Learning styles of nurse anesthesia students
related to level in a master of science
in nursing program
LINDA SHERBINSKI, CRNA, MSN Springfield, Illinois
To alleviate the shortage of anesthetists, nurse anesthesia programs are expanding and new programs are being developed while they simultaneously move into the master's degree framework. Students' learning style preferences can provide valuable information for educators engaged in facilitating and enhancing learning.
This study identified the learning styles of nurse anesthesia students enrolled in 12 programs that confer a master of science in Nursing degree in relation to the students' gender and level in an anesthesia program. Learning profiles were determined by scores
on the Learning Style Inventory (Kolb, 1985). A personal data sheet was used to elicit the students'demographic characteristics. Surveys were administered to a sample of 264
nurse anesthesia students, with 164 usable responses (62.8%).
Results indicated a preference for the assimilator learning style (37.2%). A statistically significant relationship between learning style and level in an anesthesia program was found (chi-square = 11.14, df = 3, P< .05). Whereas students who had completed fewer than 12 months in an anesthesia program showed no dominant preference for a learning style, students who had completed more than 12 months were predominantly distributed in two learning
style categories: assimilators (40.0%) and convergers (38.8%). No statistically significant relationships were identified
between learning styles and gender. Key words: Learning styles, master of
science in nursing anesthesia students, nurse anesthesia education.
Introduction
A significant number of certificate anesthesia
pro-grams have closed for a variety of reasons, includ-ing financial and clinical site difficulties that have
been reflected by a decrease in the number of nurse anesthesia graduates from 1,063 in 1978 to approx-imately 600 in 1989, contributing to the national shortage of anesthetists. To counter this shortage, the AANA proposes to open new programs, ex-pand existing programs, and encourage collabora-tion between universities and healthcare facilities. The endeavors to alleviate the shortage might best be accomplished by establishing new programs within the graduate level and moving the existing certificate programs to the graduate level, which is
the current trend of nurse anesthesia programs.' The AANA has projected that, by January 1, 1998, nurse anesthesia programs will be in the mas-ter's framework.' In 1989, 60% of the 93 programs were at the graduate level.2* Fourteen of the 93 pro-*In 1993, 85% of the 94 accredited nurse anesthesia education programs offered a master's degree.
grams were incorporated into graduate schools of nursing that confer a master of science in Nursing (MSN) degree. Nursing students have been re-ported to be among the most frequently studied groups of health professionals in regard to learn-ing styles; however, studies of learnlearn-ing styles of anesthesia students have been scarce and studies of graduate nursing students' learning styles were absent.3-6
Learning style has been defined as the process by which individuals organize information and experiences.7 They are based on experiential learn-ing theory, which assumes that students learn best, as demonstrated by their motivation and achieve-ment, if they are taught in the style they prefer.8 It is postulated that each profession demonstrates a particular learning style and, with repetition of that style, learners will assimilate that profession's learning style norm.8
The identification of learning styles can be a useful tool to facilitate and enhance learning for students. To meet the demands of the current shortage and to expedite the AANA's goal of in-creasing the number of graduates, new programs will open and existing programs will eventually move to the graduate level. The identification of students' learning styles appears to be an impor-tant element in facilitating these plans of action. The better that educators and students understand learning preferences, the more effective the teaching-learning process can become.9
There have been reports that men and women have different learning style preferences, a factor that may have important implications in nurse an-esthesia. The 10% increase in male nurse anesthe-tists-from 27% in 1979 to 37% in 1989-clearly demonstrates the need to include this important variable.'
To meet the demands of the current shortage and to expedite AANA's goal of increasing the number of graduates, the identification of nurse anesthesia students' learning styles is an important element in implementing these plans of action as quickly and efficiently as possible.
Experiential learning theory
Experiential learning theory (ELT) considers learning to be a lifelong process of adaptation. ELT has its basis in the disciplines of social psy-chology, philosophy, and cognitive psychology. It defines learning as "the process whereby knowl-edge is created through the transformation of experience."'0
The experiential learning model makes two basic assumptions: (1) "People learn from the im-mediate, here-and-now experience, as well as from
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concepts and books," and (2) "People learn differ-ently; that is, according to their preferred learn-ing styles."'0 ELT has the advantage of combining experience, perception, cognition, and behavior, thereby integrating behavioral and cognitive theories."
The characteristics of ELT are as follows: 1. Learning is best conceived as a process, not in terms of outcomes.
2. Learning is a continuous process grounded in experience.
3. The process of learning requires the reso-lution of conflicts between dialectically opposed modes of adaptation to the world.
4. Learning involves transactions between the person and the environment.
5. Learning is a process of creative knowl-edge.10
Learning style types
The Learning Style Inventory (LSI) is an in-strument designed to identify an individual's learning style preference and correlates with the experiential learning model. The model depicts learning as a four-stage cycle, correlating experi-ence with concepts. The four stages of the learning cycle are (1) concrete experience, (2) observations and reflections, (3) formation of abstract concepts and generalizations, and (4) testing the implica-tions of concepts in new situaimplica-tions.'0
The learning styles identified by Kolb are ac-commodator, assimilator, converger, and diverger.
* Accommodator emphasizes concrete
experi-ence and active involvement. This learning style is characterized by active doing and risk-taking.
* Assimilator emphasizes inductive reasoning
and the ability to create models based on theoreti-cal principles. The dominant abilities of the assim-ilator are abstract conceptualization and reflective observation. This learning style is characterized by an interest in abstract concepts and less interest in people.
* Converger emphasizes problem-solving,
decision-making, and the practical application of ideas. This learning style relies predominantly on abstract conceptualization and active experimen-tation. It is characterized by deductive reasoning and a preference for dealing with technical tasks and problems rather than people.
* Diverger emphasizes concrete experience
and reflective observation. This learning style is characterized by the ability to imaginatively adapt by observation rather than direct action.'0
Methodology
* Design and sample. This investigation was a
nonexperimental, descriptive study that focused on the relationship between learning styles, gen-der, and level in an MSN anesthesia program. The learning styles were determined by the scores ob-tained on the LSI.
The sample consisted of 12 MSN programs. Two hundred sixty-four students comprised the population of the 12 participating programs, of which 166 first- and second-year students
partici-pated.
The LSI, developed by David Kolb in 1976 and revised in 1985, has its theoretical basis in ELT. The instrument is a 12-item, rank-order question-naire designed to measure an individual's learn-ing preferences. The individual is instructed to arrange in rank order of preference four endings for each of 12 sentences, indicating the number 4 for the ending that best describes "how you learn best or is most indicative of yourself," to the num-ber 1 for the ending that appears to be the "least like the method you learn or least like yourself." Each sentence ending is designed to form one of four columns which correspond to the four stages of the learning cycle that Kolb identified: column 1-concrete experience, column 2- reflective ob-servation, column 3-abstract conceptualization, column 4- active experimentation. The 12 num-bers in each column are added together to obtain raw scores.
Two additional combination scores indicate the extent to which the individual emphasizes ab-straction over concreteness.10
The raw scores of col-umn 1 are subtracted from those of colcol-umn 3, and the raw scores of column 2 are subtracted from those of column 4. These scores are then plotted on the corresponding vertical and horizontal axes of the scoring grid. The point of intersection rep-resents the individual's preference for one of the four learning styles.
The LSI is reported to have good internal re-liability, as measured by Chronbach's alpha, .87 to .93 (n = 236, P<.001).8 The combination scores, which are used to indicate learning style type, show almost perfect additivity (1.0) when Tukey's test was used. The Spearman-Brown split-half
reliabil-ity shows results of .71 to .85, (n = 268, P< .001).10
Normative profiles and standardized percen-tile scores were based on a sample of 1,446 adults between the ages of 18 and 60. The normative study showed differences between men and women in the abstract-concrete grouping. Men (59%) demon-strated a preference for abstraction over concrete-ness compared to women (41% of the sample).
Pearson product-moment correlations were carried out on the sample of 1,446 adults, and neg-ative correlations between active
experimentation-reflective observation (r = -33) and abstract conceptualization-concrete experience (r = -42) were revealed. These negative correlations dem-onstrate the desired effect, that the instrument is measuring different learning styles.10
The LSI has been reported to be valid.8
.
10 In observing that individuals are fairly accurate perceivers, Smith and Kolb noted that self-description is "one of the most powerful perspec-tives on behavior.., self-descriptions can be more valid for some activities than other descriptions."'10The LSI has undergone testing in several areas and settings, including medical, educational, and managerial training. The validity of the LSI and Kolb's four stages, based on ELT, has been tested by numerous authors, who concluded that Kolb's four diverse learning styles can be identified.8' 11-15
* Personal data sheet. This was a four-item
ques-tionnaire developed by the investigator to elicit demographic data. The items surveyed the partic-ipant's age, gender, level in an anesthesia program, and the number of years of critical care experience as a professional nurse prior to anesthesia school.
* Procedure. Permission to conduct this study
was obtained from the Institutional Review Board at Duquesne University, Pittsburgh, Pennsylvania.
Permission to implement the study was ob-tained from the program directors of the nurse anesthesia MSN programs. The instrument pack-ets, instructions, consent forms, and return enve-lopes were sent to the program directors who had agreed to participate in the study. First- and second-year anesthesia students were asked for their voluntary consent by the participating pro-gram directors. The anesthesia students who elected to participate were read a cover letter by their program director that explained the purpose of the study and informed them that their re-sponses to the Kolb LSI and the personal data sheet would remain confidential.
The LSI was coded to correspond to the per-sonal data gathered, and the individual partici-pants' names were in no way identified with this data. Each school that participated was identified by a school code, and each was sent its own aggre-gate results to compare with the total sample. Results
* Demographic variables. The majority of
stu-dents (69.3%) were between the ages of 26 and 35 years of age (Table I). The second largest group of students were between the ages of 36 and 45 years of age. Students between the ages of 41 and 45 years of age represented the smallest group (4.2%).
Of the nurse anesthesia students in this sam-ple (n = 166), 109 (65.7%) were female, and 57
Table I
Distribution of nurse anesthesia students by age Age in years Number Percentage
21-25 15 9.0 26-30 58 35.0 31-35 57 34.3 36-40 29 17.5 41-45 7 4.2 Total 166 100.0
(34,3%) were male. There was an even split in dis-tribution for the percentages of males and females in the first and second year of the anesthesia pro-grams surveyed. There were 50.5% females in the first year and 49.5% females in the second year. No statistically significant relationships were identi-fied between gender and learning styles.
Eighty-five (51.2%) of the nurse anesthesia stu-dents were enrolled in the first year, and 81 (48.8%), were enrolled in the second year of an anesthesia program.
The majority of students (53.2%) had between 1 and 4 years of critical care experience prior to entering an anesthesia program (Table II). The next largest group (28.8%) had between 5 and 8 years of experience. The students with the most experience, 9 years or more, represented the small-est group (18.0%).
Table II
Distribution of nurse anesthesia students by years of
critical care experience
Years experience Number Percentage
1-2 42 25.4 3-4 46 27.8 5-6 29 17.4 7-8 19 11.4 9-10 12 7.2 Greater than 10 18 10.8 Total 166 100.0
* Statistical results. All four learning styles were
identified in the nurse anesthesia students enrolled in the 12 MSN programs (Table III). The predom-inant learning style identified in this sample (37.2%) was the assimilator style, which emphasizes reflective observation and abstract conceptualiza-tion.
The converger learning style was the next most frequently occurring style, with 51 students
(31.1%) in this category. The converger style
em-42
Table III
Learning styles of nurse anesthesia students Learning style Number Percentage
Accommodator 30 18.3
Converger 51 31.1
Diverger 22 13.4
Assimilator 61 37.2
Total 164 100.0
Two of the subjects scores were eliminated from the data related to learning styles. The two students were included in the demographic data, therefore the total is 166 for demographic characteristics.
phasizes active experimentation and abstract conceptualization.
The accommodator learning style was the third most frequently occurring style, with 30 (18.3%) in this category. The accommodator style emphasizes concrete experience and active experi-mentation.
The diverger learning style occurred least fre-quently in this study with 22 students (13.4%) in this category. The diverger style emphasizes con-crete experience and reflective observation.
All four learning styles were identified in both men and women in the sample of MSN students (Table IV). The percentages which represented the distribution of the four learning styles for males and females were similar. The diverger learning style had a difference of 1.4% between men and women. The greatest difference between men and women was represented by the accommodator learning style with 11.4%, which was not statisti-cally significant. It can be concluded from the find-ings shown in Table IV that there is no statistically significant relationship between gender and Kolb's learning style types.
There were 84 students in the first year and 80
Table IV
Relationship of learning styles and gender
Learning Males
style Number Percentage Accommo-dator Diverger Converger Assimilator Total 6 7 21 22 56 10.7 12.5 37.5 39.3 100.0 Females Number Percentage 24 15 30 39 108 22.2 13.9 27.8 36.1 100.0 Chi=square = 3.94, df = 3, P> .05
Journal of the American Association of Nurse Anesthetists
Table V
Relationship between leeming styles and level in an aneshe-la program Learning styles Accommodator Number % Diverger Number % Converger Assimilator Number % Number % First year (n = 84) 23 Second year (n = 80) 7 Chi-aquare = 11.14, df = 3, P< .05
students in the second year of the sample. A statis-tically significant relationship was revealed by the chi-square analysis (Table V), when learning styles of the first-year students were compared to the second-year students' learning styles. The learn-ing styles of the first-year students were spread over the four learning styles, in contrast to those of the second-year students, whose distribution pre-dominantly fell into two of the learning style cate-gories. Chi-square analysis revealed a statistically significant (P< .05) relationship between learning style type and level in an anesthesia program.
Discussion
The data indicated that all four learning styles were represented in the sample, with 61 subjects (37.2%) demonstrating a preference for the assimi-lator style. Students whose dominant learning style is assimilator tend to display abstract conceptual-ization and reflective observation. They are in-clined to excel at inductive reasoning and the cre-ation of models and theories. They tend to be goal setters and systematic planners. They have the ability to assimilate disparate observations into in-tegrated, rational explanations. This learning style is focused less on people and more focused on ideas and abstract concepts.'6
The converger learning style occurred in 51 nurse anesthesia students (31.1%). Convergers' strengths lie in their ability to solve problems, make decisions, and use deductive reasoning. The accommodator learning style occurred in 30 nurse anesthesia students (18.3%); accommodators' major strengths lie in doing things, getting involved, tak-ing risks, and getttak-ing thtak-ings done.'1 The least pre-ferred learning style, diverger, was identified in 22 nurse anesthesia students (13.4%). Divergers' strengths are reported to be imagination and un-derstanding people; a diverger could be described as a "people person."'0
The identification of the assimilator as the predominant learning style in nurse anesthesia
stu-dents is in contrast to the results reported by
Ramsborg and Holloway in 1985, who concluded
that the predominant learning style for the first-and second-year anesthesia students was the ac-commodator. In 1981, the accommodator learning style was reported to be the predominant style
among anesthesiologists and anesthesia
resi-dents.17 1
The difference in the identification of a pre-dominant learning style for nurse anesthesia stu-dents may be the result of a variety of factors. Cur-rently, a baccalaureate degree is required for
admission to anesthesia programs, but it was not an admission requirement in the early 1980s. The
literature suggests that baccalaureate preparation may have influenced the students' learning style preference.10 This study may reflect the trend to-ward placement of nurse anesthesia programs in a master's curriculum. This study included only MSN anesthesia students who are exposed to an environment in which practicing anesthetists are being encouraged to pursue higher education. The two studies that yielded contrasting results were conducted in the early 1980s and may not reflect the trend toward placement of anesthesia programs in the master's framework. The differences in these findings may be related to the trend toward higher education for students and practicing anesthetists.
The normative profile study of the LSI con-cluded that nursing students demonstrated a pref-erence for the accommodator style.'0 However, nurse anesthesia students may not fit this category, because their backgrounds put considerable em-phasis on the sciences and technical skills. The majority of nurse anesthesia students (53.2%) had between 1 and 4 years of critical care experience that enhances technical skills. Differences in learn-ing styles have been reported when comparlearn-ing un-dergraduate and graduate students in the same
major.8 Anesthesia students may not fit this typical picture, because they are required to have work
February 1994/ VoL 62/No. 1 Program year 27.4 8.8 12 10 14.3 12.5 20 31 23.8 38.8 29 32 34.5 40.0 - - -qw- ---- F - --43
experience as well as an undergraduate degree be-fore entering the graduate program.
There were no statistically significant relation-ships between learning styles and gender. This finding is in contrast to the normative profile study on the instrument.8, 10"15 Gender has not been a vari-able that has been frequently investigated; there-fore, it is difficult to compare and contrast results. The studies with contrasting results were con-ducted in the '70s and '80s, which may not reflect the attitudes of the student population of the '90s.
This study revealed a statistically significant relationship between length of time in a program and learning style preference. The learning style types of the first-year students were distributed over the four learning styles. The second-year stu-dents' learning style preferences were predominant in two learning style types, convergers and assimilators.
There was no relationship between age or years of critical care experience before entering an anesthesia program and learning style preference. This suggests that experience in the practice of nurse anesthesia might be responsible for the pre-dominant learning style preference held by the second-year students.
These findings appear to be consistent with ELT; that is, individuals assimilate the learning styles of the profession to which they are exposed, and learning styles are based on experience.10 The second-year students had greater than 12 months' experience in nurse anesthesia compared to the first-year students, who had less than 12 months' experience. Perhaps, in accordance with ELT, the learning styles of these students may have changed toward one of the predominant styles, based on their experiences in the program and their expo-sure to practicing anesthetists for whom higher ed-ucation may also be an influential factor.
Implications for education
The AANA has a goal of opening new pro-grams and expanding existing propro-grams into the master's framework. The identification of a pre-dominant learning style and the statistically sig-nificant relationship between learning styles and level in an MSN program may enhance the design of curricula for the new or expanding programs that are moving to the graduate level.
Appropriate teaching strategies may be used to enhance students' ability to learn didactically and clinically. Faculty may be able to make adjust-ments to meet students' needs by altering their teaching approach to accommodate the types of learners who enter their programs. Students may be able to make adjustments in their learning styles
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if they have a better understanding of how they learn best.
The identification of assimilator as the pre-dominant learning style among nurse anesthesia students enrolled in MSN programs has important implications for educators, because abstract con-ceptualization and reflective observation are the dominant characteristics of this style.
Those who have abstract conceptualization as a dominant ability put a priority on thinking and are concerned with general theories that use logic, ideas, and concepts; their concern is with under-standing general areas rather than unique, specific areas.16 Such individuals learn best by thinking and prefer to act on the basis of their understanding of a situation. They see the instructor as a communi-cator of information, with preferred learning situ-ations being clear and well structured when pre-sented with new ideas These individuals prefer to read theories and to study alone.10
Reflective observation as a dominant learning ability is manifested in the individual's ability to focus on understanding the meaning of ideas and situations by observation. Such individuals empha-size understanding rather than practical applica-tions.16 They are concerned with understanding how things happen rather than what works in a particular situation. Their emphasis is on reflec-tion and understanding things, as opposed to ac-tion. Reflective observers have a tendency to rely on their own thoughts to form opinions after ob-servation as a dominant ability. Their preferred learning situation involves lectures, where the in-dividual may take an observer role to see different perspectives. These individuals prefer objective tests, with a dominance in reflective observation, but they may have difficulty with practical appli-cations or applied solutions.10 Efforts directed at structuring lectures to guide these individuals through the critical thinking process may be help-ful in enhancing their ability to make applications.
Discussions have also been recognized to give students the opportunity to apply principles, con-cepts, and theories and, in the process, transfer their learning to new and different situations or practice the use of critical thinking. 8 The utiliza-tion of journal clubs in nurse anesthesia programs might be an excellent way to enhance critical thinking and promote focused discussions. Several medical schools have developed a special problem based learning curriculum which emphasizes small group discussions to enhance critical thinking, problem solving abilities, motivation, and the stu-dents' recognition of learning needs.19' 20
The number of MSN programs has approxi-mately doubled since this study was conducted and
the trend toward all graduate level anesthesia
pro-grams is now at 85%.21 Utilization of this data may be extremely valuable to promote problem solving
and critical thinking as we rapidly approach all
graduate level programs. REFERENCES
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AUTHOR
Linda Sherbinski, CRNA, MSN, received her bachelor of science in Nursing from Alfred University, New York, and her master of sci-ence in Nursing Education from Duquesne University, Pittsburgh. Pennsylvania. As a graduate student, she was the recipient of a re-search award grant and excellence in nursing, scholarship and profes-sional commitment award from Sigma Theta Tau, Epsilon Phi Chapter. She is a graduate of the University Health Center of Pittsburgh School of Anesthesia and has held university faculty positions in an anesthesia program. Ms. Sherbinski is currently an anesthetist at Memorial Medi-cal Center, Springfield, Illinois, and a cliniMedi-cal instructor for the Bradley/Decatur Nurse Anesthesia Program.
ACKNOWLEDGMENTS
The author gratefully acknowledges the support and guidance of Kathleen Gaberson, RN, PhD, throughout the entire research process. The author also would like to acknowledge the research award grant
from Sigma Theta Tau, Epsilon Phi Chapter.
