they pro cess, interpret, and retrieve information, commonly known as learning style. Learning styles are characteristic

cognitive, effective, and psychosocial be hav iors that serve as relatively stable indicators of how learners perceive, interact with, and respond to their learning environment.3 Simply put, learning styles are approaches or methods of learning.

The concept of learning styles, which originated in the 1970s, helps us understand that we all have preferences in the way we learn — a preferred method of pro cessing information; thus, understanding or recognizing an individual’s preferred way of learning may help him or her learn better and in less time.4

Learning styles are not fixed personality traits; however, individuals usually prefer one style over another. Preferences may also change over time and/or based on learning environ- ment.3 While each style may suggest a certain preference for a specific learning strategy, a single learning style is not all encompassing. For example, an individual may prefer to learn by doing but could also learn the same information by the passive act of reading.

The application of learning styles has been debated since their inception. Should the learning style of the student match the learning style of the teacher? Some suggest students might become disengaged if their preferred learning style is not integrated into the educational program3 while others believe that presenting students with learning situations in which they

STRATEGY AND INNOVATION

American Association for Physician Leadership® n Physician Leadership Journal 27

are uncomfortable will challenge their learning and lead to a more productive educational experience.

The diversity of learning styles among students in class- rooms, hospitals, or clinical sites pre sents challenges for phy- sician educators because students bring vari ous educational backgrounds, life experiences, cultures, and learning styles into healthcare — a profession that has embraced multidisci- plinary teams to improve patient care. Overall, educators with an awareness of dif fer ent learning styles can develop diversified teaching approaches to fit most of their students’ needs. Simply knowing a student’s learning style improves student learning, in de pen dent of the teaching method.3 Understanding and ad- dressing learning styles also provides individual students insights into their own learning strengths and weaknesses.5

Based on this information, students and preceptors can use learning styles to initiate discussions about learning, especially during student orientation or new work assignments, and to promote self- reflection by students and preceptors about how the student likes to learn, which helps both in the professional development pro cess.

Because physicians at every level can be described as life- long learners, a scholarly review of learning style pro cesses can improve their learning experiences. Examination of physician leadership effectiveness influenced by learning style aware- ness is warranted if we want to continue to diversify the ranks of physicians taking leadership roles in clinical, academic, and public health.

LEARNING STYLE MODELS

Several models can help educators and students better un- derstand and leverage their learning styles.

Kolb’s Experiential Learning Model

The Kolb model defines learning as “the pro cess whereby knowledge is created through the transformation of expe- rience.”6 In this approach, learning is viewed as a lifelong pro cess punctuated with experiences that require adaptation throughout learning.6 It emphasizes not only the outcome of learning, but also the pro cess or experience of learning. This model suggests that learning should begin as an educational pro cess with an understanding of each student’s beliefs and attitudes toward learning.

Kolb’s learning model describes vari ous styles of learning in a hy po thet i cal circular four- stage cycle beginning with a two- step pro cess (see Figure 1):

1. How the learner gathers information:

● Concrete experience (experiencing) — learning from new experiences; or

● Abstract conceptualization (thinking) — learning from conceptual and analytical thinking to achieve understanding of the experience.

2. How the learner internalizes or acts on information:

● Active experimentation ( doing) — active trial- and- error learning; or

● Reflective observation (reflecting) — considering the task and potential solutions before attempt- ing action.

Kolb’s circular model defines four learning styles: conver- gence, divergence, assimilation, and accommodation,3 which can be summarized across axes (see Figure 1):

FIGURE 1. KOLB’S LEARNING MODEL33 – Modified from Manolis, et al. (2013)

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3. Sequential (linear thinking in small incremental steps) versus Global (holistic thinking in large leaps).

4. Active (learn by doing and experimentation) versus Reflective (learn by thinking and reasoning).

(The Felder- Soloman interactive questionnaire can be found at https:// www . webtools . ncsu . edu / learningstyles / )

Herrmann Brain Dominance Instrument®

Developed by Ned Herrmann in 1995, the Herrmann Brain Dominance Instrument is a 120- question student survey. The instrument is based on the assertion that brain dominance is natu ral and normal for all human beings10 and quantifies an individual’s preference for a specific “thinking” style.

The Herrmann model groups people into four categories of preferential thinking based on the task specialized function of the physical brain (see Figure 2):9

n Quadrant A: External learning (left brain, ce re bral). Logical, analytical, factual, critical. Used for learning via lectures and textbooks.

n Quadrant B: Procedural learning (left brain, limbic). Sequential, or ga nized, planned, detailed, structured. Learn through methodical step- by- step testing of what is being taught, with practice through repetition.

n Quadrant C: Interactive learning (right brain, limbic). Emotional, interpersonal, sensory, kinesthetic, symbolic. Learn by discussing and hands-on, sensory-based ex- periments where learners repeatedly fail but continue trying with positive verbal feedback and encourage- ment.

n Quadrant D: Internal learning (right brain, ce re bral). Visual, holistic, innovative. Learn by understanding concepts.

Table 1 summarizes these learning styles, their strengths and weaknesses.

Although students with the same preferred thinking style communicate and understand each other in study groups, stu- dents who do not share those preferences will have difficulty communicating and learning in that group; therefore, being aware of learning styles may help guide the composition of small educational and study groups.

(The Herrmann Brain Dominant interactive questionnaire can be found at http:// interactive . hbdi . com . )

LEARNING STYLES AND HEALTHCARE PROFESSIONALS

Healthcare professionals can use their knowledge of learn- ing styles to the advantage of patients, colleagues, and themselves.

Physician- Patient Relationship

The overall goal of patient education is to help patients as- sume responsibility for their own care. A prerequisite is that physicians assess patients’ knowledge, be hav iors, attitudes, and skills, including their learning needs and style11 so physi-

n Converger (Abstract, Active): The Converger uses ab- stract conceptualization and active experimentation. Action is based on an abstract understanding of the task and projected strategies for successful comple- tion of the task. Convergers prefer to work in small groups, enjoy competitive environments, and aspire to be responsible for their own learning.

n Diverger (Concrete, Reflective): The Diverger combines concrete experience and reflective observation. These individuals are creative learners  because they reflect on multiple strategies for learning, prob lem solving, and developing inventive solutions. Divergers prefer working in groups, but only when they are involved in activities without time constraints.

n Assimilator (Abstract, Reflective): The Assimilator favors abstract conceptualization and reflective observation. Concerned primarily with explanations of their obser- vations, Assimilators prefer individual assignments and extensive feedback on their per for mance.

n Accommodator (Concrete, Active): The Accommodator uses concrete experience and active experimentation. Accommodators have a strong preference for hands-on learning and active learning strategies and often are better able than most to adapt to diverse situations.

VARK Learning Model

Introduced by Neil Fleming in 2006,7 the VARK learning model allows students to categorize their learning styles based on the sensory modalities involved in taking in information:4 Visual, Auditory, Read/Write, and Kinesthetic. The theory considers that most individuals are multimodal, meaning they have a preference for more than one VARK learning style.

n Visual: Learners prefer information presented as graphs, pictures, and symbols — data represented with meth- ods other than words.

n Auditory: Learners prefer information to be audio. They learn best from oral questions, answers, and discussion.

n Read/Write: Learners prefer information that is written or read: text, books, or handouts.

n Kinesthetic: Learners prefer hands-on learning that uses the senses of sight, taste, smell, touch.

The VARK learning style is popu lar in educational programs for its simplicity and intuitive sense.8

Felder- Soloman Model

The Felder- Soloman model was designed in 1987 to provide an approach aimed specifically at engineering instructors.5 This model describes four contrasting student learning styles:9

1. Sensing (concrete, practical, orientated toward facts and procedures) versus Intuitive (abstract, innovative, orientated toward theories and under lying meanings).

2. Visual (visual repre sen ta tions of presented material) versus Verbal (written and spoken explanations).

American Association for Physician Leadership® n Physician Leadership Journal 29

cians can provide care plans in language appropriate both to the patients and to medical colleagues.

Studies show patients’ self- care skills are often enhanced by the inclusion of more than one learning approach, further strengthening the notion that physicians should continually confirm their patients’ preferred learning styles.12 Although physicians may be able to use multiple tools and formats that address their patients’ preferred learning styles, se lection must be based on an assessment of each patient’s needs, willingness, barriers, and abilities. For example, in explain- ing a procedure for surgical consent, the physician will know whether to use life- like models and radiographs, brochures and pamphlets, or a video to help the patient understand the procedure and its risks, benefits, and alternatives.

Health literacy, which refers to individuals’ ability to un- derstand their healthcare issues and how to properly care for themselves, is often an explanation for patients’ non- compliance and non- adherence to treatment plans; they simply lack the skills necessary to comprehend them.13

Because many Americans have below- average literacy skills, written documents and other patient education tools should be aimed at the third- to fifth- grade reading level and routinely used in combination with other teaching strategies for rein- forcement.14 Patients who receive materials tailored to their health literacy level and learning style preference show better comprehension of their medical conditions than patients receiv- ing materials customized for the general health literacy level.15

The VARK model is a simple guide for evaluating patient preferences. When physicians recognize which VARK learn- ing style each patient prefers, they can tailor their medical

explanation to the patient’s learning preference. Incidentally, studies have shown that patients who play online games have increased health- related knowledge, greater self- efficacy to engage in health- related be hav iors, and improved adherence to medical recommendations and regimes.16 Games combine entertainment with multiple learning styles, all while educat- ing patients at their own pace.

Medical Students and Physicians

As students pro gress through medical school, their learning experiences transition from knowledge- based learning to ap- plication of acquired knowledge to real- life contexts.17 Most students eventually develop their own study methods, but initially they are more likely to use study strategies that have been recommended by older students than to trust in their own learning style.5

Knowing this, medical educators should encourage stu- dents to recognize their own learning styles and preferences in the way they absorb and pro cess information. Felder argues that teachers and professors who are unaware of learning styles may unintentionally teach in a way that creates a dis- advantage for some students called “mismatching.” Alterna- tively, if professors try to teach exclusively in their students’ preferred learning styles, the students may not make the effort to adapt to other styles and reach their potential in school and as professionals.5

The challenge is to “teach around the learning cycle” in an attempt to address all students’ learning styles,18 but students must understand that when they are physicians, they may elicit a negative response from their patients if they approach

FIGURE 2. HERRMANN BRAIN DOMINANCE WHOLE BRAIN THINKING® MODEL34 Modified from Herrmann Solutions (2020)

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them using a learning style with which the patients are un- comfortable.

The most preferred VARK modality among medical stu- dents is kinesthetic followed by aural. In the Kolb learning style, the most common type of learning style among students is Converger, which describes learners who prefer to work in small groups, enjoy competition, and like to be responsible for their own learning.3

This information is useful as medical schools adapt the teaching approaches to their students. For example, some medical schools have replaced the traditional gross anatomy laboratory with computer- based anatomy lessons and tools. While this change appeals to some learners, it has the po- tential to leave those with a kinesthetic (hands-on) learning style behind.

With regard to continuous learning, once board certified, physicians must complete board recertification requirements every two years for maintenance of certification (MOC).19 In the past, physician board recertification consisted of an in- person test every 10 years; however, with the new MOC model, physicians’ multiple learning styles are taken into ac- count as they prepare for and then complete their MOC ex- ams biannually with regular assessments and per for mance improvement activities.

Physician Leaders

Critics of traditional medical education curricula question whether medical students receive ample content and experi- ence to become effective leaders. Despite recognition that leadership skills are impor tant to physicians, medical education

TABLE 1: SUMMARY OF STRENGTHS AND WEAKNESSES OF FOUR LEARNING STYLE MODELS

Learning Styles Strengths Weaknesses

Kolb • Recognizes learning styles are not fixed personality traits but rather patterns of be hav ior

• Can be applied to overall curriculum design

• Is used for numerous studies on learning styles and career choices of medical students, physicians, and healthcare professionals

• Not suitable for individual se lection

• No evidence of improved academic per for­ mance

VARK • Is easier to understand versus other learning styles

• Promotes effective learning in multiple settings

• Is flexible for multimodal learners as they can adapt to multimodal learning environments

• Demonstrates how to manage teams more efficiently

• Difficult to accommodate all learning styles in a single learning environmental setting

• Difficult for teachers to create a curriculum that encompasses every VARK modality

• Does not factor in motivation or personality of learner

Felder­ Soloman • Is based on tendencies

• Allows mentors to use a range of teaching techniques to improve student learning, self­ confidence, and satisfaction with their instruction

• Acknowledges high­performing learners with be hav ior tendencies can act differently on occasion

• Gives students insights into their pos si ble learning strengths and weaknesses

• Lack of success in predicting academic per for mance

• Application of learning style dependent on designing effective instruction

Herrmann Brain Dominance

• Addresses four distinct thinking preferences (analytical, or ga nized, strategic, interpersonal) vs. traditional left/right brain theory

• Improves communication through further understanding of how others receive information

• Positively encourages change and growth while considering mature values and attitudes

• Addresses established habits and personality traits, while including situational preferences

• Can be considered overly simplistic for certain situations

• Only applicable to older age groups

• Needs additional research and academic study

American Association for Physician Leadership® n Physician Leadership Journal 31

curricula rarely teach leadership skills.20 Traditional medical school curricula largely exclude content in the public health domain, the business of healthcare, or leadership.

Current and future designers of medical school curricula should recognize that medical students need and value skills beyond traditional medical education because they become de facto leaders the moment they step into the clinical context. In a recent national survey, medical residents indicated that they supported the addition of business management and leadership education to their curricula.21 Unfortunately, the time required for accreditation in gradu ate medical education (GME) precludes opportunities for such training during medi- cal school and residency.

Although the majority of the lit er a ture surrounding learn- ing styles is embedded in education and the classroom, a medical organ ization’s new employees also have learning needs.22 Consequently, there are many advantages to physi- cian leaders determining the learning styles of their employees and applying the appropriate method of training or education to suit each individual’s learning styles.

Learners who are actively engaged in the training or learn- ing pro cess are more likely to achieve success in the task at hand. Learners engaged in their own learning pro cess feel a sense of control, which in turn promotes higher self- esteem and motivation that will then have a positive influence on the outcomes.23

ACTIVE APPLICATION OF LEARNING STRATEGIES

An advanced understanding of learning styles can improve the leadership qualities of physicians, which will enhance their interaction with patients, their students, and those whom they supervise.

Although learning styles cannot be used as a predictor of success, they may promote self- awareness of the vari ous ways individuals teach and learn a range of content. Student and educator learning styles do not have to match for the student- teacher relationship to be successful.3 On its own, learning style awareness does not influence academic per for mance; therefore, the exploration of other potential strategies that integrate learning styles into curricula may help to teach and maintain competent physicians.24

Implementing active and self- directed learning strategies will produce a positive behavioral change in future medical professionals, resulting in an increase in competent physicians and perhaps leaders.25

Simulation- based training is an example of an active ap- plication of vari ous learning strategies that provides realistic medical education in a safe, error- tolerant environment with advantages over conventional bedside training.26 A vital edu- cational aid that complements clinical instruction, simulation can provide future physicians and physician leaders with ad- vanced clinical scenarios while offering structured, realistic, and safe learning environments earlier in the curriculum.27 Poor per for mances during clinical simulations reveal and pre- vent provider errors without harming actual patients.

Simulation has surpassed traditional clinical education as a power ful educational tool that yields immediate and lasting

results while reducing the training time to competence.27 It pre sents an opportunity to use more rigorous, scientific meth- ods to identify key medical competencies, including leader- ship. Two examples of modern simulation- based training technologies that encompass active and self- directed learn- ing style adaptations are virtual real ity and three- dimensional modeling.

Virtual Real ity

Technology advancement has made information and con- tent readily available to learners. No longer is it a question of whether a student can access or retain facts, but how to apply them to patient care.28

Virtual real ity (VR) is emerging as an effective means to deliver instantaneous patient simulations and interactions. The growth of VR as an educational tool is transforming medical education at many levels. VR also could be used to enhance leadership education through simulated team meetings, ex- amples of simulated coaching, or even during peer review sessions or reviews of patient safety events.

Virtual real ity simulations can encompass each VARK learn- ing modality, as the simulations are visual, auditory, display written words, and have a touch- enhanced virtual world.28 Learners best retain information and succeed by doing, particularly when the experience is self- directed, and VR is a practical example of an active and self- directed learning strat- egy that can directly aid in increasing competence among physicians.29

Virtual real ity offers experiential learning as clinical scenar- ios are discussed in the classroom then immediately simulated in real time. If the physician makes an error during a simula- tion, the software provides instantaneous feedback and the physician can repeat the scenario until competence is assured.

VR provides opportunities to learn from clinical encoun- ters without jeopardizing real- life patients. Having physicians apply their knowledge to simulated clinical practice while si- mul ta neously learning from their mistakes improves clinical competency and patient safety.

Three- Dimensional Modeling

With restrictions on work hours and the supervision require- ments for trainees, mastering procedures efficiently can be difficult.30

Three- dimensional modeling (3- D modeling) in medical education is the creation of an anatomically accurate replica- tion of patient- specific models. These replicable models allow for improved hands-on learning for students, proceduralists, or surgeons. Similar to VR simulations, 3- D modeling allows students to learn and hone their skills without practicing on real patients. Additionally, 3- D models have proven to improve learning, per for mance, and the confidence of the trainees regardless of their area of expertise.29

SUMMARY

The dual leadership responsibility of addressing the public’s expectations for patient safety and assuring adequate educa- tion for physicians across their life cycle from student through

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physician leader increases the need for further research into learning styles and their role in physician education.

Current research shows little evidence that an advanced understanding of learning styles positively impacts educa- tional outcomes; however, modern technology has changed the medical education pro cess.31 Today’s physician will need additional assistance navigating the rapidly changing medi- cal environment while efficiently integrating the plethora of content that is available.

It is inevitable that future physicians will be required to rapidly integrate formal knowledge and clinical experience, familiarity in patient-centered, a comprehension of healthcare systems management, educational princi ples, and leadership.32 Learning style preferences should continue to be researched at the medical student and educator level, with initial discus- sions covering the vari ous styles of learning. This can begin with a discussion of learning style preferences during student orientations or healthcare training programs and evolve to include patient-centered approaches and leadership.

As medicine advances, it is essential that physicians em- brace lifelong learning early in their careers and understand how to integrate both content and methods of learning. Computer technologies hold promise in providing medical professionals access to medical knowledge and case scenarios faster and more efficiently, while embracing multiple learn- ing styles instantaneously; however, other innovative teach- ing approaches will also likely be developed to augment the repertoire of modalities available to physicians in the future.

Lacey Shreve, MS4, is a medical student at Saint George’s University School of Medicine in Grenada, West Indies.

John Fardell, MPH, MS4, is a medical student at Saint George’s University School of Medicine in Grenada, West Indies.

Helen See, MPH, is program and proj ect coordinator at Renown Health in Reno, Nevada.

Anthony D. Slonim, MD, DrPH, FAAPL, is president and CEO at Renown Health, professor, medicine and pediatrics, University of Nevada, School of Medicine in Reno, Nevada. He is also the editor in chief of the Physician Leadership Journal. aslonim@renown . org

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1. Loganath K, Adamson PD, Moss AJ. See One, Do One, Teach One: Finding Your Mentor in Academic Medicine. Future Science OA. 2019;5(4):FSO385.

2. Armstrong E, Parsa- Parsi R. How Can Physicians’ Learning Styles Drive Educational Planning? Acad Med. 2005;80(7):680–84.

3. Robles J, Cox CD, Seifert CF. The Impact of Preceptor and Student Learning Styles on Experiential Per for mance Mea sures. Am J Pharm Educ. 2012; 76(7):128.

4. SK S, Helena TC. VAK Styles of Learning Based on the Research of Fernald, Keller, Orton, Gillingham, Stillman, Montessori and Neil D Fleming. International Journal for Innovative Research in Multidisciplinary Field. 2017; 3(4):2455–620.

5. Felder R, Spurlin JE. Applications, Reliability and Validity of the Index of Learning Styles. International Journal of Engineering Education. 2005; (21):103–12.

6. Colucciello ML. Learning styles and instructional pro cesses for home healthcare providers. Home Healthc Nurs. 1993;11(2):43–50.

7. Saga Z, Qamar K, Trali G. Learning Styles- Understanding for Learning Strategies. Pak Armed Forces Med.  2015; 65(5):706–709.

8. Fleming N, Bonwell C. How Do I Learn Best? A Learner’s Guide to Improved Learning. 2019; https:// vark - learn . com / wp - content / uploads / 2019 / 07 / How - Do - I - Learn - Best - Sample . pdf. Accessed February 7, 2020.

9. Felder RM. Matters of Style. ASEE prism. 1996;6(4):18–23.

10. Boer DM, Berg VD. The Value of the Herrmann Brain Dominance Instrument (HBDI) in Facilitating Effective Teaching and Learning of Criminology. Acta Criminologica. 2001:14(1):119–29.

11. Marcus C. Strategies for Improving the Quality of Verbal Patient and Family Education: A Review of the Lit er a ture and Creation of the Educate Model. Health Psychol Behv Med. 2014;2(1):482–95.

12. Bokhari N, Mubashir  Z. Learning Styles and Approaches Among Medical Education Participants. Educ Health Promot. 2019;30(8):1–5.

13. Miller TA. Health Literacy and Adherence to Medical Treatment in Chronic and Acute Illness: A Meta- Analysis. Patient Educ Couns. 2016;99(7):1079–86.

14. Sudore RL, Schillinger D. Interventions to Improve Care for Patients with Limited Health Literacy.  J Clin Outcomes Manag. 2009;16(1):20–29.

15. McCray AT. Promoting Health Literacy.  J Am Med Inform Assoc. 2005;12(2):152–63.

16. Primack BA, Carroll MV, McNamara, M, et al. Role of Video Games in Improving Health- Related Outcomes: A Systematic Review. Am J Prev Med. 2012;42(6):630–38.

17. Roberts V, Perryman M, Rivers PA. A Discussion Paper on the Assessment of Student Learning Outcomes for Healthcare Management. Health Education Journal. 2009;68(2): 140–48.

18. Felder RM. Reaching the Second Tier: Learning and Teaching Styles in College Science Education. J. College Science Teaching.1993;23(5):286–90.

19. Kaplan DA. Physicians’ Battle to Limit Maintenance of Certification Requirements Continues Despite Testing Changes. Medical Economics. 2018;95(19).

20. Bokhari NM, Mubashir  Z. Learning Styles and Approaches Among Medical Education Participants. J Educ Health Promot. 2019;8:1–5.

21. Gnanavel  S. Leadership and Management Skills for Psychiatry Trainees: An Integral Part of Curriculum? Asian Journal of Psychiatry. 2016;19:24–25.

22. Hardy GE, West MA, Hill  F. Components and Predictors of Patient Satisfaction. British Journal of Health Psy chol ogy. 1996;1(1):65–85.

23. Pritchard, Alan. Ways of Learning. Journal of Educational Technology. 2014;46(6): E34– E35.

24. Rashid A, Shah HA, Allaf M. Medical Student Learning Styles: Does It Really Matter? Adv Med Educ Pract. 2019;10:513–14.

25. Armstrong E, Parsa- Parsi R. How Can Physicians’ Learning Styles Drive Educational Planning? Acad Med. 2005;80(7):680–84.

26. Murphy JG, Cremonini F, Kane GC, Dunn W. Is Simulation Based Medicine Training the Future of Clinical Medicine? Eur Rev Med Pharmacol Sci. 2007;11(1):1–8.

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27. Pottle  J. Virtual Real ity and the Transformation of Medical Education. Future Healthc J. 2019;6(3):181–85.

28. Gorman PJ, Meier AH, Rawn C, Krummel TM. The Future of Medical Education Is No Longer Blood and Guts, It Is Bits and Bytes. Am J Surg. 2000;180(5):353–56.

29. Garcia J, Yang Z, Mongrain R, Leask RL, Lachapelle K. 3D Printing Materials and Their Use in Medical Education: A Review of Current Technology and Trends for the Future. BMJ Simulation and Technology Enhanced Learning. 2018;4(1):27–40.

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34. Herrmann N. The Theory Behind the HBDI and Whole Brain Technology. Better Results Through Better Thinking; Herrmann Solutions website. https:// think . herrmannsolutions . com / hubfs / Articles / Theory _ Behind _ The _ HBDI _ _ _ and _ Whole _ Brain _ _ _ Technology . pdf. Accessed February 7, 2020.

KOLB LEARNING STYLE QUESTIONNAIRE33

If you agree more than you disagree with a statement, mark the box to the left of the question. If you disagree more than you agree, leave the box blank. If you find yourself wondering which situation to think of when answering a question, just think about how you are when you are working with people. Go with your first gut reaction instead of over- thinking your response.

❏ I have strong beliefs about what is right and wrong, good and bad.

❏ I often act without considering the pos si ble consequences.

❏ I tend to solve prob lems using a step- by- step approach.

❏ I believe that formal procedures and policies restrict people.

❏ I have a reputation for saying what I think, simply and directly.

❏ I often find that actions based on feelings are as sound as those based on careful thought and analy sis.

❏ I like the sort of work where I have time for thorough preparation and implementation.

❏ I regularly question people about their basic assumptions.

❏ What matters most is whether something works in practice.

❏ I actively seek out new experiences.

❏ When I hear about a new idea or approach, I immediately start working out how to apply it in practice.

❏ I am keen on self- discipline such as watching my diet, taking regular exercise, sticking to a fixed routine, etc.

❏ I take pride in doing a thorough job.

❏ I get on best with logical, analytical people and less well with spontaneous, ‘irrational’ people.

❏ I take care over how I interpret data and avoid jumping to conclusions.

❏ I like to reach a decision carefully after weighing up many alternatives.

❏ I am attracted more to novel, unusual ideas than to practical ones.

❏ I don’t like disor ga nized things and prefer to fit things into a coherent pattern.

❏ I accept and stick to laid down procedures and policies so long as I regard them as an efficient way of getting the job done.

❏ I like to relate my actions to a general princi ple, standard or belief.

❏ In discussions, I like to get straight to the point.

❏ I tend to have distant, rather formal relationships with people at work.

❏ I thrive on the challenge of tackling something new and dif fer ent.

❏ I enjoy fun- loving spontaneous people.

❏ I pay careful attention to detail before coming to a conclusion.

❏ I find it difficult to produce ideas on impulse.

❏ I believe in coming to the point immediately.

❏ I am careful not to jump to conclusions too quickly.

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❏ I prefer to have as many sources of information as pos si ble – the more information to think over the better.

❏ Flippant, superficial people who don’t take things seriously enough usually irritate me.

❏ I listen to other people’s points of view before putting my own view forward.

❏ I tend to be open about how I’m feeling.

❏ In discussions, I enjoy watching the plotting and scheming of the other participants.

❏ I prefer to respond to events in a spontaneous, flexible way rather than plan things out in advance.

❏ I tend to be attracted to techniques such as flow charts, contingency plans etc.

❏ It worries me if I have to rush work to meet a tight deadline.

❏ I tend to judge people’s ideas on their practical merits.

❏ Quiet, thoughtful people tend to make me feel uneasy.

❏ I often get irritated by people who want to rush things.

❏ It is more impor tant to enjoy the pre sent moment than to think about he past or future.

❏ I think that decisions based on a careful analy sis of all the information are better than those based on intuition.

❏ I tend to be a perfectionist.

❏ In discussions, I usually produce lots of spontaneous ideas.

❏ In meetings, I put forward practical, realistic ideas.

❏ More often than not, rules are there to be broken.

❏ I prefer to stand back from a situation and consider all the perspectives.

❏ I can often see inconsistencies and weaknesses in other people’s arguments.

❏ On balance I talk more than I listen.

❏ I can often see better, more practical ways to get things done.

❏ I think written reports should be short and to the point.

❏ I believe that rational, logical thinking should win the day.

❏ I tend to discuss specific things with people rather than engaging in social discussion.

❏ I like people who approach things realistically rather than theoretically.

❏ In discussions, I get impatient with irrelevant issues and digressions.

❏ If I have a report to write, I tend to produce lots of drafts before settling on the final version.

❏ I am keen to try things out to see if they work in practice.

❏ I am keen to reach answers via a logical approach.

❏ I enjoy being the one that talks a lot.

❏ In discussions, I often find I am a realist, keeping people to the point and avoiding wild speculations.

❏ I like to ponder many alternatives before making up my mind.

❏ In discussions with people I often find I am the most dispassionate and objective.

❏ In discussions I’m more likely to adopt a ‘low profile’ than to take the lead and do most of the talking.

❏ I like to be able to relate current actions to the longer- term bigger picture.

❏ When things go wrong, I am happy to shrug it off and ‘put it down to experience’.

❏ I tend to reject wild, spontaneous ideas as being impractical.

❏ It’s best to think carefully before taking action.

❏ On balance, I do the listening rather than the talking.

❏ I tend to be tough on people who find it difficult to adopt a logical approach.

❏ Most times I believe the end justifies the means.

❏ I don’t mind hurting people’s feelings so long as the job gets done.

American Association for Physician Leadership® n Physician Leadership Journal 35

❏ I fi nd the formality of having specifi c objectives and plans stifl ing.

❏ I’m usually one of the people who puts life into a party.

❏ I do what ever is practical to get the job done.

❏ I quickly get bored with methodical, detailed work.

❏ I am keen on exploring the basic assumptions, princi ples and theories underpinning things and events.

❏ I’m always interested to fi nd out what people think.

❏ I like meetings to be run on methodical lines, sticking to laid down agenda.

❏ I steer clear of subjective (biased) or ambiguous (unclear) topics.

❏ I enjoy the drama and excitement of a crisis situation.

❏ People often fi nd me insensitive to their feelings.

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