Adv Physiol Educ 30: 1316, 2006;

doi:10.1152/advan.00045.2005.

How We Learn

First-year medical students prefer multiple learning styles

Heidi L. Lujan and Stephen E. DiCarlo
Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan
Submitted 29 July 2005; accepted in final form 10 October 2005

visual, auditory, read/write, kinesthetic; learning modes; medical

education; knowledge transfer
THE TRANSITION FROM UNDERGRADUATE to first-year medical education can be difficult for students because of the dramatic
increase in the volume of content. Furthermore, todays medical students represent a broad spectrum in terms of age,
experience, culture, ethnicity, and level of preparedness as well
as learning preferences and styles. This diversity is welcomed;
however, it also presents a challenge for instructors to meet the
educational needs of all students. Specifically, student motivation and performance improves when instruction is adapted to
student learning preferences and styles (22). Thus, because
students have significantly different learning styles, it is the
responsibility of the instructor to address this diversity of
learning styles among students and develop appropriate learning approaches (33).
A learning style or preference is the complex manner in
which, and conditions under which, learners most efficiently
and most effectively perceive, process, store, and recall what
they are attempting to learn (16). One characterization of
learning styles is to define the learners preferred mode of
learning in terms of the sensory modality by which they prefer
to take in new information. VAK is an acronym that stands for
three major sensory modes of learning: visual, aural, and
kinesthetic, depending on the neural system with which a
learner prefers to receive information. Thus VAK is a perceptual, instructional preference model that categorizes learning

Address for reprint requests and other correspondence: S. E. DiCarlo, Dept.

of Physiology, Wayne State Univ. School of Medicine, Detroit, MI 48201
(e-mail: sdicarlo@med.wayne.edu).

by sensory preferences. Recently, Fleming (11) expanded

VAK to VARK to include reading/writing as an additional type
of mixed sensory learning modality. Although learners can use
all of these sensory modes of learning, one mode is often
dominant and preferred. For example, visual learners learn
through seeing drawings, pictures, and other image-rich teaching tools. Auditory learners learn by listening to lectures,
exploring material through discussions, and talking through
ideas. Reading/writing learners learn through interaction with
textual materials, whereas kinesthetic learners learn through
touching and experiences that emphasize doing, physical involvement, and manipulation of objects.
We were interested in learning the preferred learning styles
of our first-year medical students so that we could develop
appropriate learning approaches. To achieve this goal, we
designed a descriptive study, a study that attempted to reveal
patterns associated with a specific group without an emphasis
on prespecified hypotheses. Sometimes these types of studies
are called hypothesis-generating studies (to contrast them with
hypothesis-testing studies). The rational for this descriptive
study was to help us design a lesson plan that addressed all
students and to identify areas for further research. We used the
VARK Inventory Tool for assessing individual preferences for
learning with sensory domains. The VARK questionnaire,
developed by Fleming (12), was administered to our first-year
medical students.
METHODS

Design. The VARK questionnaire developed by Fleming

identifies the preferences of students for particular modes of
information presentation. The following are internet links to
the VARK homepage (http://www.vark-learn.com/english/index.
asp) and questionnaire (http://www.vark-learn.com/english/
page.asp?pquestionnaire). We administered the VARK questionnaire to our first-year medical students to determine their
preferred modes of information presentation. The VARK questionnaire (12) was included with the class packet for the
physiology course; 166 of the 250 students (66%) returned the
completed questionnaire. We administered the questionnaire as
a hard copy; however, the VARK questionnaire is freeware
that can be completed online. If you are using a virtual learning
environment, e.g., the Blackboard Learning System, eCollege,
Creation of Study Environment, or WebCT, the administration
and analysis of the questionnaire can be completely managed
on the virtual learning environment.
Procedures. The VARK questionnaire was administered
during the respiratory component of our medical physiology
class at Wayne State University School of Medicine. The class
consisted of 250 first-year medical students. The VARK questionnaire with instructions can be obtained free of charge (12).

1043-4046/06 $8.00 Copyright 2006 The American Physiological Society

13

Downloaded from http://advan.physiology.org/ by 10.220.33.2 on September 29, 2016

Lujan, Heidi L., and Stephen E. DiCarlo. First-year medical

students prefer multiple learning styles. Adv Physiol Educ 30: 1316,
2006; doi:10.1152/advan.00045.2005.Students have preferences for
the ways in which they receive information. The visual, auditory,
reading/writing, kinesthetic (VARK) questionnaire identifies students preferences for particular modes of information presentation.
We administered the VARK questionnaire to our first-year medical
students, and 166 of 250 students (66%) returned the completed
questionnaire. Only 36.1% of the students preferred a single mode of
information presentation. Among these students, 5.4% preferred visual (learning from graphs, charts, and flow diagrams), 4.8% preferred
auditory (learning from speech), 7.8% preferred printed words (learning from reading and writing), and 18.1% preferred using all their
senses (kinesthetics: learning from touch, hearing, smell, taste, and
sight). In contrast, most students (63.8%) preferred multiple modes [2
modes (24.5%), 3 modes (32.1%), or 4 modes (43.4%)] of information
presentation. Knowing the students preferred modes can 1) help
provide instruction tailored to the students individual preference, 2)
overcome the predisposition to treat all students in a similar way, and
3) motivate teachers to move from their preferred mode(s) to using
others.

How We Learn
14

VARK STYLES OF LEARNING

Analysis. The number of students who preferred each mode

of learning was divided by the total number of responses to
determine the percentage of students in each category.
RESULTS

DISCUSSION

Fig. 2. Percentages of students who preferred two, three, or four modes of

information presentation. Of the 106 students (63.8% of all students) who
preferred multiple modes of information presentation, some students preferred
two modes (bimodal, 24.5%), some students preferred three modes (trimodal,
32.1%), and some students preferred four modes (quadmodal, 43.4%). Most
students preferred three or four modes (76%) of information presentation.

Only 36.1% of the students preferred a single mode of information presentation (either visual, auditory, reading/writing, or
kinesthetic). Of the students who preferred a single mode of
information presentation, only 5% of the students preferred
receiving information by speech, which arrives to the learners
ear and is therefore coded as auditory by the questionnaire.
Similarly, only 8% revealed a preference for accessing information from printed words; these students were coded as
reading/writing learners because they use reading and writing
as their preference for taking in information. Only 5% of the
students preferred the visual. These students prefer information
to arrive in the form of graphs, charts, and flow diagrams. They
are sensitive to different or changing spatial arrangements and
can work easily with symbols. Eighteen percent of the students
preferred their learning by using all their senses, including

In this study, we administered the VARK questionnaire to

our first-year medical students to determine their preferred
modes of information presentation. One hundred sixty-six of
the 250 students (66%) returned the completed questionnaire.

Fig. 1. Percentages of students who preferred visual (V; 5.4%), auditory (A;
4.8%), reading/writing (R; 7.8%), kinesthetic (K; 18.1%), and multiple modes
(63.8 %) of information presentation. Only 36.1 % of the students preferred a
single mode of information presentation (either V, A, R, or K).

Fig. 3. Of the students who preferred three modes of information presentation,

some students preferred V, R, and K (11.3%), some students preferred V, A,
and K (8.4%), and some students preferred A, R, and K (12.3%). Of the
students who preferred two modes of information presentation, some students
preferred V and R (4.7%), some students preferred V and K (5.6%), some
students preferred V and A (0.9%), some students preferred A and R (6.6%),
and some students preferred R and K (6.6%). Obviously, of the students who
preferred four modes of information presentation, all students preferred V, A,
R, and K (43.4%).

Advances in Physiology Education VOL

30 MARCH 2006

Downloaded from http://advan.physiology.org/ by 10.220.33.2 on September 29, 2016

Figure 1 presents the percentages of students who preferred

visual (5.4%), auditory (4.8%), reading/writing (7.8%), kinesthetic (18.1%), and multiple modes (63.8%) of information
presentation. Only 36.1 % of the students preferred a single
mode of information presentation (either visual, auditory, reading/writing, or kinesthetic).
Of the 106 students (63.8% of all students) who preferred
multiple modes of information presentation, some students
preferred two modes (bimodal, 24.5%), some students preferred three modes (trimodal, 32.1%), and some students preferred four modes (quadmodal, 43.4%). Figure 2 presents the
percentages of students who preferred two, three, or four
modes of information presentation. Most students preferred
three or four modes (76%) of information presentation.
Of the students who preferred three modes of information
presentation, some students preferred visual, reading/writing,
and kinesthetic (11.3%), some students preferred visual, auditory, and kinesthetic (8.4%), and some students preferred
auditory, reading/writing, and kinesthetic (12.3 %) (Fig. 3). Of
the students who preferred two modes of information presentation, some students preferred visual and reading/writing
(4.7%), some students preferred visual and kinesthetic (5.6%),
some students preferred visual and auditory (0.9 %), some
students preferred auditory and reading/writing (6.6%), and
some students preferred reading/writing and kinesthetic (6.6%)
(Fig. 3). Obviously, of the students who preferred four modes
of information presentation, all students preferred visual, auditory, reading/writing, and kinesthetic (43.4%).

How We Learn
VARK STYLES OF LEARNING

Future directions. The rationale for this descriptive study

was to help us design a lesson plan that addresses all students
and to identify areas for further research. With regard to future
research, several questions regarding learning styles emerged
from this study. For example, do multiple-mode learners perform better in the classroom than single-mode learners? From
the instructor perspective, should one mode be used more than
another? How well do grades correlate with learning styles for
specific classes, e.g., do kinesthetic learners perform better in
laboratory classes and do aural learners perform better in
lecture classes? Are there gender effects on learning styles?
How does the professor accommodate both those who prefer
only one style and those who prefer many? Simply accommodating the plurality may improve results to some extent but
does not address the preferences of all the students. Does
accommodating learning preference really address learning
outcomes? All of these questions merit further research.
In conclusion, the VARK questionnaire identifies students
preferences for particular modes of information presentation.
Students have significantly different learning styles; it is the
responsibility of the instructor to address this diversity of
learning styles among the students and develop appropriate
learning approaches (33). Knowing the students preferred
modes can enrich the learning experience.
REFERENCES
1. Armstrong E and Parsa-Parsi R. How can physicians learning styles
drive educational planning? Acad Med 80: 680 684, 2005.
2. Bailey CM, Hsu CT, and DiCarlo SE. Educational puzzles for understanding gastrointestinal physiology. Adv Physiol Educ 21: 118, 1999.
3. Bergman LG and Fors UG. Computer-aided DSM-IV-diagnosticsacceptance, use and perceived usefulness in relation to users learning styles.
BMC Med Inform Decis Mak 5: 1, 2005.
4. Chan V, Pisegna JM, Rosian RR, and DiCarlo SE. Construction of a
model demonstrating neural pathways and reflex arcs. Adv Physiol Educ
271: 14 42, 1991.
5. Collins HL, Rodenbaugh DW, Murphy TP, Kullics JM, Bailey CM,
and DiCarlo SE. An inquiry-based teaching tool for understanding
arterial blood pressure regulation and cardiovascular function. Adv Physiol
Educ 277: 1528, 1999.
6. Collins J. Education techniques for lifelong learning: principles of adult
learning. Radiographics 24: 14831489, 2004.
7. Cortright RN, Collins HL, and DiCarlo SE. Peer instruction enhanced
meaningful learning: ability to solve novel problems. Adv Physiol Educ
29: 107111, 2005.
8. Cortright RN, Collins HL, Rodenbaugh DW, and DiCarlo SE. Student
retention of course content is improved by collaborative-group testing.
Adv Physiol Educ 27: 102108, 2003.
9. DiCarlo SE and Collins HL. Colored letters: a tool to increase class
participation in a large classroom. Adv Physiol Educ 25: 143, 2001.
10. DiCarlo SE, Sipe E, Layshock JP, and Rosian RL. Experiments and
Demonstrations in Physiology. Upper Saddle River, NJ: Prentice Hall,
1998.
11. Fleming ND. Im different; not dumb. Modes of presentation (VARK) in
the tertiary classroom. In: Research and Development in Higher Education, edited by Zelmer A. Proceedings of the 1995 Annual Conference of
the Higher Education and Research Development Society of Australasia
18: 308 313, 1995.
12. Fleming ND. VARK, A Guide to Learning Styles. [On-line: http://www.
vark-learn.com/english/page.asp?pquestionnaire.]
13. Forrest S. Learning and teaching: the reciprocal link. J Contin Educ Nurs
35: 74 79, 2004.
14. Gordon HRD. Identifying learning styles. Educational Resources Information Center ED 424 287, 1998.
15. Howard MG, Collins HL, and DiCarlo SE. Survivor torches Who
Wants to be a Physician? in the educational games ratings war. Adv
Physiol Educ 26: 30 37, 2002.

Advances in Physiology Education VOL

30 MARCH 2006

Downloaded from http://advan.physiology.org/ by 10.220.33.2 on September 29, 2016

touch, hearing, smell, taste, and sight. This group was described as kinesthetic. These students prefer concrete, multisensory experiences in their learning. Although learning by
doing matches their needs, they can easily learn conceptual and
abstract material provided it arrives with suitable analogies,
real-life examples, or metaphors (11). Most students (64%),
however, preferred multiple modes of information presentation. These students had a balanced set of preferences, which
means that they prefer information to arrive in a variety of
modes. These students may adjust to the different teaching
styles faced in a day or they may opt in and out of alternative
strategies, such as being visual in cardiovascular physiology
and reading/writing in respiratory physiology, for example.
Knowing the students preferred modes can provide a focus for
developing strategies that are tailored for individuals (11). In
so doing, this helps to overcome the predisposition of many
educators to treat all students in a similar way (11). The
questionnaire can motivate teachers to move from their preferred mode(s) to using others. In so doing, they can reach
more students because of the better match between teacher and
learner styles (1, 3, 6, 13, 14, 18 20, 22, 25, 30, 34).
Most students (64%) preferred multiple modes of information presentation. These students had a balanced set of preferences, which means they prefer information to arrive in a
variety of modes. Thus most students may benefit from active
learning strategies over the traditional lecture format. Active
learning strategies reach all types of learners in the visual,
auditory, reading/writing, and kinesthetic schemes. In contrast,
the traditional lecture format assumes that all students are
auditory learners. In addition, the traditional lecture format
assumes that all students acquire the same information presented orally at the same pace without dialogue with the
presenter.
Most students are able to learn effectively as long as the
teacher provides a blend of visual, auditory, reading/writing,
and kinesthetic activities. However, some students prefer one
of the modalities over the other three so strongly that they
struggle to understand the subject matter unless special care is
taken to present it in their preference mode. To meet these
needs, teaching should be multisensory and filled with variety.
To achieve this goal, it becomes important to use active
learning strategies (28). With active learning strategies, visual
learners are targeted by the presence of models and demonstrations (4, 10, 29). Auditory learners are reached through
discussion during peer instruction (7, 27), collaborative testing
(8, 26), debate (31), games (2, 5, 15, 21, 23, 24), and answering
questions (9). Manipulating models (4, 32) and role playing
(17) satisfies kinesthetic and tactile learners. Cooperative
learning exercises, role playing, simulations, models, debates,
and games are active learning strategies that can be used
effectively in large classrooms. These activities also promote
working in groups and generate high levels of motivation and
enthusiasm. This is important because employment opportunities in the future will require employees to work cooperatively
to solve problems and develop solutions. Furthermore, investigators have reported an increase in students achievement
with the use of simulations and games, and students usually
expressed positive feeling about the experiences (35). For all
these reasons, active learning strategies may be superior to the
traditional lecture format in promoting thinking, reasoning,
problem-solving, and decision-making skills.

15

How We Learn
16

VARK STYLES OF LEARNING

26. Rao SP, Collins HL, and DiCarlo SE. Collaborative testing enhances
student learning. Adv Physiol Educ 26: 37 41, 2002.
27. Rao SP and DiCarlo SE. Peer instruction improves performance on
quizzes. Adv Physiol Educ 24: 5155, 2000.
28. Rao SP and DiCarlo SE. Active learning of respiratory physiology
improves performance on respiratory physiology examinations. Adv
Physiol Educ 25: 55 61, 2001.
29. Rodenbaugh DW, Collins HL, and DiCarlo SE. Construction of a
model demonstrating cardiovascular principles. Adv Physiol Educ 277:
67 83, 1999.
30. Sandmire DA and Boyce PF. Pairing of opposite learning styles among
allied health students: effects on collaborative performance. J Allied
Health 33: 156 163, 2004.
31. Scannapieco FA. Formal debate: an active learning strategy. J Dent Educ
61: 955961, 1997.
32. Silverthorn DU. Using demonstrations to uncover student misconceptions: the law of LaPlace. Adv Physiol Edu 277: 281282, 1999.
33. Tanner K and Allen D. Approaches to biology teaching and learning:
learning styles and the problem of instructional selection-engaging all
students in science courses. Cell Biol Educ 3: 197201, 2004.
34. Veenman MV, Prins FJ, and Verheij J. Learning styles: selfreports versus thinking-aloud measures. Br J Educ Psychol 73: 357
372, 2003.
35. Wolfe J. The teaching effectiveness of games in collegiate business
courses. Simulations Games 16: 251258, 1985.

Advances in Physiology Education VOL

30 MARCH 2006

Downloaded from http://advan.physiology.org/ by 10.220.33.2 on September 29, 2016

16. James W and Gardner D. Learning styles: implications for distance

learning. New Dir Adult Contin Educ 67: 19 32, 1995.
17. Kuipers JC and Clemens DL. Do I dare? Using role-play as a teaching
strategy. J Psychosoc Nurs Ment Health Serv 36: 1217, 1998.
18. Laight DW. Attitudes to concept maps as a teaching/learning activity in
undergraduate health professional education: influence of preferred learning style. Med Teach 26: 229 233, 2004.
19. Lang H, Stinson M, Kavanagh F, Liu Y, and Basile M. Learning styles
of deaf college students and instructors teaching emphases. J Deaf Stud
Deaf Educ 4: 16 27, 1999.
20. Lewthwaite BJ and Dunham HP. Enriching Teaching Scholarship
through Learning Styles. Educational Resources Information Center
(ERIC), ED 428 057, 1999.
21. Mierson S. Skits and games to enhance students learning of physiology.
Am J Physiol Adv Physiol Edu (could not determine journal name) 277:
S283 4, 1999.
22. Miller P. Learning styles: the multimedia of the mind. Educational
Resources Information Center ED 451 140, 2001.
23. Moy JR, Rodenbaugh DW, Collins HL, and DiCarlo SE. Who wants to
be a physician? An educational tool for reviewing pulmonary physiology.
Adv Physiol Educ 24: 30 37, 2000.
24. Odenweller CM, Hsu CT, and DiCarlo SE. Educational card games for
understanding gastrointestinal physiology. Adv Physiol Educ 20: 7884, 1998.
25. Pillemer DB, Wink P, DiDonato TE, and Sanborn RL. Gender differences in autobiographical memory styles of older adults. Memory 11:
525532, 2003.