An Assessment of Learning Styles among Undergraduate Medical Students at King Saud bin Abdulaziz University (KSAUHS), King Saud University (KSU) and Imam Mohammad Ibn Saud Islamic University (IMSIU)

Learning style refers to how students prefer to receive, process and recall information. Research in academia suggests that different teaching strategies could have an impact on learning style. The study aims to identify the learning style of medical students in three different universities in Riyadh, Saudi Arabia. Method: This cross-sectional study examined the learning preferences among medical students in basic science years in three universities in Riyadh, Saudi Arabia. By using consecutive sampling, we collected 316 responses. The questionnaire consisted of sociodemographic data and Index of Learning Style (ILS) instrument. Descriptive data were analyzed using chi-square by SPSS. and and (P 0.012) There was no signicant association between academic years with learning style in the three universities. The comparative assessment of medical students’ learning styles in the three universities revealed similar patterns among students, in particular the active/reective and visual/verbal dimensions. Negative mean indicates preference of learning toward active, sensing, sequential, and visual, while positive mean indicates preference toward reective, intuitive, global, and verbal. The mean of active/reective is 0.9, 0.6, and 0.6 for KSAU-HS, KSU, and IMSIU, respectively. The equal mean is shown in visual/verbal category − 3.6, -3, and − 3.2 for KSAU-HS, KSU, and IMSIU, while the mean (-2.5) is slightly less sensing in KSU than KSAU-HS (-3.3) and IMSIU (-3.7) participants. Also, KSU students have a more balanced mean (-1) in sequential/global dimension compared with KSAU-HS (-1.7) and IMSIU (-2.2) students. In sensing/intuitive and sequential/global categories, there was a marked difference in the median, minimum, and maximum results, shown in graph 1. The median (-3) of IMSIU was shifted to sequential in comparison to KSAU-HS and KSU, while KSU participants had narrower quartiles than KSAUHS and IMSIU. KSU median less sensing (-3) in comparison to KSAU-HS IMSIU

questionnaires are an essential tool to identify the pros and cons of the applicated learning strategy and create better programs that meet the student's needs. (4) Generally, student learning can be enhanced when the medical curriculum includes a variety of teaching methods suitable for different learning styles.
(3) It can be argued, however, that the in uence of the medical curriculum type on students' learning style preferences is not well studied.
The student-centered approach focuses on delivering information in various ways to different students. It is crucial to use effective tools that help identify speci c types of learning styles. Many instruments have been invented to determine students' learning styles to make the most of their abilities. Visual, Aural, Read/Write, and Kinesthetic (VARK) is a case in point, developed by Fleming.(5) VARK divides learners into Visual, Auditory, Write/Read, and Kinesthetic. While VARK is easy to use and provides reliable results, it depends mainly on the sensory modality to obtain the information rather than the process of how students comprehend new information. On the other hand, Kolb's learning style inventory (K-LSI) is a widely used tool for the identi cation of the different learning styles.(6) K-LSI divides learners into four main learning styles: divergent, assimilator, convergent, and accommodator, based on experiential learning theory (ELT) by David Kolb.(6) Another learning style instrument is the Index of Learning Styles (ILS), invented by Richard M. Felder and Linda K. Silverman.(7-10) ILS has been recently validated for research in the medical eld (11)(12)(13), and several studies utilized ILS due to its simplicity and accessibility. (14)(15)(16) It has four dimensions: active/re ective, sensing/intuitive, visual/verbal and sequential/global. Every dimension has two categories, and learners could be strong in one category or balanced.
In Saudi Arabia, several studies have been conducted to determine the learning style preferences of medical students. (17)(18)(19)(20)(21)(22) These studies used a variety of tools to determine the learning styles of the participants;(5-7, 23) however, none compared the different learning styles of medical students in colleges.
Due to the limitations of global and local research on the impact of different learning strategies on the development of learning styles, this study aims to identify the learning styles of medical students in three universities, namely King Saud bin Abdulaziz University for Health Sciences (KSAUHS), King Saud University (KSU) and Imam Mohammad Ibn Saud Islamic University (IMSIU). Each university follows a distinct learning strategy. In KSAUHS, the main principle is self-directed learning represented by three Problem-Based Learning (PBL) sessions per week during the pre-clinical phase where students are innovative and active throughout the learning process. KSU adopts an approach to teaching in which lectures are the primary focus. Finally, IMSIU uses a hybrid approach to teaching strategies, focusing on lectures, and student-centered learning such as PBL. This study compares the different learning styles adopted in the three universities.

Method:
This cross-sectional study was conducted on pre-clinical year students in three medical colleges at King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), King Saud University (KSU), and Al-Imam Mohammad Ibn Saud Islamic University (IMSIU) in Riyadh, Saudi Arabia. Only colleges that share a similar PBL-based curriculum were included. Students in the preparatory year and clinical year programs, interns, and incomplete ILS responses were excluded. Prior to data collection, an IRB approval was obtained from King Abdullah International Medical Research Center (KAIMRC). Informed consent was secured before participants' enrollment in the study.
By using consecutive sampling techniques, we collected data from 334 pre-clinical year medical students in three universities. Out of 334 students, we excluded 18 questionnaires with missing data. We used a self-administered Index of Learning Styles (ILS) questionnaire to assess the different learning styles, developed by Richard M. Felder and Barbara A. The Index of Learning Styles (ILS) was distributed among students along with sociodemographic data, including age, gender, university, basic medical year, and GPA. The ILS has four dimensions: active/re ective, sensing/intuitive, visual/verbal, and sequential/global. Each dimension consists of 11 statements (a total of 44 statements) and has 2 options: (A) which scores for active, sensing, visual, and sequential, and (B) which corresponds to other categories in the dimensions. The highest score in A or B determines the participant's inclination towards that learning style. The learner's styles in each dimension are represented as follows: We utilized Google forms for data entry and SPSS version 22 for data analysis. We presented categorical data as percentages and frequencies and used chi squared test to compare students' learning styles. For numerical data, we calculated mean and standard deviation. A P value less than 0.05 was considered statistically signi cant.

Results:
A total of 316 responses were found eligible. The male to female ratio was 1:1. Most of the students were in the 20-year-old age group. The most received responses were from IMSIU (36%), as 40% of the participants have a 5-4.75 GPA. The complete demographic information is illustrated in Table 1. Irrespective of college, most of the participants are primarily balanced in active/re ective (mean = 0.7), with slight shift toward sensing (mean =-3.2), visual (mean =-3.2), and sequential (-1.7).  Table 2 represents the association of participants' learning styles with gender, age, and GPA. A signi cant difference between males and females was shown in the visual/verbal dimension (P = 0.034). Females (9.5%) were slightly more verbal than males (2.5%). Other demographic characteristics showed no association with learning styles. The comparative assessment of medical students' learning styles in the three universities revealed similar patterns among students, in particular the active/re ective and visual/verbal dimensions. Negative mean indicates preference of learning toward active, sensing, sequential, and visual, while positive mean indicates preference toward re ective, intuitive, global, and verbal. The mean of active/re ective is 0.9, The comparative assessment also showed no signi cant association in the active/re ective and visual/verbal dimensions. However, a signi cant association between universities in sensing/intuitive (P = 0.005) and sequential/global (P = 0.012) categories was reported. In the active/re ective dimension, two quarters of each college are balanced. KSAU-HS (50%) and IMSIU (57.9%) participants shifted toward sensing while most KSU participants were balanced. In visual/verbal and sequential/global categories, most of the participants were balanced (Table 3). There was no signi cant association between academic years in each university, but it should be noted that a slight insigni cance (P = 0.064) was found in the visual/verbal category in IMSIU. The visual/verbal domain in IMSIU showed that as students progress towards last year of basic science, they become more balanced (74.1%) in comparison with rst (43.5%) and second (48.8) years, respectively.
(See Table 4) Discussion: One of the most effective ways to achieve quality education in student-centered learning is to identify and adapt the learning styles to the education system, which can ultimately improve students' learning performance. To this end, we identi ed the learning styles of basic science year medical students and found discrepancies in the learning styles between the three universities.
Irrespective of college, most of the participants are primarily balanced in active/re ective with a slight shift toward sensing, visual, and sequential, which means they can learn effectively from active discussions in groups, or independently, and think the situation through before acting. Also, they slightly prefer facts and use visual materials such as pictures, graphics, and books for stepwise learning. A study conducted on undergraduate health education students (n = 505) showed similar results.(24) Out of 505 participants, 72 Pre-medicine students are more likely to be re ective (56.9%), sensing (83.4%), visual (76.4%), and sequential (70.8). (24) First-year medical students' learning preferences were sensing (54.9%), active (50.9%), sequential (60.5%), and visual (80.8%) with medians equal − 0.9, 0.7, -0.8, and − 5.1, respectively. (15) Two studies revealed that participants were mainly more visual (76.7% and 90%) and sensing (79.3% and 64%). (25,26) The current study reported a signi cant difference between colleges and information perception P = 0.005 It is usually assumed that medical students are more sequential (learning stepwise) than global (gaining knowledge by covering a lot of ground). Medical students learn step-by-step because the nature of subjects studied, for example microbiology, anatomy, and embryology, requires a process of incremental phases that re ect the sequential aspect. However, KSU students tend to be more global than KSAU-HS, The study highlights the importance of learning preferences among medical students. Educators are advised to incorporate discussions and hands-on activities into the classroom, and students should be given enough time to grasp new information. Through visual illustrations, step-by-step learning could be highly bene cial. Educators should also evaluate their teaching methods to determine whether the instructional materials complement students' learning preferences. For example, some educators tend to give lectures in a disjointed manner, where they jump from one point to another, then return to the previous point. In this class, students with sequential learning style, most of whom are medical students, may nd it di cult to keep up with the progress of the lesson.
Despite the pedagogical bene ts of the study, it has some limitations. The cross-sectional design was one of the drawbacks that proved inadequate to determine a causal relationship. Further, the sample was considerably small and only examined the pre-clinical years. It is recommended to opt for longitudinal studies on a larger sample, including clinical-year students, which will provide more reliable data on the learning preferences among medical students in Saudi Arabia.

Conclusion:
The study showed that age and GPA had no association with students' learning styles, while gender was signi cantly correlated with the visual/verbal dimension. Most of the participants can learn alone, and/or in groups, and prefer visual illustrations supported by hands-on teaching in a stepwise process. It has also been shown that students in a single university tend to develop the same learning styles as they advance through the years. Declarations