In our study, we discovered that a vast majority of students utilized SA as their preferred learning approach. This was the same between both genders as well as between preclinical students and pre-intern doctors. This is in keeping with the study done by Samarakoon et al. (2) which analyzed the learning approaches of 147 participants comprising of medical students from the first year and the final year of the University of Colombo as well as students from the Postgraduate Institute of Medicine, Colombo. A study done in Singapore (11) yielded similar results in a cohort of 238 medical students with 50.8% using SA.
The predominance of the use of SA to learning as opposed to DA reveals important facts about the current medical curriculum as well as the students’ learning preference. In studies done by Biggs and Entwistle (7, 8), they discovered that strategic learners were motivated by achievement and a sense of competition. They were also academically more successful, achieved higher grades than those who used other approaches and were found to have the lowest level of anxiety (12). Since only the very high performers at the GCE Advanced Level examination are selected to gain entry into the Sri Lankan state medical faculties, it is likely that at the secondary school level also these students have used the SA; the same pattern seems to persist during their undergraduate period as well. The competition prevalent within medical schools coupled with the heavy workload and tight schedules may promote this approach among students keen to survive and flourish in a fast-paced environment.
However, in a study performed in Saudi Arabia (13), DA was found to be the predominant approach among 610 first, second and third year medical students. Cebeci et al. (14) conducted a study among 287 medical students in Ankara, Turkey at the beginning of first, second and third years, determined that the medical students mostly preferred DA. This may be due to the fact that students in their preclinical years have comparatively more time to engage in deep learning as opposed to those in their clinical years where the speed of learning is just as important as the depth of knowledge in the subject matter. Another reason may be that students may have developed their approaches before university entry. In the Sri Lankan setting, academic achievements are held in great esteem and students are trained to perform well in pre-university examinations by both school teachers and private tutors. When gaining higher scores and performing well is deemed more important than in-depth understanding of the content, it is a realistic assumption that students would prefer the technique that helps them succeed in their studies.
In our study, the mean scores of the three approaches remained consistent between the preclinical and pre-intern groups and we did not find a significant difference among the usage of the three learning approaches between the two groups. The study by Chonkar et al. (11) revealed that demographic characteristics such as age, gender and highest educational achievement had no influence over the predominant learning approach. This appears to imply that learning approaches were somewhat fixed and students continue to use their preferred approach even as they progress along the academic ladder.
In contrast, in a previous study done in Sri Lanka (2), postgraduates had a significantly higher mean scores for both DA and SA than first years or final years (p < 0.05). Mean scores for the SAA did not differ significantly between groups. This study revealed a shift towards DA and SA in postgraduate students. Postgraduate students are involved in more hands-on training and less instructor-centered teaching and they spend less time engaged in traditional studying compared to undergraduate medical students. As patient management based learning is used widely at this level of education and this method promotes active learning and thereby, DA (15). These factors may explain the reason for the rise of the preference for DA to attain a more complete understanding of the subject (16).
The importance of identifying the learning approach of students is not just limited to maximizing their educational achievement although it has been identified that DA and SA are associated with better grades at medical school (17). Knowledge about the learning approaches used by students in the faculty is also helpful when developing and modifying the curriculum in order to provide the best possible education to the students. The approach to learning is a combination of the preferred learning styles as well as the context (4). A high workload and assessments that do not promote deep learning inevitably promote SAA, whereas problem-based learning promotes DA (15).
Considering this, educators can help create a learning environment that facilitates deep learning by recognizing the limitations to it in the medical curriculum and moving from a lecture-based theoretical approach to problem-based student-centered interactive approach. Current evidence demonstrates that students' learning approaches can change and more adaptive approaches may be learnt. Helping students develop their own positive learning approach is more effective than attempting to alter their learning styles (17).
Our study was limited by the small sample size and involved third year students and those who had recently faced their final examinations. More participants from different years of the medical school including the first year students should be included in the study to get clear understanding of the trends in the use of learning approaches over the years. Furthermore, postgraduate students could be included to analyze whether specialist education had an impact on the learning approach. In addition, a longitudinal study could be performed to observe whether any change in the predominant learning approach occurs in medical students over the span of their time in the medical school.