Precisely because individualized instruction is perceived as the key to unlocking the academic potential of each student, researchers have acknowledged that appropriate instructional planning, coupled with attention to each student’s learning-style characteristics, has produced a rewarding combination.
1,2,3 Dunn and Dunn identify learning style as “the way in which each learner begins to concentrate on, process, and retain new and difficult information.”4 A meta-analytic validation of 42 experimental studies using the Dunn and Dunn learning-style model indicated that students whose learning styles were accommodated through compatible instructional interventions could be expected to achieve 75 percent of a standard deviation higher than those who had not had their learning styles considered.5 These results indicated that matching students’ learning preferences with compatible instructional interventions significantly improved academic achievement.
Given the successful applications of learning style provided by many professors in higher education, there was a need for expanded research using the Dunn and Dunn model in the allied health professions. 6 Although researchers had incorporated learning-style intervention into higher education, few investigators focused specifically on alternative instructional strategies for teaching college students new and difficult information.7-22 Even fewer researchers focused their efforts on learning styles in the allied health professions.23-26 Except for this author, no other researcher ventured into the arena of learning styles and health information management.27,28 There is a need for further research in this area. The benefits of the opportunity to employ the technique of learning styles with allied health students and in particular with health information management students are certainly worth exploring.
Purpose of Study
This researcher examined college students’ learning styles and the extent to which the instructional resource known as a Contract Activity Package (CAP) taught selected topics of medical/legal issues in healthcare, as compared with traditional teaching.29 Therefore, this study compared the effect(s) of using CAPs with the effect(s) of using traditional instructional methodology on achievement-test and attitude test scores of college students enrolled in courses on medical/legal issues in healthcare to determine whether students with specific learning-style traits responded better to CAPs or to traditional instruction. For clarification purposes, Appendix 1 provides definitions of various terms used in this study.
This researcher was the first to investigate the effectiveness of CAPs with an adult college student population majoring in the allied health professions. This investigator probed the following hypotheses:
H1: There will be significantly higher mean scores on tests of student achievement when course content is taught with a CAP than when course content is taught traditionally.30, 31
H2: There will be significantly higher mean scores on tests of student attitudes toward instruction when course content is taught with a CAP than when course content is taught traditionally.32, 33
The participants in this study were 86 allied health college students enrolled in courses on medical/legal issues of healthcare in a college of health-related professions, part of a state university located in an urban setting. Four participating classes of allied health students (n = 86) composed the sample for this study. Student distribution in the study was as follows: Class 1: Diagnostic Medical Imaging program (n = 22); Class 2: Occupational Therapy program (n = 20); Class 3: Physical Therapy program (n = 15); and Class 4: Physician’s Assistant program (n = 29). The students ranged in age from 20 to 52, with the majority between 20 and 30 years of age. Each of the four classes comprised diverse ethnic groups. An attempt was made to include health information management students; however, this was not possible due to the limited number of individuals available. Nonetheless, beneficial results of this study have merit for all allied health students and, in particular, for health information management students. Many health information management students take joint classes with students in other allied health disciplines. The results of this study can be applied, generally speaking, to health information management students, who are an integral part of the overall healthcare team effort.
The Productivity Environmental Preference Survey (PEPS) was employed to identify the ways in which adult students preferred to learn.34 This comprehensive measure identifies the following types of stimuli that make up an individual’s preferences: (a) environmental, (b) emotional, (c) sociological, (d) physiological, and (e) cognitive. LaMothe, Billings, Belcher, Cobb, Nice, and Richardson conducted a study to establish the reliability and validity of the PEPS.35 Four hundred baccalaureate nursing students at a large, multicampus university were administered this adult learning-style instrument. A demographic data sheet was used to obtain background information on each participant. Questions elicited information about the age, type, class level, race, hours of employment, and course failure history of each student. The major focus was to determine the suitability of the PEPS for use with baccalaureate nursing students. The objectives were to (a) establish the construct validity of the instrument; (b) establish the reliability of the instrument; (c) establish the intercorrelations of the subscales of the instrument; (d) identify differences between subpopulations of nursing students according to age, class level, sex, race, type of student, and status as student at risk (having failed a prerequisite or nursing course and being employed). Construct validity was established using factor analysis (SPSSX Factor). Construct reliability was established using SPSSX Reliability. Differences in subpopulations were identified using t-tests and ANOVA. The results established the validity and reliability of the PEPS for baccalaureate nursing students. Furthermore, the PEPS has established good reliability and predictive validity through research studies conducted in the teaching, engineering, legal, and nursing professions.36-39 The reliability and validity of the PEPS has been justified for allied health students as well. It has been employed by researchers in allied health with significant results.40-43
The Semantic Differential Scale (SDS) was used to measure students’ attitudes toward the different instructional methods they experienced.44 Ingham reported that the reliability coefficient of this instrument was .98 and .99 in two sessions of administration.45
Criterion-referenced examinations consisting of multiple-choice and short-answer questions were administered. The examinations were used to test for mastery of the content.
Two different CAPs were created to present the material with an array of options for each student, and Multisensory Activity and Reporting Alternatives were used to capitalize on each individual’s identified learning-style perceptual strengths. The first CAP, entitled “Patient Consent: To Touch or Not to Touch?” is Appendix 2 of this article. The second CAP, entitled “End-of-Life Issues: Your Number Is Up!” is Appendix 3. Resource Alternatives—auditory, visual, tactual, and kinesthetic—were included in the CAPs so that individuals could learn through their primary perceptual strength and reinforce content through their secondary strengths.46
At the beginning of the semester, the concept of learning styles and background research were introduced to the four participating classes. The students were administered the PEPS, from which individual profiles were then computer generated.
This study followed a counterbalanced repeated measure design. Four units of medical/legal content were taught, alternating two instructional methods. Two of these units were taught traditionally. The other two units each were taught with a different CAP. Figure one illustrates the alternating pattern of treatments among the four classes:
In figure 1, T1 represents the first traditional treatment, C1 represents the first CAP treatment, T2 represents the second traditional treatment, and C2 represents the second CAP treatment. The same CAP was provided to all students in the class during a particular CAP treatment. Similarly, the same traditional content was provided to all students in the class during a particular traditional treatment.
An examination measuring achievement was administered to each class after each of the four units was presented. The SDS, which compared students’ attitudes toward traditional versus CAP methodology, was administered to the classes after all the units were provided to all the students. Data was collected and analyzed for achievement (mastery of content presented) as well as attitude toward learning. The results were significant and offer the opportunity for allied health students to maximize their achievement and develop a positive attitude toward learning. These findings hold promise for future research to be conducted solely with health information management students of an adequate sample size to ascertain the opportunity to maximize academic potential and attitude.
The following sections present results comparing differences in achievement between the CAP method and the traditional method of instruction for 86 allied health students. In addition, attitudes toward CAP instruction and traditional instruction were analyzed to determine which method elicited significantly higher attitude ratings among the students.
Table 1 displays the means and standard deviations for all four presentations delivered with the two methods (Traditional 1, CAP 1, Traditional 2, and CAP 2) to the allied health students.
A repeated-measures ANOVA was performed on four achievement means for the allied health students in the four participating classes. The analysis yielded results based on three tests: (1) main effect of program; (2) main effect of treatment; and (3) program by treatment interaction. The following are the results of the study on achievement (Table 2).
The test of the main effect of program sought to determine whether students in the four participating allied health programs scored differently from one another on average across the four instructional presentations. The test revealed no significant difference among the programs, F(3, 82) = 0.92, p = .43.
The test of the main effect of treatment sought to determine whether the CAP method differed from the traditional method of instruction on average over the four participating classes. The CAP method displayed a significant p value, indicating a difference between the traditional method and the CAP method of instruction, F(1, 82) = 528, p < .0001. The effect size, calculated by dividing the difference of the means by the square root of the error means square, was 1.27, which indicated a very strong difference between the two methodologies.
The analysis of program by treatment interaction sought to ascertain whether the advantage of the CAP method over the traditional method was constant for students in the four program types or whether the CAP method was more effective in some of the programs than in other programs. The results indicated that the advantage of the CAP method over the traditional method of instruction was constant over the four participating programs, p = .6019 yielding no significance.
To analyze the Semantic Differential Scale for all four participating allied health programs, a series of one-sample t-tests was performed for each item on the scale. These t-tests were designed to compare the mean ratings for each sample to a hypothetical value of 3, indicating a neutral preference. The Bonferroni method was used to adjust p values for multiple tests. All p values remained significant after this adjustment. The means of all items were significantly greater than 3 (Table 3). The results of each item on the SDS were: helpful: t(85) = 27.68, p < .0001; clear: t(85) = 16.76, p < .0001; energizing: t(85) = 26.33, p < .0001; calming: t(85) = 12.74, p < .0001; strengthening: t(85) = 16.21, p < .0001; relaxing: t(85) = 15.13, p < .0001; wonderful: t(85) = 15.87, p < .0001; steady: t(85) = 16.34, p < .0001; good: t(85) = 14.84, p < .0001; sharp: t(85) = 17.85, p < .0001; successful: t(85) = 23.78, p < .0001; interesting: t(85) = 29.55, p < .0001. In these findings, all items in the SDS indicated significantly more positive attitude ratings for the CAPs than for the traditional methodology.
The achievement test results indicated that instruction using a CAP was significantly (p < .0001) more beneficial for the students than instruction using traditional methodology. This finding supported Hypothesis 1. All items of the SDS demonstrated significantly (p < .0001) higher student attitude test scores for the CAPs than for traditional instruction. This finding supported Hypothesis 2.
This investigation documented the differences among college students’ learning styles and demonstrated statistically increased scores on achievement and attitude tests when CAPs, rather than traditional teaching, were employed. These findings are crucial, for they verify that even highly achieving and average students perform better with instructional strategies responsive to their learning styles than with dissonant instructional strategies.
Recommendations for Future Research
- Investigate using the CAP method for instruction fulfilling continuing education requirements of practicing healthcare professionals. The CAP method would be an informative and interesting way to transmit knowledge to healthcare professionals. The result would be improved mastery of content, leading to more skillful healthcare professionals. Also, CAPs could help healthcare professionals develop a more positive outlook on their chosen career.
- Explore the effectiveness of preceptors’ using a CAP when educating allied health students in the clinical setting. Manuals of clinical instruction could incorporate the CAP method for specific concepts. The implication is that CAPs give the student and preceptor an innovative method of mastering clinical content in healthcare.
- Research the effectiveness of the CAP method for educating patients on healthcare self-practices. This would provide a unique way to address educational issues for patients at all learning levels, allowing patients to grasp content concerning their care in a nonintimidating, informative, and user-friendly way.
- Repeat this study with a larger sample, over a longer duration, and in other academic/allied health subjects to determine whether similar results occur. This study should be repeated with particular emphasis on health information management students. The implications of this innovative methodology should be far-reaching and include all disciplines on the healthcare team.
Rose Frances Lefkowitz, EdD, RHIA, is a full time faculty member at the City University of New York.
It is with sincere gratitude and appreciation that I dedicate this article to Rita Dunn, EdD, professor and director for the Center on Learning Styles at St. John’s University. She is an outstanding leader, brilliant scholar, inspirational educator, and a wonderful person.
I would like to thank the editors and the editorial review board for their time, patience, and excellent recommendations in making this manuscript suitable for publication in Perspectives in Health Information Management.
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Article citation: Perspectives in Health Information Management 3; 1; Winter 2006