Original Article

Advances in Health Sciences Education

, Volume 14, Issue 1, pp 79-90

First online:

Lack of interaction between sensing–intuitive learning styles and problem-first versus information-first instruction: a randomized crossover trial

  • David A. CookAffiliated withDivision of General Internal Medicine, College of Medicine, Mayo Clinic Email author 
  • , Warren G. ThompsonAffiliated withDivision of Preventive, Occupational and Aerospace Medicine, College of Medicine, Mayo Clinic
  • , Kris G. ThomasAffiliated withDivision Primary Care Internal Medicine, College of Medicine, Mayo Clinic
  • , Matthew R. ThomasAffiliated withDivision Primary Care Internal Medicine, College of Medicine, Mayo Clinic

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Adaptation to learning styles has been proposed to enhance learning.


We hypothesized that learners with sensing learning style would perform better using a problem-first instructional method while intuitive learners would do better using an information-first method.


Randomized, controlled, crossover trial.


Resident ambulatory clinics.


123 internal medicine residents.


Four Web-based modules in ambulatory internal medicine were developed in both “didactic” (information first, followed by patient problem and questions) and “problem” (case and questions first, followed by information) format.


Knowledge posttest, format preference, learning style (Index of Learning Styles).


Knowledge scores were similar between the didactic (mean ± standard error, 83.0 ± 0.8) and problem (82.3 ± 0.8) formats (p = .42; 95% confidence interval [CI] for difference, −2.3 to 0.9). There was no difference between formats in regression slopes of knowledge scores on sensing-intuitive scores (p = .63) or in analysis of knowledge scores by styles classification (sensing 82.5 ± 1.0, intermediate 83.7 ± 1.2, intuitive 81.0 ± 1.5; p = .37 for main effect, p = .59 for interaction with format). Format preference was neutral (3.2 ± 0.2 [1 strongly prefers didactic, 6 strongly prefers problem], p = .12), and there was no association between learning styles and preference (p = .44). Formats were similar in time to complete modules (43.7 ± 2.2 vs 43.2 ± 2.2 minutes, p = .72).


Starting instruction with a problem (versus employing problems later on) may not improve learning outcomes. Sensing and intuitive learners perform similarly following problem-first and didactic-first instruction. Results may apply to other instructional media.


Cognitive style Internet Instructional method Learning style Medical education Problem-based learning Web-based learning