2015, 37: 344–347
Learning styles and the prospective ophthalmologist NEIL MODI1, OLAYINKA WILLIAMS1, ANDREW J. SWAMPILLAI1, SALMAN WAQAR1, JONATHAN PARK1, THOMAS L. KERSEY2 & TAMSIN SLEEP1 1
Department of Ophthalmology, Torbay Hospital, South Devon Foundation NHS Trust, UK, 2Frimley Park NHS Foundation Trust, Frimley, UK
Med Teach Downloaded from informahealthcare.com by Nyu Medical Center on 06/10/15 For personal use only.
Abstract Purpose: Understanding the learning styles of individual trainees may enable trainers to tailor an educational program and optimise learning. Surgical trainees have previously been shown to demonstrate a tendency towards particular learning styles. We seek to clarify the relationship between learning style and learned surgical performance using a simulator, prior to surgical training. Methods: The Kolb Learning Style Inventory was administered to a group of thirty junior doctors. Participants were then asked to perform a series of tasks using the EyeSi virtual reality cataract surgery simulator (VR Magic, Mannheim, Germany). All completed a standard introductory programme to eliminate learning curve. They then undertook four attempts of level 4 forceps module binocularly. Total score, odometer movement (mm), corneal area injured (mm2), lens area injured (mm2) and total time taken (seconds) recorded. Results: Mean age was 31.6 years. No significant correlation was found between any learning style and any variable on the EyeSi cataract surgery simulator. Conclusion: There is a predominant learning style amongst surgical residents. There is however no demonstrable learning style that results in a better (or worse) performance on the EyeSi surgery simulator and hence in learning and performing cataract surgery.
Introduction
Practice points
Limited time in an already busy operating list and requirements to stay compliant with the European Working Time Directive (EWTD) have given rise to an interesting challenge for clinical trainers. It is important to optimise time for teaching and learning, especially in a field as important as surgery. Recent work in ophthalmic surgical training has focussed on the use of the ‘‘EyeSi’’ cataract surgery simulator [VR Magic, Mannheim, Germany] (Figure 1) and its use as an adjunct for the junior ophthalmic surgeon. There are at this time 12 EyeSi cataract surgery simulators in the United Kingdom and they are now routinely used by most trainee ophthalmologists, particularly in their first years of training. The simulator provides a safe environment to practice skills and manoeuvres, which can then be translated to the clinical setting. Certain modules on this simulator have been validated, such that performance on the simulator has been shown to reflect performance in the operating theatre (Mahr & Hodge 2008). Waqar et al. (2011) and Park et al. (2011) have demonstrated this, as a useful tool to investigate parameters relevant to an ophthalmic surgeon such as fatigue and distraction. There has been a shift from a teacher-centred approach to learning to a learner-focussed approach, so the learner takes more of an active role in their education (Kolb & Kolb 2005). David A. Kolb described four learning styles of individuals in 1970 on how people perceive and transform experience. First,
There are varieties of learning styles in different surgical specialities. The predominant learning style for participants in this study was ‘‘converging’’ according to the Kolb Learning Style Theory. No particular learning style results in a better or worse performance in cataract surgery training.
a person might perceive things as they are (concrete experience) or prefer concepts and ideas (abstract conceptualisation). Next, the person ‘‘transforms’’ this into an action, which might be either that the person ‘‘gets stuck in’’ (active experimentation) or waits to see if it works (reflective observation). The two dimensions or perceiving and transforming give two axes, forming four quadrants of the learning cycle or four learning styles (Figure 2). Ideally learning should involve all four quadrants, but usually each person has a predominant learning style. The learning style can be assessed using a 12 point questionnaire, known as the Kolb Learning Style Inventory (LSI) (Kolb & Kolb 2005). People with different learning styles learn best with different activities and this can be used to plan teaching and training activities. It has been shown that learning styles vary between different surgical specialties. For example in an internal
Correspondence: Neil Modi, Department of Ophthalmology, Torbay Hospital, Torquay, TQ2 7AA, UK. E-mail: [email protected]
344
ISSN 0142-159X print/ISSN 1466-187X online/14/040344–4 ß 2014 Informa UK Ltd. DOI: 10.3109/0142159X.2014.948827
Med Teach Downloaded from informahealthcare.com by Nyu Medical Center on 06/10/15 For personal use only.
Learning styles in ophthalmology
(56%) followed by ‘‘accommodating’’ (19%; Laeeq et al. 2009). The ‘‘converging’’ learning style is also preferred by general surgical residents (Contessa et al. 2005). These findings correspond to the intuitive belief that the way in which surgeons ‘‘transform’’ their experiences are more likely to be by ‘‘active experimentation’’ rather than by ‘‘reflective observation.’’ This difference between learning styles gives an insight into how a group prefers to learn. As the majority of surgical residents prefer to transform their experiences by active experimentation, the trainers should therefore aim to provide opportunity for active experimentation. The preferred learning activities by ‘‘active experimenters’’ include projects, subjective exams, demonstrations and computer simulations. As we aim to improve the richness of the surgical training, targeting the particular learning style that suits most residents should improve their learning and performance. We hypothesise that when training on a virtual reality cataract surgery simulator, individuals who transform their experience by active experimentation will perform better than those that transform by reflective observation because use of this tool corresponds to their preferred style of learning.
Methods
Figure 1. EyeSi cataract surgery simulator. Note the right phacoemulsification pedal, left microscope pedal, instructor screen, head prop with electronic eye and viewing microscope on an adjustable platform.
Concrete experience
Accommodave
Divergent
Acve experimentaon
Reflecve observaon
Convergent
Assimilave
Abstract conceptualisaon
Figure 2.
Kolb learning theory.
residency programme, Adesunloye & Aladesanmi (2008) demonstrated that the predominant learning style was ‘‘assimilating’’ for residents (42%) and attending physicians (55%). In a survey of otolaryngology surgery residents by contrast, the predominant learning style was ‘‘converging’’
Thirty junior doctors with no previous experience of cataract surgery or microsurgery were recruited through local announcement of the study. Local research and development approval for the study was obtained, data stored anonymously and all participants provided written consent. Each of the subjects completed the Kolb LSI version 3.1 (Hay Resources Direct, Boston, MA), consisting of a 12-item self-assessment questionnaire with each item consisting of four options that the subject must grade from 1 to 4. The LSI was then used to identify the preferred learning style of the individual and thus the preference of how experiences are perceived and transformed. Subsequently each subject completed a series of tasks on the EyeSi virtual reality surgical simulator. The simulator consists of a model head housing an electronic eye, which pivots and rotates when manipulated by the surgeon. Probes inserted into the electronic eye can virtually emulate different intraocular instruments. A virtual operating microscope provides binocular stereoscopic images of the eye and instruments to the surgeon. Images from the microscope are also viewed by the instructor, on a separate monitor allowing realtime task monitoring and viewing of historical performance data. The simulator is programmed with various surgical training tasks, each with a range of difficulty levels to simulate increasingly complicated tasks. In this study, the subjects used the anterior segment forceps module (Figure 3). This requires the surgeon to use forceps to grasp six objects positioned in the anterior chamber and place them in a basket in the centre of the anterior segment. It is intended to teach surgeons the skills required to accurately grasp the edge of a capsulorhexis flap while keeping the eye centred and avoiding injury to the lens or cornea. This module was chosen as it has previously shown constructive validity (Mahr & Hodge 2008). For each attempt the total possible
345
Med Teach Downloaded from informahealthcare.com by Nyu Medical Center on 06/10/15 For personal use only.
N. Modi et al.
Figure 3. Anterior segment forceps module, level 4. Note the triangular objects in the peripheral anterior chamber which have to be grasped with the forceps and placed in a central ‘‘net’’. Successful placement is indicated by a change in colour of the object from red to green. score can vary from 0 to 100. The simulator awards positive points for the percentage of the task completed and subtracts from this for reduced efficiency and errors. This can be represented as follows: Forceps module total score ¼ number remaining objects (0 ¼ 100 points) – excessive task time score (40 s ¼ 0 points, 400 s ¼ 20 points) – corneal injury score (corneal surface touched by instrument measured, 0 mm2 ¼ 0 points, 10 mm2 ¼ 100 points) – lens injury score (lens surface touched by instrument measured, 0 mm2 ¼ 0 points, 40 mm2 ¼ 25 points) – odometer score (measuring distance travelled by instruments in the anterior chamber, 100 mm ¼ 0 points, 140 mm ¼ 20 points) – operating without red reflex score (time counted until surgeon returns into red reflex, 0 s ¼ 0 points, 400 s ¼ 20 points) – interacting out of focus score (5 points per out of focus interaction up to maximum 20 points) – non-horizontal insertion/removal of instruments score (2 points per event up to maximum 20 points). All participants received a standardised orientation to the simulator with eight practice sessions binocularly (one attempt level 1 forceps module, one attempt level 2 forceps module and six attempts level 4 forceps module) to eliminate the learning curve. Scores for these were not recorded. Main data collection then commenced. All participants completed a further four attempts of the level 4 forceps module binocularly using the dominant hand. The parameters recorded for each attempt were total score, total time, corneal area injured (mm2), lens area injured (mm2) and odometer measurement (in mm).
Results The sample size in this study was 30. The mean age of the participants was 31.6 years (SD 9 years). The most common 346
learning style in this group was converging (12) followed by diverging (9) and assimilating (8). There was only one subject with an accommodating learning style and this subject was excluded, as a sample of one would not give a reliable or meaningful analysis. All subjects had normal visual acuity and stereopsis. The average total score using the dominant hand was 60 out of 100. The average corneal area injured was 0.95mm2 and average lens area injured was 1.76 mm2. The average time taken to complete a task was 69.6 seconds and the average odometer reading of 202 mm. The average dominant hand score was represents an aggregate of all the measured values and was therefore used in the analysis. Odometer readings were also chosen as they showed greatest improvement with practice and therefore thought to be more sensitive than the other readings, in detecting the ability to learn intraocular surgical skills. The link between cornea and lens damage and time taken were not analysed separately with reference to learning style. Kruskal-Wallis tests were used to investigate the relationship between learning style and average dominant hand score and odometer reading. No evidence of differences between either average dominant hand score (p ¼ 0.75) or odometer reading (p ¼ 0.37) was found.
Discussion It is intuitive that different people learn in different ways and the Kolb LSI formalised this intangible phenomenon. It can be seen from our subjects that learning style is not uniform and that there is a distribution of learning styles. In our group, the most common learning style was converging (40%) and next there were similar numbers of diverging and assimilating types. This distribution was not dissimilar to the distribution of learning styles amongst otolaryngology-head and neck surgery residents and general surgical residents (Contessa et al. 2005; Adesunloye & Aladesanmi 2008). ‘‘Convergers’’ perceive a new experience as a theory or idea rather than as an event. They then transform or process this knowledge by active experimentation. These people are thought to learn better from simulations, laboratory assignments, presentations and demonstrations. Current teaching in most medical specialties is didactic, passive and teachercentred, for example lectures, shadowing and observing. An implication of the finding that most surgical residents are convergers, is that the current teaching may not be maximising the learning that can be achieved in a modern surgical training programme. In fact the Kolb LSI has been proposed as a basis for developing learning programmes and as having a role in ‘‘maintenance of certification’’ (Armstrong & Parsa-Parsi 2005). Our study hypothesises that subjects will vary in their performance in performing a task using a surgical simulator depending on their learning style. In particular, we hypothesised that the groups that transform experiences by active experimentation (accommodating and converging learning styles) will perform better with this learning tool. Our results did not show any difference in performance as measured by score and odometer reading between subjects with different
Med Teach Downloaded from informahealthcare.com by Nyu Medical Center on 06/10/15 For personal use only.
Learning styles in ophthalmology
learning styles. Another positive finding here is that the benefit from the use of such a simulator, with scores improving on successive attempts of each module for every subject, is equally shared between all subjects and will therefore not only benefit those of a particular learning style. The benefit of the simulator is the ability to quantify skills and measure improvement. A direct correlation could not be made with the clinical environment, as this would be ethically more difficult and technically impossible to quantify. As these trainees were junior (with no previous experience of live intraocular surgery) the simulator was the most appropriate tool to measure their skills. Since the module used in this study has been validated, it is therefore shown to reflect live cataract surgery (Mahr & Hodge 2008). An interesting further study would be to evaluate the retention of skills acquired. The study could be repeated again after a period of several weeks, to see if any of the three groups of subjects (divided by learning style) had the ability to retain their surgical skills better than the other.
Conclusion The predominant learning style amongst ophthalmic trainees is converging. However there is no demonstrable learning style that results in a better (or worse) performance for training in cataract surgery. This was measured objectively using the EyeSi virtual reality cataract surgery simulator, which is a validated tool and allows us to probe and answer such questions in an objective and controlled way.
Notes on contributors NEIL MODI FRCOphth: Specialist registrar in Ophthalmology, Torbay Hospital with an interest in oculoplastic surgery. OLAYINKA WILLIAMS MBBS: Senior house officer in Ophthalmology, Torbay Hospital.
ANDREW SWAMPILLAI MBBS: Senior house officer in Ophthalmology, Torbay Hospital. SALMAN WAQAR FRCS, FRCOphth: Specialist registrar in Ophthalmology, Derriford Hospital with an interest in glaucoma. JONATHAN PARK FRCOphth: Vitreoretinal fellow at the Hospital for Sick Children, Toronto, Canada. THOMAS L. KERSEY FRCOphth: Consultant ophthalmic surgeon at Frimley Park Hospital with a specialist interest in glaucoma. TAMSIN SLEEP FRCOphth: Consultant ophthalmic surgeon at Torbay Hospital with a specialist interest in paediatric eye diseases and strabismus.
Declaration of interest: The authors report no declarations of interest.
References Adesunloye BA, Aladesanmi O. 2008. The preferred learning style among residents and faculty members of an internal medicine residency programme. J Natl Med Assoc 2(100):172–175. Armstrong E, Parsa-Parsi R. 2005. How can physicians’ learning styles drive educational planning? Acad Med 7(80):680–684. Contessa J, Ciardiello KA, Perlman S. 2005. Surgery resident learning styles and academic achievement. Curr Surg 3(62):344–347. Kolb AY, Kolb DA. 2005. Learning styles and learning spaces: A review of multidisciplinary application of experimental learning theory in higher education. Acad Manage Learn Educ (4):193–212. Kolb DA, Kolb A. 2005. The Kolb Learning Style Inventory – Version 3.1 2005 Technical Specifications. Boston, MA: Haygroup. Laeeq K, Weatherly RA, Carrott A, Pandian V, Cummings CW, Bhatti NI. 2009. Learning styles in two otolaryngology residency programs. The Laryngoscope 12(119):2360–2365. Mahr MA, Hodge DO. 2008. Construct validity of anterior segment antitremor and forceps surgical simulator training modules: attending versus resident surgeon performance. J Cataract Refract Surg 34(6):980–985. Park J, Waqar S, Kersey T, Modi N, Ong C, Sleep T. 2011. Effect of distraction on simulated anterior segment surgical performance. J Cataract Refract Surg 37(8):1517–1522. Waqar S, Park J, Kersey TL, Modi N, Ong C, Sleep TJ. 2011. Assessment of fatigue in intraocular surgery: Analysis using a virtual reality simulator. Graefes Arch Clin Exp Ophthalmol 249(1):77–81.
347
Learning styles and the prospective ophthalmologist NEIL MODI1, OLAYINKA WILLIAMS1, ANDREW J. SWAMPILLAI1, SALMAN WAQAR1, JONATHAN PARK1, THOMAS L. KERSEY2 & TAMSIN SLEEP1 1
Department of Ophthalmology, Torbay Hospital, South Devon Foundation NHS Trust, UK, 2Frimley Park NHS Foundation Trust, Frimley, UK
Med Teach Downloaded from informahealthcare.com by Nyu Medical Center on 06/10/15 For personal use only.
Abstract Purpose: Understanding the learning styles of individual trainees may enable trainers to tailor an educational program and optimise learning. Surgical trainees have previously been shown to demonstrate a tendency towards particular learning styles. We seek to clarify the relationship between learning style and learned surgical performance using a simulator, prior to surgical training. Methods: The Kolb Learning Style Inventory was administered to a group of thirty junior doctors. Participants were then asked to perform a series of tasks using the EyeSi virtual reality cataract surgery simulator (VR Magic, Mannheim, Germany). All completed a standard introductory programme to eliminate learning curve. They then undertook four attempts of level 4 forceps module binocularly. Total score, odometer movement (mm), corneal area injured (mm2), lens area injured (mm2) and total time taken (seconds) recorded. Results: Mean age was 31.6 years. No significant correlation was found between any learning style and any variable on the EyeSi cataract surgery simulator. Conclusion: There is a predominant learning style amongst surgical residents. There is however no demonstrable learning style that results in a better (or worse) performance on the EyeSi surgery simulator and hence in learning and performing cataract surgery.
Introduction
Practice points
Limited time in an already busy operating list and requirements to stay compliant with the European Working Time Directive (EWTD) have given rise to an interesting challenge for clinical trainers. It is important to optimise time for teaching and learning, especially in a field as important as surgery. Recent work in ophthalmic surgical training has focussed on the use of the ‘‘EyeSi’’ cataract surgery simulator [VR Magic, Mannheim, Germany] (Figure 1) and its use as an adjunct for the junior ophthalmic surgeon. There are at this time 12 EyeSi cataract surgery simulators in the United Kingdom and they are now routinely used by most trainee ophthalmologists, particularly in their first years of training. The simulator provides a safe environment to practice skills and manoeuvres, which can then be translated to the clinical setting. Certain modules on this simulator have been validated, such that performance on the simulator has been shown to reflect performance in the operating theatre (Mahr & Hodge 2008). Waqar et al. (2011) and Park et al. (2011) have demonstrated this, as a useful tool to investigate parameters relevant to an ophthalmic surgeon such as fatigue and distraction. There has been a shift from a teacher-centred approach to learning to a learner-focussed approach, so the learner takes more of an active role in their education (Kolb & Kolb 2005). David A. Kolb described four learning styles of individuals in 1970 on how people perceive and transform experience. First,
There are varieties of learning styles in different surgical specialities. The predominant learning style for participants in this study was ‘‘converging’’ according to the Kolb Learning Style Theory. No particular learning style results in a better or worse performance in cataract surgery training.
a person might perceive things as they are (concrete experience) or prefer concepts and ideas (abstract conceptualisation). Next, the person ‘‘transforms’’ this into an action, which might be either that the person ‘‘gets stuck in’’ (active experimentation) or waits to see if it works (reflective observation). The two dimensions or perceiving and transforming give two axes, forming four quadrants of the learning cycle or four learning styles (Figure 2). Ideally learning should involve all four quadrants, but usually each person has a predominant learning style. The learning style can be assessed using a 12 point questionnaire, known as the Kolb Learning Style Inventory (LSI) (Kolb & Kolb 2005). People with different learning styles learn best with different activities and this can be used to plan teaching and training activities. It has been shown that learning styles vary between different surgical specialties. For example in an internal
Correspondence: Neil Modi, Department of Ophthalmology, Torbay Hospital, Torquay, TQ2 7AA, UK. E-mail: [email protected]
344
ISSN 0142-159X print/ISSN 1466-187X online/14/040344–4 ß 2014 Informa UK Ltd. DOI: 10.3109/0142159X.2014.948827
Med Teach Downloaded from informahealthcare.com by Nyu Medical Center on 06/10/15 For personal use only.
Learning styles in ophthalmology
(56%) followed by ‘‘accommodating’’ (19%; Laeeq et al. 2009). The ‘‘converging’’ learning style is also preferred by general surgical residents (Contessa et al. 2005). These findings correspond to the intuitive belief that the way in which surgeons ‘‘transform’’ their experiences are more likely to be by ‘‘active experimentation’’ rather than by ‘‘reflective observation.’’ This difference between learning styles gives an insight into how a group prefers to learn. As the majority of surgical residents prefer to transform their experiences by active experimentation, the trainers should therefore aim to provide opportunity for active experimentation. The preferred learning activities by ‘‘active experimenters’’ include projects, subjective exams, demonstrations and computer simulations. As we aim to improve the richness of the surgical training, targeting the particular learning style that suits most residents should improve their learning and performance. We hypothesise that when training on a virtual reality cataract surgery simulator, individuals who transform their experience by active experimentation will perform better than those that transform by reflective observation because use of this tool corresponds to their preferred style of learning.
Methods
Figure 1. EyeSi cataract surgery simulator. Note the right phacoemulsification pedal, left microscope pedal, instructor screen, head prop with electronic eye and viewing microscope on an adjustable platform.
Concrete experience
Accommodave
Divergent
Acve experimentaon
Reflecve observaon
Convergent
Assimilave
Abstract conceptualisaon
Figure 2.
Kolb learning theory.
residency programme, Adesunloye & Aladesanmi (2008) demonstrated that the predominant learning style was ‘‘assimilating’’ for residents (42%) and attending physicians (55%). In a survey of otolaryngology surgery residents by contrast, the predominant learning style was ‘‘converging’’
Thirty junior doctors with no previous experience of cataract surgery or microsurgery were recruited through local announcement of the study. Local research and development approval for the study was obtained, data stored anonymously and all participants provided written consent. Each of the subjects completed the Kolb LSI version 3.1 (Hay Resources Direct, Boston, MA), consisting of a 12-item self-assessment questionnaire with each item consisting of four options that the subject must grade from 1 to 4. The LSI was then used to identify the preferred learning style of the individual and thus the preference of how experiences are perceived and transformed. Subsequently each subject completed a series of tasks on the EyeSi virtual reality surgical simulator. The simulator consists of a model head housing an electronic eye, which pivots and rotates when manipulated by the surgeon. Probes inserted into the electronic eye can virtually emulate different intraocular instruments. A virtual operating microscope provides binocular stereoscopic images of the eye and instruments to the surgeon. Images from the microscope are also viewed by the instructor, on a separate monitor allowing realtime task monitoring and viewing of historical performance data. The simulator is programmed with various surgical training tasks, each with a range of difficulty levels to simulate increasingly complicated tasks. In this study, the subjects used the anterior segment forceps module (Figure 3). This requires the surgeon to use forceps to grasp six objects positioned in the anterior chamber and place them in a basket in the centre of the anterior segment. It is intended to teach surgeons the skills required to accurately grasp the edge of a capsulorhexis flap while keeping the eye centred and avoiding injury to the lens or cornea. This module was chosen as it has previously shown constructive validity (Mahr & Hodge 2008). For each attempt the total possible
345
Med Teach Downloaded from informahealthcare.com by Nyu Medical Center on 06/10/15 For personal use only.
N. Modi et al.
Figure 3. Anterior segment forceps module, level 4. Note the triangular objects in the peripheral anterior chamber which have to be grasped with the forceps and placed in a central ‘‘net’’. Successful placement is indicated by a change in colour of the object from red to green. score can vary from 0 to 100. The simulator awards positive points for the percentage of the task completed and subtracts from this for reduced efficiency and errors. This can be represented as follows: Forceps module total score ¼ number remaining objects (0 ¼ 100 points) – excessive task time score (40 s ¼ 0 points, 400 s ¼ 20 points) – corneal injury score (corneal surface touched by instrument measured, 0 mm2 ¼ 0 points, 10 mm2 ¼ 100 points) – lens injury score (lens surface touched by instrument measured, 0 mm2 ¼ 0 points, 40 mm2 ¼ 25 points) – odometer score (measuring distance travelled by instruments in the anterior chamber, 100 mm ¼ 0 points, 140 mm ¼ 20 points) – operating without red reflex score (time counted until surgeon returns into red reflex, 0 s ¼ 0 points, 400 s ¼ 20 points) – interacting out of focus score (5 points per out of focus interaction up to maximum 20 points) – non-horizontal insertion/removal of instruments score (2 points per event up to maximum 20 points). All participants received a standardised orientation to the simulator with eight practice sessions binocularly (one attempt level 1 forceps module, one attempt level 2 forceps module and six attempts level 4 forceps module) to eliminate the learning curve. Scores for these were not recorded. Main data collection then commenced. All participants completed a further four attempts of the level 4 forceps module binocularly using the dominant hand. The parameters recorded for each attempt were total score, total time, corneal area injured (mm2), lens area injured (mm2) and odometer measurement (in mm).
Results The sample size in this study was 30. The mean age of the participants was 31.6 years (SD 9 years). The most common 346
learning style in this group was converging (12) followed by diverging (9) and assimilating (8). There was only one subject with an accommodating learning style and this subject was excluded, as a sample of one would not give a reliable or meaningful analysis. All subjects had normal visual acuity and stereopsis. The average total score using the dominant hand was 60 out of 100. The average corneal area injured was 0.95mm2 and average lens area injured was 1.76 mm2. The average time taken to complete a task was 69.6 seconds and the average odometer reading of 202 mm. The average dominant hand score was represents an aggregate of all the measured values and was therefore used in the analysis. Odometer readings were also chosen as they showed greatest improvement with practice and therefore thought to be more sensitive than the other readings, in detecting the ability to learn intraocular surgical skills. The link between cornea and lens damage and time taken were not analysed separately with reference to learning style. Kruskal-Wallis tests were used to investigate the relationship between learning style and average dominant hand score and odometer reading. No evidence of differences between either average dominant hand score (p ¼ 0.75) or odometer reading (p ¼ 0.37) was found.
Discussion It is intuitive that different people learn in different ways and the Kolb LSI formalised this intangible phenomenon. It can be seen from our subjects that learning style is not uniform and that there is a distribution of learning styles. In our group, the most common learning style was converging (40%) and next there were similar numbers of diverging and assimilating types. This distribution was not dissimilar to the distribution of learning styles amongst otolaryngology-head and neck surgery residents and general surgical residents (Contessa et al. 2005; Adesunloye & Aladesanmi 2008). ‘‘Convergers’’ perceive a new experience as a theory or idea rather than as an event. They then transform or process this knowledge by active experimentation. These people are thought to learn better from simulations, laboratory assignments, presentations and demonstrations. Current teaching in most medical specialties is didactic, passive and teachercentred, for example lectures, shadowing and observing. An implication of the finding that most surgical residents are convergers, is that the current teaching may not be maximising the learning that can be achieved in a modern surgical training programme. In fact the Kolb LSI has been proposed as a basis for developing learning programmes and as having a role in ‘‘maintenance of certification’’ (Armstrong & Parsa-Parsi 2005). Our study hypothesises that subjects will vary in their performance in performing a task using a surgical simulator depending on their learning style. In particular, we hypothesised that the groups that transform experiences by active experimentation (accommodating and converging learning styles) will perform better with this learning tool. Our results did not show any difference in performance as measured by score and odometer reading between subjects with different
Med Teach Downloaded from informahealthcare.com by Nyu Medical Center on 06/10/15 For personal use only.
Learning styles in ophthalmology
learning styles. Another positive finding here is that the benefit from the use of such a simulator, with scores improving on successive attempts of each module for every subject, is equally shared between all subjects and will therefore not only benefit those of a particular learning style. The benefit of the simulator is the ability to quantify skills and measure improvement. A direct correlation could not be made with the clinical environment, as this would be ethically more difficult and technically impossible to quantify. As these trainees were junior (with no previous experience of live intraocular surgery) the simulator was the most appropriate tool to measure their skills. Since the module used in this study has been validated, it is therefore shown to reflect live cataract surgery (Mahr & Hodge 2008). An interesting further study would be to evaluate the retention of skills acquired. The study could be repeated again after a period of several weeks, to see if any of the three groups of subjects (divided by learning style) had the ability to retain their surgical skills better than the other.
Conclusion The predominant learning style amongst ophthalmic trainees is converging. However there is no demonstrable learning style that results in a better (or worse) performance for training in cataract surgery. This was measured objectively using the EyeSi virtual reality cataract surgery simulator, which is a validated tool and allows us to probe and answer such questions in an objective and controlled way.
Notes on contributors NEIL MODI FRCOphth: Specialist registrar in Ophthalmology, Torbay Hospital with an interest in oculoplastic surgery. OLAYINKA WILLIAMS MBBS: Senior house officer in Ophthalmology, Torbay Hospital.
ANDREW SWAMPILLAI MBBS: Senior house officer in Ophthalmology, Torbay Hospital. SALMAN WAQAR FRCS, FRCOphth: Specialist registrar in Ophthalmology, Derriford Hospital with an interest in glaucoma. JONATHAN PARK FRCOphth: Vitreoretinal fellow at the Hospital for Sick Children, Toronto, Canada. THOMAS L. KERSEY FRCOphth: Consultant ophthalmic surgeon at Frimley Park Hospital with a specialist interest in glaucoma. TAMSIN SLEEP FRCOphth: Consultant ophthalmic surgeon at Torbay Hospital with a specialist interest in paediatric eye diseases and strabismus.
Declaration of interest: The authors report no declarations of interest.
References Adesunloye BA, Aladesanmi O. 2008. The preferred learning style among residents and faculty members of an internal medicine residency programme. J Natl Med Assoc 2(100):172–175. Armstrong E, Parsa-Parsi R. 2005. How can physicians’ learning styles drive educational planning? Acad Med 7(80):680–684. Contessa J, Ciardiello KA, Perlman S. 2005. Surgery resident learning styles and academic achievement. Curr Surg 3(62):344–347. Kolb AY, Kolb DA. 2005. Learning styles and learning spaces: A review of multidisciplinary application of experimental learning theory in higher education. Acad Manage Learn Educ (4):193–212. Kolb DA, Kolb A. 2005. The Kolb Learning Style Inventory – Version 3.1 2005 Technical Specifications. Boston, MA: Haygroup. Laeeq K, Weatherly RA, Carrott A, Pandian V, Cummings CW, Bhatti NI. 2009. Learning styles in two otolaryngology residency programs. The Laryngoscope 12(119):2360–2365. Mahr MA, Hodge DO. 2008. Construct validity of anterior segment antitremor and forceps surgical simulator training modules: attending versus resident surgeon performance. J Cataract Refract Surg 34(6):980–985. Park J, Waqar S, Kersey T, Modi N, Ong C, Sleep T. 2011. Effect of distraction on simulated anterior segment surgical performance. J Cataract Refract Surg 37(8):1517–1522. Waqar S, Park J, Kersey TL, Modi N, Ong C, Sleep TJ. 2011. Assessment of fatigue in intraocular surgery: Analysis using a virtual reality simulator. Graefes Arch Clin Exp Ophthalmol 249(1):77–81.
347
