Psychiatric Bulletin (2001) 25: 306-309. doi: 10.1192/pb.25.8.306
© 2001 The Royal College of Psychiatrists
Psychiatric Bulletin (2001) 25: 306-309
© 2001 The Royal College of Psychiatrists
Learning styles of psychiatrists and other specialists
Nicholas Airey, Specialist Registrar in Adult Psychiatry and
James Marriott, Medical Audit Facilitator
Somerset Partnership NHS & Social Care Trust, Beech Court, Bridgwater
TA6 3LS
June Rodd, Management Development Consultant
Coombe House, Stoke Hill, Chew Stoke, Bristol BS18 8XF
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Abstract
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AIMS AND METHOD
To describe how the Learning Styles Inventory was used to assess the
preferred learning styles of a group of senior and specialist registrars from
different specialities attending a management course.
RESULTS
Of the 272 doctors studied, the learning styles of psychiatrists
(n=42) emerged as significantly different to the group as a whole,
favouring reflective observation and concrete experience rather than active
experimentation or abstract conceptualisation.
CLINICAL IMPLICATIONS
Knowledge of learning styles can help improve interactions with other
specialities that adopt different learning strategies, and assist with the
individual psychiatrist's lifelong learning. To engage the interest of medical
students, psychiatrists may need to consider different teaching approaches in
line with the prevalent learning style.
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Introduction
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Doctors spend much of their time learning. When they qualify they may have
spent nearly 20 years in full-time education. They will have been tested at
various stages and become used to the idea of acquiring the knowledge that
examiners expect of them. Learning, however, continues, both in the
acquisition of skills needed in the clinical area and the facts needed to
satisfy higher professional examiners. Doctors are almost unique among other
professional groups in the number of examinations they sit and with the
emergence of clinical governance there is an added weight placed upon lifelong
learning. So, doctors need to continue learning. A better understanding of the
way in which they learn must be valuable.
The business world has been interested in the idea of learning styles since
the Second World War, with the Learning Styles Inventory devised by Kolb
et al (1984) being the
most widely-used tool. Although formulated to study organisational behaviour
in the business environment, it is equally applicable to medical
practitioners, both for doctors in training
(Gatrell & White, 1999) and
as a reflective tool used by experienced consultants
(Brigden, 1999).
Kolb et al postulate learning as a four-stage cycle (see
Fig. 1). The individual has
experiences upon which he or she reflects and makes observations. These are
then used to form concepts and generalisations. Experimental actions follow
and these, in their turn, create new experiences. The Learning Styles
Inventory described by Kolb et al
(1984) measures individual
strengths and weaknesses of the learner in these four stages (or modes) of the
learning process. It is a simple self-description test that has nine sets of
four descriptions with the respondent marking words that are most, through to
least, like him- or herself. This then generates two axes, one being active
experimentation (AE) v. reflective observation (RO), the other being
concrete experience (CE) v. abstract conceptualisation (AC). These
axes are then plotted out to give the four learning styles described in
Fig. 1. For example, one set of
four words is ‘feeling, watching, thinking and doing’, which
reflect CE, RO, AC and AE, respectively.
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Fig. 1. Learning as a four stage cycle, with the four learning styles:
converger, diverger, assimilator and accommodator
Converger: knowledge focused on specific problems. Use abstract
conceptualisation and active experimentation in problem solving,
decision-making and the practical application of ideas. Prefer to deal with
technical tasks rather than social and interpersonal issues. Style
characteristic of engineers and technical specialists.
Diverger: opposite strengths to the converger, emphasises concrete
experience and reflective observations. View situations from many perspectives
and organise relationships into a meaningful ‘gestalt’. Style
characteristic of counsellors and personnel managers.
Assimilator: by combining abstract conceptualisation and reflective
observations are able to create theoretical models and assimilate observations
into an integrated explanation. Style characteristic of mathematicians and
those in research and planning departments.
Accommodator: opposite strengths to the assimilator, emphasises concrete
experience and active experimentation. Intuitive trial and error approach;
action orientated and adapt well to changing circumstances. Style
characteristic of business world, especially marketing and sales. Based on
Kolb et al. 1984.
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The study
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Senior and specialist registrars of all specialities working in the South
and West Region are encouraged to attend the 6-day management course organised
locally by the Postgraduate Dean. Selection bias is unlikely to be an issue
because all trainees are expected to attend a management course. The majority
of doctors elect to attend this particular course. Over the past 4 years 272
such doctors have attended the course and as part of the programme have
completed the Learning Styles Inventory, as described above.
The nine questions and scoring instructions were distributed to the
participants, who then completed and scored their responses. The results were
plotted and individual learning styles recorded by the course organiser.
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Findings
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Table 1 shows the higher
professional trainees divided by speciality and the number within each
professional group recording each of the four types of learning style. Half
scores are possible where the individual fell exactly on the dividing line
between two different styles. It can be seen that all specialities, except
psychiatry, have convergence as the most numerous category. Psychiatrists'
learning styles were more evenly spread, the most numerous category being
divergers at 32% of the total. The data were further analysed by separating
the scores according to the two axes described above, axis one being AE as
opposed to RO with axis two being CE as opposed to AC
(Table 2). If the results of
psychiatrists are compared with the pooled results of all the specialities
collectively, there is a significant difference in scores on both these
scales. Generally the whole sample favours AE, with psychiatry split more
evenly between this and RO (P=0.03). Differences are even more marked
in axis two with specialist/senior registrars in general favouring AC while
those from psychiatry favour CE (P=0.01). For surgeons, there is also
significant variation in their scoring on both scales (P=0.03, 0.01)
and it is in the opposite direction to psychiatrists. The two modes that
contribute to the converger style (AE and AC) are more prevalent in surgeons
when compared to the group as a whole and less prevalent in psychiatrists. All
probabilities were calculated using 
2 tables.
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Comments
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The ‘popularity’ of convergers in the medical profession has
been demonstrated in research on surgical trainees
(Drew et al, 1998), paediatricians (Kosower, 1995)
and medical students (Lynch et al,
1998). The results suggest that psychiatrists approach learning
and problem solving in a different way to other doctors in general and
surgeons in particular. This has a number of implications.
First, in the liaison psychiatry setting the psychiatrist may approach a
clinical problem in a very different way to the other specialists involved.
Convergers seem to work best when there is a single correct answer or solution
to a question or problem, as can be seen with surgeons. Divergers can organise
many relationships into one meaningful ‘gestalt’, an invaluable
approach for a psychiatrist. It is to be imagined that this could potentially
create conflict between specialities over patient management, and it is known
that non-psychiatric doctors view the psychiatric consultation in a very
different way to the psychiatrist
(Cohen-Cole, 1982).
Second, it is known that medical students commonly have a negative view of
psychiatry, regarding the speciality as unscientific, different from medicine
generally and not using medical skills
(Creed & Goldberg, 1987).
The work of Lynch et al
(1998) showed that in a sample
of medical students, 45% were convergers, 26% assimilators, 21% accommodators
and only 8% were divergers. So, for example, 66% of students are convergers or
accommodators and are thus drawn to AE. Psychiatrists are less likely to
espouse this stage of the learning process and may approach teaching in a way
that dwells on reflective observation, their preferred approach. This is
unlikely to be a style that would engage the majority of medical students, and
would help to explain the students' negative views of psychiatry. A
consideration of this may help engage students with the speciality —
both to have a more favourable attitude generally and to consider it as a
career.
Third, among all doctors, including those who have chosen psychiatry as a
career, there is a need to consider lifelong learning. Using a learning
portfolio is one approach to this that helps keep the individual interested
and engaged (Brigden, 1999).
This exercise in reflecting on experience and future objectives can be
expressed in terms of different quadrants of the learning cycle. The
individual's knowledge of his or her own learning style helps inform this
process, helps people to understand why they find some forms of learning more
acceptable than others and helps people take full advantage of learning
opportunities as they arise (Gatrell &
White, 1999).
Finally, it is worth remembering that Kolb et al
(1984) suggest that to become a
more effective learner one needs to develop competencies in all learning
styles. The key to effective learning is to be competent in each mode where
appropriate.
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References
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Abstract
Introduction
