Introduction

Learning style is an individual’s characteristic method of gaining knowledge, skills, and attitudes through study or experiences [1]. Among the different models that have been proposed, the visual, aural, read/write, and kinesthetic (VARK) model developed by Neil Fleming is one of the most frequently used methods, and describes preferences in terms of 4 types of preferred learning styles (visual, aural, read/write, and kinesthetic) [2]. Learning preferences are also categorized into 4 modes (unimodal, bimodal, trimodal, and quadmodal), based on the number of learning types preferred. The VARK tool is commonly used by researchers in a variety of disciplines, including medical education.

Studying medicine requires a variety of modes of learning. In previous reports, 56.0% to 86.8% of medical students chose multiple modes of learning. Among the multiple-mode possibilities, 27.6%–43.4% preferred quadmodal learning, and 30.3%–41.0% preferred bimodal learning [3,4,5,6]. Many reports have found unimodal learning to be most prevalent (53.8%–81.9%) [7,8]. Within unimodal learners, aural (21.2%) and kinesthetic (30.1%) were the 2 most preferred VARK styles [3,7,9,10]. Some studies found that the preference of visual and read/write learning styles was associated with gender. However, other studies have reported that VARK results were not associated with gender [7].

Inconsistent findings have been reported regarding the relationship between learning styles and academic achievement [11]. Whether preferred learning styles have an impact on academic achievement among medical students remains unknown. Learning styles and study habits may also predict a medical student’s approaches to and satisfaction with work, stress, and mental health, both when applying to medical school and in the final year. Prior performance may not only predict achievement among students, but also be associated with future achievement at the postgraduate level (i.e., during residency training).

However, the relationships among learning styles, achievement, stress, and mental health require further analysis. To our knowledge, no evidence exists regarding VARK styles, stress, and mental health among medical students. Therefore, our study aimed to explore the prevalence of various learning styles according to the VARK framework among medical students, the correlations between academic achievement and learning styles, and the correlations of stress and mental health problems with the learning styles of these students. Insights about how students learn can result in improved understanding and detection of learners who are at risk of stress-related health problems in medical school.

Methods

Study design and subjects

The study employed a cross-sectional design. A total of 140 of the 250 first-year medical students attending Chiang Mai University were recruited in the 2014 academic year.

Measurement

The measurement tools used included demographic data and grade point average (GPA). Other measures included are listed below.

Thai version of the visual, aural, read/write, and kinesthetic questionnaire version 7.1

VARK is a tool that categorizes learning styles into 4 types (visual, aural, read/write, and kinesthetic). The 4 modes of VARK depend on the number of VARK types chosen (unimodal, bimodal, trimodal, and quadmodal). VARK is commonly used in the education field in a variety of disciplines, including the medical sciences. A Thai version has been made available [12]. The VARK questionnaire contains 16 items, and each has 4 choices reflecting different learning style preferences. More than 1 answer can be endorsed for each item if that matches the participant’s perceptions. The reliability (α) scores of the learning styles are 0.85, 0.82, 0.84, and 0.77 for the visual, aural, read/write, and kinesthetic styles, respectively [13].

Outcome inventory, 21 items

The 21-item outcome inventory (OI-21) is a self-rating questionnaire that measures 4 common mental health problems (depression, anxiety, somatic symptoms, and interpersonal difficulties). The OI-21 contains 21 questions using a 5-choice Likert scale ranging from 1 (never) to 5 (always). The Cronbach α value was found to be 0.92, and its concurrent validity with different measures has been well studied. This tool takes approximately 5–10 minutes to complete [14].

Thai version of the 10-item Perceived Stress Scale

It consists of 10 questions on a 5-choice Likert scale ranging from 0 (never) to 4 (very often), and can be completed within 3–5 minutes. It comprises 2 structures: stress, which is measured by 6 questions, and control, which is measured using 4 questions. The Thai version of 10-item Perceived Stress Scale (PSS-10) had a Cronbach α (total) of 0.85, and an intraclass correlation coefficient of 0.82. Confirmatory factor analysis showed that the goodness-of-fit index was 0.981, the root mean square residual was 0.022, the standardized root mean square residual was 0.037, the comparative fit index was 0.989, the normed fit index was 0.96, the non-normed fit index was 0.981, and the root mean square error of approximation was 0.031 [15].

Statistical analysis

Descriptive statistics was used to analyze the participants’ demographic data, such as gender and age. Analysis of variance was used to compare VARK modes among different GPA, PSS, and OI groups. The predictive power of VARK type on GPA was evaluated using regression analysis. IBM SPSS for Windows ver. 22.0 (IBM Co., Armonk, NY, USA) was used to analyze the data. An α value of 95% was applied throughout.

Ethical approval

Informed consent was obtained from the participants. The study was approved by the Ethics Committee of the Faculty of Medicine, Chiang Mai University, Thailand (IRB no. 004/2015).

Results

Among the 140 participants, the average age was 18.86±0.74 years. The majority (60%) were women. The most prevalent VARK types and modes were kinesthetic (35%) and quadmodal (43.57%) (Fig. 1). Table 1 shows the mean and standard deviation of VARK types and the frequency of VARK modes. No significant differences were observed regarding VARK types or modes between male and female participants. In terms of academic achievement, only the kinesthetic type had a significantly negative correlation with GPA in the first semester (time 1). No significant differences were found between other VARK types, VARK modes, and GPA (Tables 2, 3). No differences were observed among VARK types or modes with regard to the PSS score. No significant differences were found regarding VARK mode and the OI score, except for interpersonal difficulties, for which trimodal participants obtained the highest score. Trimodal learning was associated with significantly higher interpersonal difficulties scores than quadmodal learning (P=0.040) (Tables 4, 5).

Discussion

The present study showed that most medical students (65%) had a preference for multimodal VARK learning, which is similar to what has been reported in previous studies. Among these, quadmodal was the most preferred (43.57%) mode of learning. These findings are similar to those of previous studies that reported multiple modes to be the most preferred learning style, with quadmodal learning being the most prevalent among first-year or preclinical students [3,4], while Baykan and Nacar [5] and Prithishkumar and Michael [6] reported that bimodal was the most preferred VARK mode. The authors conjecture that culture and curriculum may contribute to these discrepancies. Our findings imply that medical students preferred their instructors to use different methods of teaching to ensure effective learning. Although the students’ learning preferences were not associated with variations in learning outcomes, providing opportunities to express these abilities and skills may result in success.

In terms of VARK types among individuals who preferred unimodal learning, kinesthetic was the most common learning style. The finding that the visual learning style was found the least preferred type in this study is in line with previous reports [3,4]. The reason that students did not prefer visual learning is unknown, although it constitutes 1 of the 4 required skills for clinical examinations (inspection, palpation, percussion, and auscultation). This may reflect the fact that the participants were surveyed while they were in their first year of medical school. Visual strategies may be least used at that stage of learning because the curriculum design of the first year differs from that of higher levels, especially clinical years where visual ability is required for activities such as using a microscope in histology or pathology classes, investigating structures in anatomy class, examining patients in the clinical years, and so on. This finding may assist curriculum developers in designing a preparatory course for students to enhance their visual strategies in the early years of study. Academic achievement, as defined by GPA, was not related to VARK mode. This finding is consistent with the results reported by Almigbal [7].

In general, achievement outcomes differ in many details, with examples including paper examination scores and rankings, laboratory scores, group assignments or reports, objective structured clinical examinations, and so on. GPA, as a representative measure of academic achievement, may not be sensitive enough to show the differences among VARK learning styles. Therefore, the authors do not recommend that GPA should be used as the only outcome measure for academic achievement. Interestingly, the kinesthetic learning style was found to be negatively related to GPA. This might be because among preclinical students, more time was spent on lectures and learning theories than in practical learning due to the design of the curriculum.

While modes of VARK learning were not associated with perceived stress, anxiety, depression, or somatization, individuals who preferred trimodal VARK learning reported higher scores on the interpersonal difficulties subscale than others. Since insufficient information is available to explain this relationship, further study of this issue might be encouraged. In addition, repeated outcomes and longitudinal monitoring may be warranted.

In conclusion, the most preferred learning style among medical students was quadmodal. Learning styles were not associated with academic achievement or mental health. However, the trimodal learning style was associated with interpersonal problems.

Supplementary materials

Fig. 1.

Types of visual-aural-read/write-kinesthetic learning styles of 140 first-year medical students of Chiang Mai University, Thailand in 2014.

References

• 1. James S, D’Amore A, Thomas T. Learning preferences of first year nursing and midwifery students: utilising VARK. Nurse Educ Today 2011;31:417-423. https://doi.org/10.1016/j.nedt.2010.08.008 ArticlePubMed
• 2. Fleming ND, Mills C. Not another inventory: rather a catalyst for reflection. In: Wulff DH, Nyquist JDProfessional and Organizational Development Network in Higher Education, editors. To improve the academy: resources for faculty, instructional and organizational development. Stillwater (OK): New Forums Press; 1992. p. 137-155.
• 3. Peyman H, Sadeghifar J, Khajavikhan J, Yasemi M, Rasool M, Yaghoubi YM, Nahal MM, Karim H. Using VARK approach for assessing preferred learning styles of first year medical sciences students: a survey from Iran. J Clin Diagn Res 2014;8:GC01-GC04. https://doi.org/10.7860/JCDR/2014/8089.4667 Article
• 4. Panambur S, Nambiar V, Heming T. Learning style preferences of preclinical medical students in Oman. Oman Med J 2014;29:461-463. https://doi.org/10.5001/omj.2014.120 ArticlePubMedPMC
• 5. Baykan Z, Nacar M. Learning styles of first-year medical students attending Erciyes University in Kayseri, Turkey. Adv Physiol Educ 2007;31:158-160. https://doi.org/10.1152/advan.00043.2006 ArticlePubMed
• 6. Prithishkumar IJ, Michael SA. Understanding your student: using the VARK model. J Postgrad Med 2014;60:183-186. https://doi.org/10.4103/0022-3859.132337 ArticlePubMed
• 7. Almigbal TH. Relationship between the learning style preferences of medical students and academic achievement. Saudi Med J 2015;36:349-355. https://doi.org/10.15537/smj.2015.3.10320 ArticlePubMedPMC
• 8. Liew SC, Sidhu J, Barua A. The relationship between learning preferences (styles and approaches) and learning outcomes among pre-clinical undergraduate medical students. BMC Med Educ 2015;15:44. https://doi.org/10.1186/s12909-015-0327-0 ArticlePubMedPMCPDF
• 9. Slater JA, Lujan HL, DiCarlo SE. Does gender influence learning style preferences of first-year medical students? Adv Physiol Educ 2007;31:336-342. https://doi.org/10.1152/advan.00010.2007 ArticlePubMed
• 10. Sarabi-Asiabar A, Jafari M, Sadeghifar J, Tofighi S, Zaboli R, Peyman H, Salimi M, Shams L. The relationship between learning style preferences and gender, educational major and status in first year medical students: a survey study from iran. Iran Red Crescent Med J 2014;17:e18250. https://doi.org/10.5812/ircmj.18250 ArticlePubMedPMC
• 11. Jiraporncharoen W, Angkurawaranon C, Chockjamsai M, Deesomchok A, Euathrongchit J. Learning styles and academic achievement among undergraduate medical students in Thailand. J Educ Eval Health Prof 2015;12:38. https://doi.org/10.3352/jeehp.2015.12.38 ArticlePubMedPMCPDF
• 12. Pawuttipatthrapong S. VARK (Thai version) [Internet] Chon Buri (Thailand): Burapha University; 2014 [cited 2016 Jul 24]. Available from: http://vark-learn.com/wp-content/uploads/2014/08/The-VARK-Questionnaire-Thai.pdf
• 13. Leite WL, Svinicki M, Shi Y. Attempted validation of the scores of the VARK: learning styles inventory with multitrait–multimethod confirmatory factor analysis models. Educ Psychol Meas 2010;70:323-339. https://doi.org/10.1177/0013164409344507 Article
• 14. Wongpakaran T, Wongpakaran N. How the interpersonal and attachment styles of therapists impact upon the therapeutic alliance and therapeutic outcomes. J Med Assoc Thai 2012;95:1583-1592. PubMed
• 15. Wongpakaran N, Wongpakaran T. The Thai version of the PSS-10: an investigation of its psychometric properties. Biopsychosoc Med 2010;4:6. https://doi.org/10.1186/1751-0759-4-6 ArticlePubMedPMC

Figure & Data

References

Citations

Citations to this article as recorded by  

• Death recollection moderates stress-influenced depression in Thai boarding school students
  Justin DeMaranville, Tinakon Wongpakaran, Nahathai Wongpakaran, Danny Wedding
  BMC Psychology.2025;[Epub]     CrossRef
• Unraveling the nexus between learning styles and academic performance: the mediating effect of pre-service teachers’ satisfaction
  Zacharia Mohammed, Vera Arhin, Oppong Samuel
  Cogent Education.2025;[Epub]     CrossRef
• Prevalence and associated factors of ADHD-like symptoms among pharmacy students at Prince of Songkla University, Thailand in 2024: a cross-sectional study
  Krittiya Rakchat, Saranan Eadcharoen, Amarawan Pentrakan
  The Ewha Medical Journal.2024;[Epub]     CrossRef
• Learning styles in science education at university level: A systematic review
  Albina R. Shaidullina, Natalia A. Orekhovskaya, Evgeny G. Panov, Marina N. Svintsova, Oksana N. Petyukova, Nataliya S. Zhuykova, Elena V. Grigoryeva
  Eurasia Journal of Mathematics, Science and Technology Education.2023; 19(7): em2293.     CrossRef
• The Mediating Role of Precepts and Meditation on Attachment and Depressive Symptoms in Adolescents
  Justin DeMaranville, Tinakon Wongpakaran, Nahathai Wongpakaran, Danny Wedding
  Healthcare.2023; 11(13): 1923.     CrossRef
• Learning styles and their relationship with preferred teaching methodologies and academic achievement among medical students in teaching medical college, Tamil Nadu
  Tamilarasan Muniyapillai, Karthikeyan Kulothungan, Shagirunisha Rizvana Abdul Malik, Shekshi Janet Jeevaraj, Shrimathi Ashokan, Sindhurajeswari Ravichandran, Sivaranjani Ambalavanan, Sowmiya Jayaraman
  Journal of Education and Health Promotion.2023;[Epub]     CrossRef
• “METAPAD” (METAbolic PAthways Decoded) – a gaming innovation to ease the complexity of metabolic pathways by promoting self-directed, active, participatory learning in small groups
  Krishna Mohan Surapaneni
  BMC Medical Education.2023;[Epub]     CrossRef
• Depression and Its Associated Factors among Undergraduate Engineering Students: A Cross-Sectional Survey in Thailand
  Yuanyue Huang, Tinakon Wongpakaran, Nahathai Wongpakaran, Patraporn Bhatarasakoon, Preda Pichayapan, Shirley Worland
  Healthcare.2023; 11(16): 2334.     CrossRef
• Estilos de aprendizaje y salud mental en estudiantes de educación superior tecnológica
  Diego Armando Santos Pazos, Adriana Salomé Polo Ureña, Verónica Adriana Freire Palacios, Jeniffer Vanessa Palacios Moreno
  Anatomía Digital.2023; 6(4.3): 468.     CrossRef
• The impact of the transition from flipped classroom to online lectures on learning outcomes and student satisfaction in a rehabilitation medicine clerkship during the COVID-19 pandemic
  Phichamon Khanittanuphong, Khanin Iamthanaporn, Jongdee Bvonpanttarananon
  BMC Medical Education.2022;[Epub]     CrossRef
• The association between learning styles and academic achievement among medical students
  Abdulaziz Alturki, Eyad Alsuhaibani, Waleed Mufarrih, Hessah Alsayahi, Roba Altameem, Nouf Almansour, Yara Alessa, Arwa Abdulsalam, Ibrahim Alodhaibi, Bandar Alzuair, Reham Alturki
  International Journal of Medicine in Developing Countries.2021; : 751.     CrossRef
• Instruments to evaluate undergraduate healthcare student learning styles globally: A scoping review
  Daniel Gonçalves Campos, Juliany Lino Gomes Silva, Melissa Jarvill, Roberta Cunha M. Rodrigues, Ana Railka de Souza Oliveira Kumakura, Daniel Gonçalves Campos
  Nurse Education Today.2021; 107: 105141.     CrossRef
• An Assessment of Learning Styles of Undergraduate Medical Students in Three Different Types of Curriculum
  Abdulrahman Alfawzan, Moeber Mahzari, Sajida Agha, Aamir Omair, Omar Alfawzan, Reema Alessa, Abdulaziz Alturki, Kholoud Alshiha
  Journal of Nature and Science of Medicine.2021; 4(3): 267.     CrossRef
• Identifying learning styles of language learners: A useful step in moving towards the learner-centred approach
  Sudarat PAYAPROM, Yupares PAYAPROM
  Dil ve Dilbilimi Çalışmaları Dergisi.2020; 16(1): 59.     CrossRef
• Use of Learning Style Frameworks in Health Science Education
  Lindsey Childs-Kean, Mary Edwards, Mary Douglass Smith
  American Journal of Pharmaceutical Education.2020; 84(7): ajpe7885.     CrossRef
• Preferred teaching styles of medical faculty: an international multi-center study
  Nihar Ranjan Dash, Salman Yousuf Guraya, Mohammad Tahseen Al Bataineh, Mohamed Elhassan Abdalla, Muhamad Saiful Bahri Yusoff, Mona Faisal Al-Qahtani, Walther N. K. A. van Mook, Muhammad Saeed Shafi, Hamdi Hameed Almaramhy, Wail Nuri Osman Mukhtar
  BMC Medical Education.2020;[Epub]     CrossRef
• Study Habits of Dental Students of Ahvaz Jundishapur University of Medical Sciences (2018)
  Abdolreza Gilavand
  Educational Research in Medical Sciences.2019;[Epub]     CrossRef
• Does MMPI assessed at medical school admission predict psychological problems in later years?
  Kulvadee Thongpibul, Pairada Varnado, Nahathai Wongpakaran, Tinakon Wongpakaran, Pimolpun Kuntawong, Danny Wedding
  BMC Research Notes.2019;[Epub]     CrossRef
• Are There Gender-Dependent Study Habits of Medical Students in Times of the World Wide Web?
  A. Benditz, L. Pulido, T. Renkawitz, T. Schwarz, J. Grifka, M. Weber
  BioMed Research International.2018; 2018: 1.     CrossRef
• DİŞ HEKİMLİĞİ FAKÜLTESİ ÖĞRENCİLERİNİN ÖĞRENME STİLLERİNİN İKİ FARKLI YÖNTEMLE ANALİZİ
  Ayşe KOÇAK BÜYÜKDERE
  Atatürk Üniversitesi Diş Hekimliği Fakültesi Dergisi.2018; : 371.     CrossRef