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

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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.

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  1. We intentionally avoided the use of a pretest because of the weaknesses the pretest introduces to education research (Fraenkel and Wallen 2003). In a randomized study, individual differences (including knowledge assessed on pretest) should be distributed equally among groups, obviating the need for a pretest.

  2. In the mixed linear model, analysis of variance (ANOVA) is a special case of linear regression. Thus the mixed linear model can be used for both regression and analysis of variance.


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Funding source: Mayo Clinic Department of Medicine.

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Correspondence to David A. Cook.

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Cook, D.A., Thompson, W.G., Thomas, K.G. et al. Lack of interaction between sensing–intuitive learning styles and problem-first versus information-first instruction: a randomized crossover trial. Adv in Health Sci Educ 14, 79–90 (2009).

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