U-11_Learning Styles Research Proposal

Royal College of Surgeons of Edinburgh
&
University of Bath

MSc in Healthcare Informatics

Medical Students’ Cognitive and Learning Styles Assessment –
A Multi-modal Survey Methodology

This project proposal is submitted in accordance with the requirements for the degree of
Master of Healthcare Informatics of the Royal College of Surgeons of Edinburgh and
University of Bath.

Supervisor: Robin Beaumont

October 2006

Sanjoy Sanyal

Table of contents

Section Page number
1. Summary 3
2. Introduction 3
3. Literature review – identifying deficiencies 3–4
4. Aim and objectives 4–5
5. Methods 5–7
5.1 Study design 5
5.2 Setting 5
5.3 Participants and data sources 5
5.4 Questionnaires 5
5.5 Rationale for tool selection 6
5.6 Data extraction, scoring, representation 6
5.7 Data analysis methods 6
5.8 Main outcome measures 7
5.9 Enhancing validity of results 7
5.10 Quality checks 7
5.10.1 Checks in questionnaire survey process 7
5.10.2 Checks in data collection and entry 7
6. Project timeline – Gantt chart 7–9
7. Estimated cost / proposal budget 9 – 10
8. Strengths and limitations of study 10
8.1 Strengths 10
8.2 Limitations 10
9. Benefits of study 10
10. Write-up of report 10
11. Ethical approval 10 – 11
12. Acknowledgements 11
13. Conflicts of interest 11
14. References 11 – 13
15. Appendix 13 – 17
15.1 Appendix 1: Memletics Learning Styles Inventory 13 – 14
15.2 Appendix 2: Learning Styles Type-Indicator 14 – 16
15.3 Appendix 3: Herrmann Brain Dominance Instrument 16
15.4 Appendix 4: General Health Questionnaire (GHQ-12) 16 – 17

RCSEd & University of Bath; MSc Healthcare Informatics; Unit 11 Assignment – Research Proposal Final (Oct 2006); Tutor: David; Student: Sanjoy 2

1. Summary

Background
The University of Seychelles American Institute of Medicine (USAIM), Seychelles teaches pre-clinical
subjects to medical students from Pre-clinical (PC) 1 to 5. The curriculum is based on semester system
followed in USA, with three semesters in one calendar year. Over successive years, the general observation has
been that the students’ academic performance was falling short of expectations. This provided the impetus for
this study.

Objectives
The ultimate aim of this research is to find a way to improve medical students’ learning and curricular
performance. After implementation of the results of the research, the objective would be to attain improvement
in the students’ learning ability through best-practice learning guidelines, demonstrable by an overall average
of 90% first-attempt pass in each semester. This is based on US national pass rates, because USAIM follows
the United States Medical Licensing Examination (USMLE) curriculum.

Design
The study is designed along the lines of a paper-based questionnaire survey. It would be a cross-sectional study,
the data being collected at a specified fixed point in time, in order to maximize efficiency and reduce wastage
of time.

Setting
The USAIM campus, Anse Royale, Mahé, Republic of Seychelles would be the test-bed of the study.

Participants and data sources
The pre-clinical (PC) students of USAIM would be the participants and their responses to the questionnaires
would be the data sources. It is proposed to select at least 50 students by random sampling (10 students from
each class; PC-1 to PC-5), stratified by class.

Main outcome measures
Students’ Herrmann brain dominance pattern of learning, their Memletics learning styles, their Myers Briggs
Type Indicator (MBTI) personality-type, stress levels and relationships between these would be the main
outcome measures.

Benefits of study
This study would identify the USAIM students’ learning styles and their thinking patterns while studying. It
would therefore help to identify their learning and cognitive strengths and weaknesses. Then this knowledge
would be utilized to capitalize on their strengths, overcome their weaknesses and lay the foundation for
developing best-practice learning guidelines, which would be applicable to all.

2. Introduction
The oft-repeated refrain in many medical universities is that academic performance of students leaves much to
be desired. The University of Seychelles American Institute of Medicine (USAIM), Seychelles is no exception
in this regard. Some common denominators underlying this lackluster performance are; virtual limitlessness of
the syllabus, strict time-bound nature of the same, limited time available for each module (especially in the
semester system of education), and constant pressure of tests throughout the semester. Introduction of online
modules, as is the practice in many universities, further compounds the problem. The students are subjected to
cognitive overload, if one were to quantify the same in terms of magnitude of content and the time available to
complete the same. In other words, they are stressed out.[1] The mental characteristics and learning attributes
that served them so well in high school, which in fact got them into medical school, may not be of much use
within the portals of medical academia or in the cyber world of e-Learning.[2]

3. Literature review – identifying deficiencies

Individual mental abilities confer cognitive styles, which in turn specify learning styles. Cognitive styles refer
to characteristics adopted by individuals during information gathering / organizing processes; while learning
styles are specific cognitive styles that are relevant in applied learning environments. Seventy-one learning
style models have been identified.[3] Different models have been designed to classify these learning-style
models. Curry’s ‘onion’ model, adopted by Indiana State University, classifies 27 of these learning-style
models into 4 families. This easy-to-understand model arranges learning-style models and examines them from
outside to inside, like ‘layers of an onion’; from those that focus on external factors to those that are based on
personality theory.[4] The Joint Information Systems Committee (JISC) on the other hand, considers only 13
learning-style models to be significant and classifies them into 5 ‘families’, based on their fixedness to various
cognitive and personality characteristics.[3] The latter classification, though conceptually more difficult to
comprehend, identifies several lacuna in the existing knowledge about learning styles, and personality and
cognitive functions of the brain. It thus provides a foundation on which to base further research on learning
styles and preferences.

Current practices are geared towards matching pedagogy to mental abilities and thus to learning preferences, in
what is termed as learner-centred pedagogy.[3] There are moves afoot to design e-Learning systems that take
into consideration concepts like learner diversity, the learning cycle and ‘whole-brain’ learning.[5] An essential
pre-requisite for achieving these aims is to have a clear understanding of the target student population’s
learning styles / preferences, and their diversity. This therefore forms the basis of an important area of study.

Herrmann’s ‘whole brain model’ can be used to build learning experiences to enhance learning and make it
more memorable. When teaching and learning are going well, they are most likely ‘whole-brained’. But when
things do not seem to be working, most likely one/more of the quadrant(s) of the whole-brain model have been
overlooked.[6] The Herrmann Brain Dominance Instrument (HBDI) is based on the premise that learning styles
are ‘flexibly-stable’ learning preferences. The HBDI offers considerable promise for use in education, but it has
been under-represented in academic research.[3] Knowledge of students’ ‘brain-dominance’ insofar as it
pertains to learning would pave the way for designing and imparting ‘whole-brain’ learning. This also forms an
important area of study.

The literature also reveals that learning styles are a component of a relatively stable personality type; but it is
not clear which element(s) of the 16 personality types of Myers Briggs Type Indicator (MBTI) are relevant to
education.[3] Correlation between MBTI and HBDI preferences have been postulated, but multiple studies have
yielded ambiguous and inconclusive results.[6] Therefore, these provide fertile grounds for further research.

Gardner defined seven different aspects of intelligence, to which an eighth component was added later.[3,4,7,8,9]
Learning styles have also been correlated to each of Gardner’s intelligence types;[8,9] and it has been proposed
that each learning style uses different parts of the brain.[8] The literature agrees that by involving more of the
brain during learning, the student remembers more of what they learn.[6,8] However, further study is required to
determine how the Gardner model fits with Herrmann brain dominance model.

Finally, there is clear evidence of mental stress in medical undergraduates. This constitutes a significant
element of psychological morbidity, and detracts from optimal student performance. Various stressors, and
methods adopted by students to cope with stress, have been identified.[1] Given these findings, it is pertinent to
investigate levels of stress in medical students, particularly in relation to new online teaching modules.
Likewise, there is also a clear rationale for examining how this stress could be minimized, specifically by
exploring the relationship between stress levels and learning styles.

4. Aim and objectives
The ultimate aim of this research is to find a way to improve medical students’ learning and curricular
performance. After implementation of the results of the research, the objective would be to attain improvement
in the students’ learning ability through best-practice learning guidelines, as demonstrated by an overall
average of 90% first-attempt pass in each semester. The current pass rate in USAIM varies between 67% and

75%. The target figure, though somewhat higher than the pass rates in UK medical schools,[10-12] has been
selected on the basis of reported US national pass rates in medical/health curricula, which vary between 81%
and 91%, with several colleges claiming even higher pass rates.[13-15] USAIM follows the US curriculum, with
semester system of classes (three semesters per year), and prepares students for United States Medical
Licensing Examinations (USMLE) Step 1.

In order to generate best-practice learning guidelines, the following study questions are formulated, based on
preliminary review of literature:

1. What is the association, if any, between the components of Herrmann’s brain model and elements of MBTI?
2. Which element(s) of 16 personality types of MBTI are relevant to education?
3. How does the Gardner multiple intelligence-based learning model fit in with Herrmann’s 4-brain learning
model?
4. What is the role of Herrmann brain dominance model in education and academic research?
5. Is there any cause-effect relationship between stress levels and learning styles?

In order to answer the questions the study would;

• Measure each student’s learning style/preference
• Determine each student’s personality type
• Map each student’s brain thinking pattern
• Assess the stress level in each student
• Explore relationships between stress levels, learning styles, thinking pattern and personality types

The answers to these questions would generate uniformly applicable best-practice learning guidelines to
enhance students’ learning and academic performance.

5. Methods

5.1 Study design
The study is designed along the lines of a paper-based questionnaire survey. It would be a cross-sectional study,
the data being collected at a specified fixed point in time, in order to maximize efficiency and reduce wastage
of time.

5.2 Setting
The USAIM campus, Anse Royale, Mahé, Republic of Seychelles would be the test-bed of the study.

5.3 Participants and data sources
The pre-clinical (PC) students of USAIM would be the participants and their responses to the questionnaires
would be the data sources. The study would be conducted systematically, class-wise, starting from PC-5, and
progressing down to PC-1. Each class-participation would be supervised by the author, who would be present
to give the preliminary instructions and to clarify any doubts pertaining the wordings / verbiage of the
questionnaires.

Since USAIM is a relatively small medical school at present, the researcher has only about 70 students under
his tutelage. Therefore it is proposed to select at least 50 students by random sampling (10 students from each
class; PC-1 to PC-5), stratified by class. Each student would be given each of the four tests sequentially, with a
sufficient temporal gap to avoid questionnaire fatigue.

5.4 Questionnaires
Four survey instruments would be employed [Appendix 1 to 4]. The first is a 70-item Memletics learning styles
(LS) inventory based on Gardner’s multiple intelligence theory.[16] The second is a 28-item learning styles type-
indicator based on MBTI pattern.[17] The third is a 10-item HBDI (with multiple responses in each).[18] The
fourth is the 12-item General Health Questionnaire (GHQ-12) for assessing students’ stress levels.[19]

5.5 Rationale for tool selection
All the assessment instruments are publicly available on the Internet, from educational institutions and/or
reputed sites.[16-19] Secondly, all instruments are worded in a simple, easy-to-understand language. This is
particularly relevant in the setting of this study where the subjects, though they have a uniformly good
command of English, do not necessarily use it as their first language. Thirdly, it is estimated that everybody
would be able to complete all four questionnaires in 45 to 50 minutes, which is equivalent to typical lecture
duration as far as attention span is concerned. Fourthly, all instruments give results that can be scored
numerically and/or represented graphically. Thus they can be analysed statistically and their graphical output
can be compared visually. Fifthly, each instrument has been tried and tested in educational settings; the HBDI
instrument has been modified for, and used on, college students (Bendigo Senior Secondary College,
Australia); the MBTI-based instrument has been specifically designed for medical students (from Texas Tech
University, USA); GHQ-12 has also been used on 1st year medical students (Glasgow University Medical
School, Glasgow, UK), and Memletics LS inventory has been tested on over 180,000 people.[16-19] Thus, all are
ideally suited for the medical students of USAIM.

5.6 Data extraction / scoring / representation
Since all are paper-based questionnaire (as opposed to online), student responses for all but the Memletics
instrument would be extracted and scored manually, according to pre-determined scoring guidelines for each
instrument. The HBDI result would be graphically represented on printed sheets. The Memletics LS inventory
data would be entered into an MS Excel format with the calculation formula pre-fed into the cells. Thus the
result from this instrument, and its graphical output, would be automatically generated and recorded.

5.7 Data analysis methods
The correct number of students to be chosen would be determined by a priori or compromise power analysis,
using G*Power software tool, a freely-available general purpose power analysis program from University of
Düsseldorf, Germany.[20] Preliminary compromise power analysis with sample size of 50, Cohen’s effect size
index of 0.5 (‘medium’ effect), one-tailed test, and β/α ratio of 1, has revealed power (1-β) of the test to be
nearly 0.9 (Figure-1).

Figure-1: Screenshot of
G*Power showing
calculation of power of
the test with sample size
of 50. Courtesy Buchner
A, Erdfelder E, Faul F

The statistical software incorporated in Epi Info Version 3.3.2 (February 9, 2005) and MS Excel would be used
to perform the complex statistical analyses.[21]

The relationship between HBDI components and MBTI elements would be established by scatter-gram plots,
because the two sets of data are likely to be independent of each other.


Since the results from HBDI instrument and Memletics LS instruments are recorded in ranked (ordinal) scales,
one of the non-parametric correlation methods, namely Spearman’s or Kendall’s rank correlation coefficients
would be used.

Another, qualitative visual comparison would be done on the results of these two instruments. Each one of the
Memletics LS inventory corresponds to one of Gardner’s original 7 levels of intelligence;[8,9] and each of these,
in turn, correspond to 1-2 specific regions of the brain.[8] Therefore each Memletics LS result would be marked
on a schematic representation of the brain, which would be visually mapped to a graphical representation of
HBDI, to assess the degree of association between the two results.

Finally, the Ishikawa cause-effect ‘fishbone’ diagram is a method used in a root-cause analysis, and is used as a
graphical method for finding the most likely causes for an undesired effect.[22] Therefore this tool would be
used to determine which Memletics learning style(s) is/are the root cause for stress in the students, if any, as
determined by GHQ-12 scores.

5.8 Main outcome measures
Students’ Herrmann brain dominance pattern of learning, their Memletics learning styles, their MBTI
personality-type, stress levels and relationships between these would be the main outcome measures.

5.9 Enhancing validity of results
Triangulation is a means of enhancing the validity of results. Triangulation is defined as using three or more
research methods in combination; principally as a check of validity.[23] This study uses three different methods
to assess students’ learning styles. Therefore, apart from improving the validity of the findings, each testing
tool would serve to cross-validate the other.

5.10 Quality checks
The following quality control procedures would be implemented in the study;

5.10.1 Checks in questionnaire survey process
• Prior preparation of students about the questionnaire survey by informal discussions and bulletin board
notices
• Clear instructions at the beginning of the questionnaire, reinforced verbally by the researcher
• Modifying the wordings and / or syntax so as render each question easily comprehensible and minimize
ambiguity
• Using different fonts for instructions and questions

5.10.2 Checks in data collection and entry
• Checking for completeness of responses, illegible responses, ambiguous responses or inadmissible
responses
• Provision for calling back the participants for error corrections, if any
• Entering data for analysis on same day as collection, as far as possible
• Maintaining hard and soft copies of collected and entered data
• Cross-checking of entered data by a third (neutral) party

6. Project timeline – Gantt chart


(Continued from previous)


7. Estimated cost / proposal budget

Budget item Description Estimated cost
Personnel One data analyst-cum-statistician 5000 SCR (£ 483.86) x 1 month
Equipment Computer Available; no extra cost
Internet connection (Cable 250 SCR (£ 24.19) / month x 6
broadband from Intelvision) months = 1500 SCR (£ 145.14)
Software Microsoft Word, Microsoft Excel, 1st two came with computer; rest
Epi Info 3.3.2, G*Power, were downloaded freely from the
BiblioExpress Reference Internet; SmartDraw: $ 179 (£
Manager, SmartDraw 95.63); (one user)
Testing instruments (Memletics HBDI instrument (4-MAT) – $ 300 (£ 160.27) + $ 9 (£ 4.81) =
learning styles inventory and Comprehensive group profile + $ 309 (£ 165.08)
GHQ-12 are free) Overseas mailing
MBTI instrument ($ 99.99 x 1st 10 users) + ($ 74.99
x Subsequent 40 users) = $ 3999.5
(£ 2136.72)
Researcher’s travel Related to study 1625 SCR (£ 157.26)
Participant support Post-study transport expenses 3900 SCR (£ 377.41)
Other direct costs Materials & supplies (A-3, A-4 A-3 = $ 120 (£ 63.89) ; A-4 = $ 55
paper) (£ 29.28) = $ 175 (£ 93.49)
Paid online journals (those not ~ £ 3 / article x 50 articles
available through Athens or (estimated) = £ 150
University of Bath login)
Printing (HP toner cartridges) 12A = $ 136 (£ 72.39); 15A = $
128 (£ 68.14); Total = $ 264 (£
141.04)
Communications (phone, fax, 1950 SCR (£ 188.71)
postage etc)
Total direct cost £ 4134.34
Indirect / hidden cost Inflation (change in wholesale Estimated @ 10% of previous = £
price index) and /or devaluation of 413.43
local currency (SCR) during
course of study
Grand total (direct + indirect cost) £ 4547.77
[24]
Conversion rate (as on the date of submission of proposal)

• 1 SCR (Seychelles Rupee) = £ 0.09677
• 1 SCR = $ 0.1811
• $ 1 = £ 0.5342

8. Strength and limitations of study

8.1 Strengths
• This study involves participants in their actual settings, who are experiencing the problems being
analysed by this study in real-life situations. This contributes to construct validity of this study.
• Cross-validation of results and of each testing instrument, through triangulation by three different
testing tools, is a major strength of this study.
• Preliminary compromise power analysis has confirmed the adequacy of number of participants.
• The results of this study could be extrapolated to the rest of the student population in this university and
also in other institutions in the region, given similar student demographics.

8.2 Limitations
• Study subjects are students of the university, and include a large proportion of students who have been /
are being taught by the author of this study. Thus there is scope of inclusion bias.
• Cross-sectional studies, providing a snap-shot at one point in time as they do, often need very large
samples to counter any potential sources of bias. In this study, limited number of students in the course
precluded large sample sizes.
• Hawthorne effect is the possible alteration of response by subjects by knowledge of the fact that they
are being tested, and the presence of the researcher.[23,25] This is another possible source of bias.
• Ideally this study should have been repeated after one year, to assess students’ response to the changes
initiated through the first study

9. Benefits of study
This study would identify the USAIM students’ learning styles and their thinking patterns while studying. It
would therefore help to identify their learning and cognitive strengths and weaknesses. Then this knowledge
would be utilized to capitalize on their strengths, overcome their weaknesses and lay the foundation for
developing best-practice learning guidelines, which would be applicable to all.

10. Write-up of report
Once the draft write-up of the study is complete, it would be submitted to the project supervisor. He would
suggest revisions / amendments / modifications or otherwise give suggestions for improvement. These would
be incorporated in the next iteration of the write-up and resubmitted to the supervisor. The cycle would be
repeated till it is considered worthy of submission as an MSc dissertation. Then the final submission would be
made.

11. Ethical approval
This study would be conducted in the University of Seychelles American Institute of Medicine, Seychelles,
where the author is employed as a lecturer. USAIM administration or Seychelles authorities do not have any
objection to the study being carried out. However, a communication was sent to University of Bath School for
Health Ethics Committee representative, Lisa Austin, who replied;

“I doubt that there will be any objection to your research but it would be best if I made the School for Health
Ethics Committee aware to avoid any problems. Perhaps you could e-mail me your questionnaire with a brief
explanation of the objectives plus a description of how you intend to contact students, how many responses you
need and whether the students need to come from a particular Department.”[26]


Therefore, before embarking on the study, the appropriate action would be taken, as advised by her.

12. Acknowledgements
The President of USAIM, LLC (Fort Wayne, Indiana, USA) has approved the study and granted permission for
the study to be conducted on the students. The Dean of USAIM has also expressed his support for the project.
The students of USAIM are enthusiastic and willing to participate in the study. The support of all is gratefully
acknowledged.

13. Conflicts of interest
The researcher-cum-author of this study is a lecturer in USAIM and draws monthly salary from there. Study
subjects are students of the university, and include a large proportion of students who have been / are being
taught by the author of this study.

14. References
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problem-based learning medical curriculum. Med Educ [serial on the Internet]; 2004 March 15 [cited 2006
October 2]; 38(5):482-91[about 10 pages]. Available from: http://www.blackwell-
synergy.com/doi/pdf/10.1046/j.1365-2929.2004.01814.x

2. Pelley JW. The Texas Tech University Health Sciences Center [homepage on the Internet]. TTU; ©
copyright 1998 May 8 [last updated 2005 February 24; cited 2006 October 2]. SuccessTypes Survival Strategy;
[about 3 pages]. Available from: http://www.ttuhsc.edu/SOM/Success/Survival.htm

3. Mayes T. Joint Information System Committee [homepage on the Internet]. JISC; [cited 2006 October 2].
JISC e-Learning Models Desk Study – Stage 2: Learner-centred pedagogy: Individual differences between
learners; [about 17 pages]. Available from:
http://www.jisc.ac.uk/uploaded_documents/Stage%202%20Learning%20Styles%20(Version%201).pdf

4. O’Connor T. Indiana State University [homepage on the Internet]. Center for Teaching and Learning
[published 1997 February 21; cited 2006 October 2]. Using Learning Styles to Adapt Technology for Higher
Education; [about 7 pages]. Available from: http://web.indstate.edu/ctl/styles/learning.html

5. Australian National Training Authority [homepage on the Internet]. ANTA; copyright 1996 [cited 2006
October 2]. A Checks and Balances Planning Model; [about 1 page]. Available from:
http://www2.tafe.sa.edu.au/lsrsc/one/natproj/tal/bestprac/imagemap.htm

6. Leonard S. Leonard Consulting [homepage on the Internet]. Copyright Leonard Consulting [cited 2006
October 2]. Whole Brain Teaching and Learning; [about 4 pages]. Available from:
http://www.leonardconsulting.com/Whole%20Brain%20Learning2.htm

7. Ldpride.net [homepage on the Internet]. Ldpride.net; copyright © 2006 [cited 2006 October 2]. Multiple
Intelligence Explained; [about 2 pages]. Available from: http://www.ldpride.net/learningstyles.MI.htm

8. Learning-styles-online.com [homepage on the Internet]. © Advanogy.com 2003 [cited 2006 October 2].
Overview of Learning Styles; [about 2 pages]. Available from: http://www.learning-styles-
online.com/overview/

9. Learning Disabilities Resource Community [homepage on the Internet]. LDRC; © 2001, 2002 [cited 2006
October 2]. Eight Styles of Learning; [about 2 pages]. Available from:
http://www.ldrc.ca/projects/miinventory/miinventory.php?eightstyles=1


10. Bessant R, Bessant D, Chesser A, Coakley G. Analysis of predictors of success in the MRCP (UK) PACES
examination in candidates attending a revision course. PMJ [serial on the Internet]. 2006 [cited 2006 October
2]; 82:145-49 [about 5 pages]. Available from: http://pmj.bmjjournals.com/cgi/content/full/82/964/145

11. Tyrer SP, Leung W-C, Smalls J, Katona C. The relationship between medical school of training, age,
gender and success in the MRCPsych examinations. Psychiatric Bulletin [serial on the Internet]. 2002 [cited
2006 October 2]; 26:257-63 [about 7 pages]. Available from: http://pb.rcpsych.org/cgi/content/full/26/7/257

12. The Student Doctor Network [homepage on the Internet]. The Student Doctor Network; © 1995-2006 CRG
[cited 2006 October 2]. ABS national pass rate; [about 1 screen]. Available from:
http://forums.studentdoctor.net/archive/index.php/t-51429.html

13. Berkeley Optometry University of California [homepage on the Internet]. Regents of the University of
California; Copyright © [cited 2006 October 2]. NBEO Examination Pass Rates (Berkeley Optometry
Students); [about 2 screens]. Available from:
http://spectacle.berkeley.edu/opt_txtpp/programs/clinical_prog/clinprog_nbeo.html

14. The Lewis University College of Nursing and Health Professions [homepage on the Internet]. Lewis
University; Copyright © 2006 [cited 2006 October 2]. College of Nursing and Health Professions; [about 1
page]. Available from: http://www.lewisu.edu/academics/nursing/index.htm

15. Indiana University [homepage on the Internet]. The Trustees of Indiana University; copyright ©2003
[published 2004 May 14; cited 2006 October 2]. IU East nursing ‘pass rates’ above national norm; [about 2
screens]. Available from: http://homepages.indiana.edu/051404/text/faeture2.shtml

16. Learning-styles-online.com [homepage on the Internet]. © Advanogy.com 2003 [cited 2006 October 2].
Free learning styles inventory, including graphical results; [about 3 pages]. Available from:
http://www.learning-styles-online.com/inventory/

17. Pelley JW. The Texas Tech University Health Sciences Center [homepage on the Internet]. TTU; ©
copyright 1998 May 8 [last updated 2002 August 21; cited 2006 October 2]. The SuccessTypes Learning Style
Type Indicator; [about 3 pages]. Available from: http://www.ttuhsc.edu/SOM/Success/LSTI.htm

18. Bendigo Senior Secondary College [homepage on the Internet]. BSSC; © 2005 [last updated 2004
December 12; cited 2006 October 2]. Ned Herrmann Brain Dominance; [about 1 page]. Available from:
http://www.bssc.edu.au/public/learning_teaching/pd/toc/Hermann.shtml

19. WebPoll [homepage on the Internet]. WebPoll [cited 2006 October 2]. General Health Questionnaire
(GHQ-12); [about 1 page]. Available from: http://www.webpoll.org/psych/GHQ12.htm

20. Buchner A, Erdfelder E, Faul F. Department of Psychology University of Düsseldorf [homepage on the
Internet]. Düsseldorf: The University; 1997 [last updated 2001 March 28; cited 2006 October 2]. How to Use
G*Power; [about 8 pages]. Available from: http://www.psycho.uni-
duesseldorf.de/aap/projects/gpower/how_to_use_gpower.html

21. Centers for Disease Control and Prevention [homepage on the Internet]. Atlanta GA: CDC; 2004 April 26
[updated 2005 February 9; cited 2006 October 2]. Epi Info™ version 3.3.2 – Database and statistics software
for public health professionals. Available from: http://www.cdc.gov/epiinfo/downloads.htm

22. Wikipedia [homepage on the Internet]. Wikimedia Foundation, Inc. [last modified 2006 August 28; cited
2006 October 2]. Ishikawa diagram; [about 1 frame]. Available from: http://en.wikipedia.org/wiki/Cause-and-
effect_diagram


23. Pope C, Mays N. Researching the parts other methods cannot reach: an introduction to qualitative methods
in health and health services research. BMJ 1995 July 1; 311:42-5.

24. Finance Yahoo [homepage on the Internet]. CA: Yahoo! UK Ltd; Copyright(c) 2006 [cited 2006 October
2]. Available from: http://uk.finance.yahoo.com/currency/convert

25. Friedman CP, Wyatt JC. Chapter 1: Challenges of Evaluation in Medical Informatics. In: Friedman CP,
Wyatt JC, editors. Evaluation in Medical Informatics. London: 1997. p. 3 – 11.

26. Austin L. University of Bath School for Health ethics committee. Personal Communication; 2006
September 19.

15. Appendix

15.1 Appendix 1: Memletics Learning Styles Inventory
Your name_________________________________________________
(We need to know which mind is sitting at the other end of the pen!)
Instructions
• Answer ALL questions.
• Answer each question by encircling one of the numbers on the right.
• Remember there are NO RIGHT OR WRONG ANSWERS.
• Do not spend too much time with each question.
• The first response that comes to your mind is usually the best.

The scale is as follows:
0 = This is NOT AT ALL LIKE ME
1 = This is PARTLY / SOMEWHAT LIKE ME
2 = This is EXACTLY LIKE ME

Questions

1. You have a personal / private interest or hobby that you like to do alone. 0 1 2
2. When you have to do many things, you make a to-do list, and number the items and set priorities. 0 1 2
3. Themes or parts of songs pop into your head at random. 0 1 2
4. You liked Mathematics and Science subjects in school. 0 1 2
5. You are happy on your own. You like to do some activities alone and away from others. 0 1 2
6. You enjoy learning in a classroom with other people. You enjoy the contact and it helps your learning. 0 1 2
7. You like to read everything that you see – books, newspapers, magazines, menus, road signs etc. 0 1 2
8. You can easily visualize (see in your mind) objects, buildings, scenarios etc from their descriptions. 0 1 2
9. You are goal-oriented and you know where you want to go in life, study or work. 0 1 2
10. You prefer team games like football, netball, basketball, volleyball, hockey, baseball. 0 1 2
11. You find your way around easily. You rarely get lost. You have a good sense of direction. 0 1 2
12. You prefer to study or work alone. 0 1 2
13. You like being a close friend, mentor or guide for others. 0 1 2
14. You spend time alone to reflect and think about your life. 0 1 2
15. In regular conversation, you often bring up other topics /events that you have heard about or read. 0 1 2
16. You enjoy finding links /associations, for e.g. between numbers or objects. You like to classify things to help you understand the
relationship between them. 0 1 2
17. You keep a personal diary / journal to record your thoughts. 0 1 2
18. You communicate well with others, and often help solve problems between two people. 0 1 2
19. You love sports and exercise. 0 1 2
20. You like to listen. People like to talk to you because they feel you understand them. 0 1 2
21. You like listening to music – in the car, studying, anywhere. You love live music. 0 1 2
22. You know how much you have in your bank or personal account or pocket money. You like to set budgets. 0 1 2
23. You have some very close friends. 0 1 2
24. You use many hand gestures or other physical body language when communicating with others. 0 1 2
25. English or other languages, and literature, were your favorite subjects in school 0 1 2
26. You like making models, or working on jigsaw puzzles. 0 1 2
27. You prefer to talk over problems, issues or ideas with others, rather than working on them yourself. 0 1 2
28. Music was your favorite subject in school; or you liked playing in the school band. 0 1 2
29. In school you preferred art, technical drawing or geometry. 0 1 2

30. You love telling stories. 0 1 2
31. You like identifying logical flaws /problems in other people’s words or actions. 0 1 2
32. You like to take still or video-camera pictures to capture the world around you. 0 1 2
33. You use rhythm or rhyme to remember items, e.g. phone numbers, PIN numbers etc. 0 1 2
34. In school you liked sports, wood /metal-working, craft, sculpture, pottery or similar subjects. 0 1 2
35. You know lots of words and like using the right word at the right time. 0 1 2
36. You notice, and like the feel of, clothes, furniture and other objects. 0 1 2
37. You prefer to holiday on a deserted island rather than a tourist resort with many other people around. 0 1 2
38. You like books with many diagrams, illustrations or pictures. 0 1 2
39. You can easily express your ideas / information to others, either verbally or in writing. 0 1 2
40. You like playing games with others, e.g. card games or board games. 0 1 2
41. You use specific examples and references to support your point of view. 0 1 2
42. You can tell the difference between instruments, cars, aircraft etc based on their sound. 0 1 2
43. You have a good sense of color. 0 1 2
44. You like playing with the meanings of words, using double-meanings, saying tongue-twisters, making rhymes. 0 1 2
45. You like to think out ideas, problems or issues while doing something physical, like taking a shower. 0 1 2
46. You read self-help books, or been to self-help workshops, or done similar work to learn more about yourself. 0 1 2
47. You can play a musical instrument, or you can sing on key to music. 0 1 2
48. You like cross-word puzzles, scrabbles or other word games. 0 1 2
49. You like logic games and brain-teasers, or chess and other strategy games. 0 1 2
50. You like getting out of the house and being with others, at parties or social events. 0 1 2
51. You sometimes realize you are tapping in time to music, or you naturally start to hum/whistle a tune. Even after only hearing a
tune a few times, you can remember it. 0 1 2
52. You solve problems by ‘thinking aloud’. You talk through issues, questions and possible solutions. 0 1 2
53. You enjoy dancing. 0 1 2
54. You prefer to study alone. 0 1 2
55. You don’t like silence. You prefer to have some background music or noise rather than silence. 0 1 2
56. You dislike theme park rides because you hate the effect of the physical forces on your body. 0 1 2
57. You draw well. You find yourself drawing or doodling on a notepad when thinking. 0 1 2
58. You easily work with numbers; you can do decent calculations in your head. 0 1 2
59. You use diagrams and scribbles to communicate ideas and information. You white/blackboards and color pens/chalk. 0 1 2
60. You hear small things that others don’t. 0 1 2
61. You would prefer to touch or handle something to understand how it works. 0 1 2
62. You don’t mind taking the lead and showing others the way ahead. 0 1 2
63. You easily absorb information through reading, lectures or audio-cassettes. The actual words/phrases come back to you. 0 1 2
64. You like to understand how and why things work. You keep up to date with science and technology. 0 1 2
65. You like tinkering with mechanical/electrical/electronic appliances. You like pulling things apart and can easily put them back
together. 0 1 2
66. Music evokes strong emotions and images in your mind as you listen. Music is prominent in recall of memories. 0 1 2
67. You think independently. You know how you think and you make up your own mind. You understand you own strengths and
weaknesses. 0 1 2
68. You like gardening or working with your hands in the shed. 0 1 2
69. You like visual arts, painting or sculpture. You like jigsaws and mazes. 0 1 2
70. You use a specific step-by-step process to work out problems. 0 1 2

15.2 Appendix 2: Learning Styles Type-Indicator

Your name_________________________________________________
Instructions
• Answer ALL questions.
• Choose the one that describes best the way you really are; not what you want to be or what others think
you ought to be.
• Encircle the appropriate choice for each question.

Questions

1. E: I study best with other people.
I: I study best by myself.

2. E: When I study with other people, I get the most by expressing my thoughts.
I: When I study with other people, I get the most by listening to what others say.

3. E: When I study with other people, I get the most by quick, trial-and-error thinking.


I: When I study with other people, I get the most by thinking things thoroughly before I say them.

4. E: I prefer to learn by doing something active, and then considering the results later.
I: I prefer to learn by considering something thoroughly and then doing something active with it later.

5. E: I need frequent breaks when I study, and interruptions don't bother me.
I: I can study for very long stretches, and interruptions are not welcome.

6. E: I prefer to demonstrate what I know.
I: I prefer to describe what I know.

7. E: I like to know what other people expect of me.
I: I like to set my own standards for my learning.

8. S: I am more patient with routine or details in my study.
N: I am more patient with abstract / complex material.

9. S: I am very uncomfortable with factual errors.
N: I consider factual errors to be another useful way to learn.

10. S: I get uncomfortable when part of my learning is left to my imagination.
N: I get bored when everything I am supposed to learn is presented to me explicitly.

11. S: I prefer to learn fewer skills and get really good at them.
N: I prefer to keep learning new skills and I'll get good at them when I have to.

12. S: I learn much better in a hands-on situation to see what-is.
N: I learn much better when I'm thinking and imagine what it might be.

13. S: I prefer to learn things that are useful and based on established principles.
N: I prefer to learn things that are original and stimulate my imagination.

14. S: I always re-examine my answers on test questions just to be sure.
N: I usually trust my first hunches about test questions.

15. S: I emphasize observation over imagination.
N: I emphasize imagination over observation.

16. S: I'm more comfortable when the professor sticks closely to the handout.
N: I get bored if the professor sticks closely to the handout.

17. T: I prefer to have a logical reason for what I learn.
F: I prefer to see the human consequences of what I learn.

18. T: I prefer a logically organized teacher to a personable teacher.
F: I prefer a personable teacher to a logically organized teacher.

19. T: I prefer group study as a way to give and receive critical analysis.
F: I prefer group study to be harmonious.

20. T: I prefer to study first what should be learned first.
F: I prefer to study first what appeals to me the most.

21. T: The best way to correct a study partner is to be blunt and direct.
F: The best way to correct a study partner is to be tactful and understanding.

22. J: I prefer to study in a steady, orderly fashion.
P: I prefer to study in a flexible, or impulsive, way.

23. J: I stay on schedule when I study, regardless of how interesting the assignment is.
P: I tend to postpone uninteresting or unpleasant assignments.

24. J: I tend to be an overachiever in my learning.
P: I tend to be an underachiever in my learning.


25. J: I prefer to structure my study now to avoid emergencies later.
P: I prefer to stay flexible in my study and deal with emergencies when they arise.

26. J: I prefer to give answers based on the information I already have.
P: I prefer to seek more information before deciding on an answer.

27. J: I prefer to finish one assignment before starting another one.
P: I prefer to have several assignments going at once.

28. J: I like well defined learning assignments.
P: I like learning from open-ended problem-solving.

15.3 Appendix 3: Herrmann Brain Dominance Instrument

Your name_________________________________________________
Instructions
• Answer ALL questions
• Rank all questions as follows:
o MOST favorite = 4
o LESS favorite = 3
o LESSER favorite = 2
o LEAST favorite = 1

Questions

1. In class I prefer to Class discussion Brainstorming Step by step method Applying formulae
learn using
2. As a student in class Talker & sharer Questioner (what if) Planner Checker
I may be described as
3. I prefer to as ask Who? What else? How? What?
questions like
4. I preferred to learn Discussing rules Exploring rules Following rules Finding rules
mathematics by
5. I prefer a teacher Class discussion Spontaneity Organization Structured lessons
who emphasizes
6. I prefer a teacher Socialize Imagine Give clear guidelines Check answers
who provides more
time to
7. When working with With friends By going with flow With a plan Logically
groups I prefer to
work
8. When solving Gut feelings Creativity Sequential work Applying logic
problems, I rely on
9. When doing class Feel good Be original Have outcomes Get it right
work, it is important
to
10. As a person I am Social Creative Organized Logical
best described as

15.4 Appendix 4: General Health Questionnaire-12 (GHQ-12)

Your name_________________________________________________
Instructions
• Answer ALL questions
• Choose only one, which best applies to you

Questions

Much less Same as More than Much more than
than usual usual usual usual
1. Been able to concentrate on whatever you are doing?


2. Lost much sleep over worry?
3. Felt that you were playing a useful part in things?
4. Felt capable of making decisions about things?
5. Felt constantly under strain?
6. Felt that you couldn't overcome your difficulties?
7. Been able to enjoy your normal day-to-day activities?
8. Been able to face up to your problems?
9. Been feeling unhappy and depressed?
10. Been losing self-confidence in yourself?
11. Been thinking of yourself as a worthless person?
12. Been feeling reasonably happy, all things considered?


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