Abstract

---

Objective: To determine the internal consistency and construct validity of the Learning Approach Inventory (LA-i) among first year medical students.
Methods: Cross sectional study was done on 196 first year medical students in Universiti Sains Malaysia (USM). The items of the LA-i were framed based on characteristics of three learning approaches. The Cronbach’s alpha reliability analysis and factor analysis were applied to measure internal consistency and construct validity respectively. The analysis was done using Statistical Package for Social Science (SPPS) version 18.
Result: A total of 196 medical student responded to this study. The Cronbach’s alpha value of the LA-i was 0.867. The Cronbach’s alpha values of surface, strategic and deep domains were 0.69, 0.81 and 0.89 respectively. Factor analysis showed all 12 items were loaded into 3 constructs and their factor loading values were more than 0.3. Each domain of the final version LA-i has 4 items.
Conclusion: The LA-i has shown good psychometric values. It is a valid and reliability tool to identify learning approach of medical students. It is a promising inventory that can be used to identify learning approach among students in future.

Introduction

---

The variation between students is almost never-ending because each one of them has very unique characters that are strongly influenced by genetic makeup (1). Similar phenomenon happens on students approach to learning where they tend to adopt certain ways of learning that best fit with their belief, ability and capacity. Commonly, learning is referred to an active and lifelong process of acquiring information through various medium where the information are transformed and translated into meaningful ideas that lead to formation of knowledge, skills, behaviour and attitude (2-4). It is noteworthy that understanding of student learning approaches will help educators to be better and efficient teachers as well as it help students to be better learners if they are aware about their own learning approach (5, 6).
Students have different levels of motivation, different attitudes towards teaching and learning, difference levels of maturity, different levels of response to specific educational and classroom environments, and different levels of reception to specific instructional design (7). Although each of students is unique, but there are common behaviours being displayed which can be clustered together to form meaningful concepts. From that notion, Marton and Saljo (8) have proposed three different approaches to learning which are surface approach, strategic approach and deep approach.
Students who adopt surface approach commonly learn through memorizing facts from the books they read and from lectures they attended (5-9). Their learning driven by extrinsic motivation where they learn due to fear of failure, they want to pass examination and get job. Their intention is just to pass and getting thing done with minimal efforts. Most of the time they accept all the information obtained from books and lecturers unquestioning. Studies have revealed that surface approach to learning has consistently been found to negatively correlate with academic performance and achievement (10-12).
Deep learners usually learn through understanding on subjects where their intention is to seek own meaning on the subjects to enhance understanding and mastery (5-9). They love to validate information given to them prior to accepting it through relating to previous knowledge and searching for evidence. Their learning is driven by intrinsic motivation where they want to master the subjects so that they can use it for good as well as to teach and share with others. They always monitoring, updating and evaluating their understanding through self-directed and life-long learning. It is worth noting that, studies have reported that high academic achievement and performance can be predicted from students who adopt deep approach to learning either alone or in combination with strategic approach (10, 11, 13).
Students who adopt strategic approach to learning commonly learn through systematic or smart study where they are bound to the syllabus of course and their intention is to attain the highest marks as possible (5-9). They are usually competing with other learners to get top rank in the course and are reluctant to share information with others. They stick to time and plan as well as monitor their study progress to ensure every course objectives have been read and understood. Students who adopt strategic approach in combination with deep approach tend to attain high academic success (10, 11, 13).
Reliability is generally defined as consistency or reproducibility of measurement over time or occasions whereas validity is defined as to what extent the measurement measures what it should measure, (14-17). An inventory must be tested for both qualities in order to ensure it measures what it is supposed to measure and the measurement obtained is reproducible over time and occasion if similar attributes are being measured. The Reliability analysis of Cronbach’s alpha and factor analysis are commonly used by researchers to determine the internal consistency and construct of an inventory (18, 19); therefore, similar analyses were applied in this study.
This study described the reliability and validity of the Learning Approach Inventory (LA-i), which was developed to assess the three learning approaches among medical students with the hope it can be used as a valid and reliable instrument. It is also hoped that this study may provide some information on validity evidence in the use of the LA-i to identify learning approaches of students.

Methods

---

The Learning Approach Inventory (LA-i)
The inventory was developed based on the learning approach dimensions that have been proposed by Marton and Saljo (8) which are surface approach, strategic approach and deep approach. The items of LA-i were derived from literature review and discussion with the experts in medical education. The items were designed based on its compatibility and suitability with local culture and values. Items conveying characteristics of the learning approach dimensions most clearly were selected. About four items were selected for each of dimensions. The items were undergone a process of scrutiny and evaluation, as a result of that the language of the items was modified to make it simple and suitable to express the concept implied. Each item of the LA-i was rated using 5-likert scores (1=least like you, 2=in between scores of 1 and 3, 3= 50% like you, 4=in between scores of 3 and 5, 5=most like you) to indicate how close the statement described the respondents’ behaviour.
Expert evaluation of the items
In order to establish the content validity of the LA-i, the items were subjected to experts’ evaluation. The experts were drawn from the field of Medical Education. Necessary modifications were made with the feedback given by the experts.
Preliminary try-out
The items were administered to a sample of 100 first year medical students of previous batch and 20 medical teachers to check their applicability and face validity during separate face-to-face sessions. The students and medical teachers were encouraged to express their doubts freely. Necessary modifications were made with the experience gained through this preliminary try-out. The selected 12 items according to the learning approach groups were shown in table 2.
Validation study
Purposive sampling method was applied. Approximately all 196 new first year medical students were selected as respondents. Proper instructions were given before the administration of the questionnaire. The applicants were asked to respond to all the statements and no time limit was imposed. During the time of administration the investigator gave proper assistance and directions whenever necessary.
Study subjects
Population of this present study was 196 new first year medical students at the School of Medical Sciences, Universiti Sains Malaysia. All of them were selected as study subjects.
Collection of data
The investigator obtained permission and clearance from the School of Medical Sciences and Human Ethical Committee of Universiti Sains Malaysia. Informed consent was obtained from the respondents and they were requested to fill in the questionnaire. Completion of the questionnaire was voluntary and the respondents were informed that not returning the questionnaire would not affect the students’ progress in the course. Data was collected by guided self-administered questionnaire. The questionnaires were collected on the same day.
Factor Analysis
Collected data was analysed using Statistical Packages Social Sciences (SPSS) version 18. Factor Analysis was done to determine construct validity of the LA-i. Kaiser-Meyer-Olkin (KMO) test and Bartlett’s test of sphericity was applied to measure the sampling adequacy (18). The sample was considered adequate if i) KMO value was more than 0.5 and ii) Bartlett’s test was significant (p-value less than 0.05). Principal Component Analysis (PCA) method was applied to extract components. Components with Eigen values of over 1 were retained. With the assumption that all items were uncorrelated with each other, Varimax rotation was applied in order to optimize the loading factor of each item on the extracted components. Items with loading factor of more than plus or minus 0.3 were considered as an acceptable loading factor (18). Once constructs of the LA-i were finalised, reliability analysis for each construct was done.
Reliability analysis
Reliability analysis was done to determine the reliability of the questionnaire. Internal consistency of the items was measured by using Cronbach’s alpha coefficient. For an estimation of reliability, statistical reliability of individual items was done. Items with corrected-item total correlation value of more than 0.3 were selected and items with corrected-item total correlation value of less than 0.3 were removed. The Cronbach’s alpha value of deleted item could determine which item highly contributed to reliability of the LA-i. If the Cronbach’s alpha value for those items-deleted decreased, it would indicate that the items highly contributed to alpha value. In contrast, if the Cronbach’s alpha value for those items-deleted increased, it would indicate that the items poorly contributed to alpha value. The items of LA-i were considered to represent measure of good internal consistency if the total alpha value was more than 0.6 (11, 14, 17).

Results

---

A total of 196 (100%) medical students responded to this study which was considered as excellent response rate.
Table 1 shows the profile of the respondents. Majority of the respondents were female (65.3%), Malays (53.6%) and came from the matriculation (88.8%) stream. It seems that most of the respondents originated from urban areas (50.5%) and various social strata.
Factor analysis
The sample was adequate as indicated by i) a KMO value of 0.861 and ii) Bartlett’s test of sphericity being significant (p-value < 0.001).
Table 2 showed the factor analysis results where three components were extracted without forced extraction using principal component analysis (PCA) with rotation of Varimax. It seems that item Q1, Q2, Q4, Q7 and Q8 were loaded on two components with factor loading more than 0.3. Item Q4 and Q7 were highly loaded on the intended domains, whereas Q1, Q2 and Q8 highly loaded on different domains. Item Q4 and Q7 will be remained in the inventory but other items will be removed if the Cronbach’s alpha value for those items-deleted increased. The total variance explained by these three components was 69.98% which was acceptable.
Reliability analysis
Reliability analysis shows that the total Cronbach’s alpha value of the LA-i was 0.867 which indicated a high level of internal consistency (14-17). The Cronbach’s alpha values of the surface, strategic and deep approach domains were 0.69, 0.81 and 0.89 respectively as shown in table 2. Those domains show good to very good level of internal consistency (17, 19). Table 2 also shows that all the items has corrected-item total correlation of more than 0.3 and highly contributed to the inventory reliability as the Cronbach’s alpha value decreased after deleting the items. Thus all the items were retained in the inventory. These findings suggested that the final 12 items LA-i is reliable and has high internal consistency.

Discussion

---

The demographic profile of the respondents was almost similar with the Malaysian population in terms of gender and ethic group. Even more, the distribution represent those from rural areas and lower social strata. These facts were considered as evidence of a good level of representativeness of study samples to the Malaysian population. Therefore findings of this study represent the study population.
The factor analysis showed that the final 12 items were loaded into three components without forced extraction as shown in the table 2. All the items loaded well into the predetermined domains as all the items had loading factor of more than 0.3 (17, 19). These findings concurred that the LA-i has shown a good construct. It provides evidence to suggest that the inventory measures what it should measure and that it is a valid tool to be utilised in identifying learning approaches among medical students. However, it is recommended that confirmatory factor analysis be conducted in the future to test the existence of the LA-i latent constructs.
The reliability analysis suggested that the LA-i demonstrated a measure of high internal consistency as their Cronbach’s alpha values were more than 0.7 as shown in table 2; it reflected the internal reliability of the inventory (14-17, 19). The three domains had also shown a measure of good internal consistency as the Cronbach’s alpha values ranged from 0.69 to 0.89; it was another important evidence for reliability of the inventory. These findings provided evidence to concur that the LA-i is a reliable instrument that could be used in the future to identify students approach to learning.
The reliability and factor analyses have consistently demonstrated evidence of validity and reliability of the LA-i in identifying students learning approach. However, a limitation of this study is that it is only confined to one institution. Therefore it is recommended that a multi-centre validation study should be conducted in the future to determine the validity and reliability of the LA-i across institutions. Apart from that, this study has provided useful baseline information for future studies in this area.

Conclusion(s)

---

The LA-i has shown good psychometric values. It is a valid and reliability tool to identify learning approach of medical students. It is a promising inventory that can be used to identify learning approach among students in future.

Abbreviation(s)

---

Nil

Acknowledgement(s)

---

Our special thanks to the School of Medical Sciences, Universiti Sains Malaysia for supporting and allowing us undertake this study. Our appreciation to all the first year medical students involved  in this study. Our special thank you also  to Dr Ahmad Fuad Abdul Rahim, Dr Mohamad Najib Mat Pa and the support staff of the Academic Office and Medical Education Department staff for their help. This study was made possible under the Short Term Research Grant 304/PPSP/6139071.

References

---

1. Sheperd P. Personality Matters: The Whole Brain Approach, Why We Learn, Think and Behave. Malaysia: Brain Works Media, 2007.
2. Yusoff MSB. Medical Education Notes: Introduction to principles of teaching and learning. Retrieved September 15, 2010 from www.saifulbahri.com website: http://saifulbahri.com/Medical_education/Medical_Education_Notes/Introduction_to_principles_of_teach ing_and_learning.pdf
3. Learning. (n.d.). Collins English Dictionary - Complete & Unabridged 10th Edition. Retrieved September 15, 2010, from Dictionary.com website: http://dictionary.reference.com/browse/learning
4. Cobb J. Definition of learning. Retrieved September 15, 2010 from www.missiontolearn.com website: http://www.missiontolearn.com/2009/05/definition-of-learning/
5. Yusoff MSB, Rahim AFA. The Study Skills Workshop. MedEdPORTAL, 2010. Available online at http://services.aamc.org/30/mededportal/servlet/s/segment/mededportal/?subid=8010
6. Biggs J B. Student Approaches to Learning and Studying. Melbourne: Australian Council for Educational Research, 1987.
7. Richard RM, Brent R. Understanding student differences. Journal of Engineering Education, 2005; 94 (1): 57-72.
8. Marton F, Säljö, R. Approaches to learning. In Marton F, Hounsell DJ, Entwistle J (Eds.), The Experience of Learning, 2nd Edn. Edinburgh:Scottish Academic Press, 1999.
9. Entwistle NJ, Ramsden P. Understanding Student Learning. London: Croom Helm, 1983.
10. Boyle EA, Duffy T, Dunleavy K. Learning styles and academic outcome: The validity and utility of Vermunt’s Inventory of Learning Styles in a British higher education setting. British Journal of Educational Psychology, 2003; 73: 267-290.
11. Diseth A. Personality and approaches to learning as predictors of academic achievement. European Journal of Personality, 2003; 17: 143-155.
12. Diseth A, Martinsen O. Approaches to learning, cognitive styles, and motives as predictors of academic achievement. Educational Psychology, 2003; 23: 195-207.
13. Chamorro-Premuzic T, Furnham A. Personality, intelligence and approaches to learning as predictors of academic performance. Personality & Individual Differences, 2008; 44: 1596-1603.
14. Streiner LD, Norman GR.  Health Measurement Scales: A Practical Guide to Their Development and Use. 3rd ed. New York: Oxford University Press, 2003.
15. McDowell I. Measuring health: A guide to rating scales and questionnaires. 3rd ed. New York; Oxford University Press: 2006.
16. Thomas KC. Fundamentals of educational research. 2nd ed. United States of America; McGraw-Hill, 1996.
17. Downing SM. Reliability: on the reproducibility of assessment data. Medical Education. 2004; 38: 1006-1012.
18. DeCoster J. Data Analysis in SPSS, 2004. Retrieved on 14th October 2008 from http://www.stat-help.com/notes.html.
19. Field A. Discovering Statistics Using SPSS. 2nd ed. London: Sage Publication, 2005.

Source(s) of Funding

---

This study was made possible under the Short Term Research Grant 304/PPSP/6139071.

Competing Interests

---

Nil

Disclaimer

---

This article has been downloaded from WebmedCentral. With our unique author driven post publication peer review, contents posted on this web portal do not undergo any prepublication peer or editorial review. It is completely the responsibility of the authors to ensure not only scientific and ethical standards of the manuscript but also its grammatical accuracy. Authors must ensure that they obtain all the necessary permissions before submitting any information that requires obtaining a consent or approval from a third party. Authors should also ensure not to submit any information which they do not have the copyright of or of which they have transferred the copyrights to a third party.
Contents on WebmedCentral are purely for biomedical researchers and scientists. They are not meant to cater to the needs of an individual patient. The web portal or any content(s) therein is neither designed to support, nor replace, the relationship that exists between a patient/site visitor and his/her physician. Your use of the WebmedCentral site and its contents is entirely at your own risk. We do not take any responsibility for any harm that you may suffer or inflict on a third person by following the contents of this website.