PURPOSE: Academic medical institutions are increasingly under the burden of training the next generation of surgeons in a more time-constrained environment. Work-hour restrictions have potentially decreased the time during which a resident may experientially learn through patient and faculty interaction. Time constraints combined with rapidly advancing technology complicate surgical education, mandating improved efficiency in teaching. Education within the medical community is unique in that many clinical surgeons do not have formal training in teaching methods, thereby forcing them to learn to teach by experimenting. This suggests clinical faculty may lack awareness of the different teaching methods available. Few studies have previously assessed surgical learning styles; fewer studies have focused on surgical sub-specialties, such as Plastic Surgery. No studies have evaluated surgical teaching styles. This study aims to determine differences in preferred learning and teaching styles among surgical faculty and residents at an academic medical institution in order to improve resident education and faculty teaching.

METHODS and MATERIALS: The Kolb Learning Style Inventory (HayGroup; Boston, MA) determines an individual’s predominant learning style based on Experiential Learning theory. The experiential “cycle of learning” includes concrete experience (experiencing), reflective observation (reflecting), abstract conceptualization (thinking), and active experimentation (doing). Combinations of these learning cycle components form four Learning Styles:  Diverging (experiencing/reflecting), Assimilating (reflecting/thinking), Converging (thinking/doing), Accommodating (doing/experiencing). The Grasha-Riechmann Teaching Style Survey determines an individual’s preferred teaching style. Grasha describes five Teaching Styles: Expert (transmits information), Formal Authority (structured instruction), Personal Model (teach by example), Facilitator (consultant, guides students), and Delegator (assigns task, teacher as a resource). Based on the preferred teaching methods employed by each group, combinations of the five styles create four Teaching “Clusters:” 1 (teacher-centered, knowledge acquisition), 2 (teacher-centered, role modeling), 3 (student-centered, problem-solving), and 4 (student-centered, facilitative). For both learning and teaching, an individual ideally incorporates all methods; however, people have stronger preferences for certain methods. Although there is no single best style, a person can improve his/her learning and teaching by incorporating methods used in the styles they use less preferentially.

The Kolb Learning Style Inventory and Grasha-Riechmann Teaching Style Survey were administered to participants (n=157) including surgical faculty (n=61) and residents (n=96) after informed consent (IRB # 06-0612). A specific subset of participants included all Plastic Surgery faculty (n=7) and residents (n=5) for pilot sub-specialty analysis. Responses were tabulated by protocols established by the creators of the validated tools.� Statistical evaluation was performed using Fisher exact test.

RESULTS: Faculty and residents most commonly preferred the Converging Learning Style (34% and 48%; Table 1); comparisons of this preference approached statistical significance (p=0.054); stronger preference differences were noted in the Assimilating Learning Style (p< .01). Both faculty and residents preferred Teaching Cluster 4 (student-centered, facilitative); however, there was a statistically significant difference in preference for Cluster 2 (faculty, 28% and residents, 16%; p=0.05). Subset analysis of Plastic Surgery faculty and residents showed no statistically significant differences in learning or teaching styles. The Converging Learning Style and Cluster 4 Teaching were most commonly preferred in Plastic Surgery.

CONCLUSIONS: Compared to surgeons overall, these findings suggest Plastic Surgery residents utilize learning and teaching methods that more closely align with those of their faculty. Larger-scale, multi-center studies using these tools are necessary to accurately determine whether statistical differences exist between Plastic Surgery faculty and resident preferences. Recognition of surgical faculty and resident learning and teaching style differences provides an informed basis for improvement in resident education and faculty teaching. Adapting teaching methods to address specific learning styles increases teaching efficiency, thereby improving medical education under work-hour restrictions. Table 1. Comparison of faculty and resident preferred Teaching and Learning Styles �

Learning Style	% Faculty Overall	% Resident Overall	p-value	% Faculty Plastic Surgery	% Resident Plastic Surgery	p-value
Diverging	22%	19%	0.39	14%	20%	0.85
Assimilating	29%	8%	<0.01	29%	0%	0.32
Accommodating	15%	24%	0.13	0%	20%	0.42
Converging	34%	48%	0.054	57%	60%	0.69
Teaching Cluster	% Faculty Overall	% Resident Overall	p-value	% Faculty Plastic Surgery	% Resident Plastic Surgery	p-value
1	6%	7%	0.56	0%	20%	0.42
2	28%	16%	0.05	0%	20%	0.42
3	15%	13%	0.43	14%	20%	0.84
4	33%	36%	0.38	57%	40%	0.50
5*	18%	28%	0.11	29%	0%	0.32

*Cluster 5 is designated for subjects who did not fall into Clusters 1-4 according to the Grasha-Riechmann Teaching Style scoring protocol.