The learning styles myth in Medicine
Table of contents
The questionnaire says you are visual. Your colleague is auditory. The student group reorganizes the class to "respect styles." The idea sounds welcoming. The problem is different: the hypothesis that teaching in the preferred style improves learning (meshing hypothesis) has no solid support when put to the test (Pashler et al., 2008; Rohrer and Pashler, 2012). In medical education, the neuromyth of styles is still alive (Newton et al., 2021; Newton, 2015).
NEXO is a daily medical diagnosis game: one clinical case a day, six progressive clues, and ICD-10 proximity feedback across five levels.
This text does not attack preferences. Preferring to read or to listen is real. The target is the promise that matching the method to the VAK/VARK label raises retention and transfer. The angle is complementary to the post on active learning (which covers TBL, flipped classroom and pairs): there the topic is productive activity; here it is why the styles map should not dictate class design.
Key points
- Learning styles as typologies (visual, auditory, reading, kinesthetic) are popular; the evidence that adapting teaching to the preferred style improves outcomes is weak (Pashler et al., 2008; Rohrer and Pashler, 2012).
- The neuromyth remains common in higher education and in medical education (Newton, 2015; Newton et al., 2021).
- What works best, in general, are high-utility techniques: retrieval practice, spacing, elaboration and feedback (Dunlosky et al., 2013; Larsen et al., 2013).
- Well-designed multimedia helps most people, not only the "visual" ones (Mayer, 2010; post on dual encoding).
- Preference can guide initial comfort; effectiveness should guide the study and class method.
What the myth claims
There are several families of "styles." The most cited in student daily life is VAK/VARK: visual, auditory, reading/writing, kinesthetic. The operational myth has two pieces:
- People have a stable dominant style.
- Whoever matches the method to that style teaches better (meshing).
Pashler and colleagues showed that the second piece requires a specific experimental design: classify learners, cross methods, and find an interaction (the visual learner learns more with a visual method than with an auditory method, and the opposite for the auditory learner). Without that interaction, preference does not prove effectiveness (Pashler et al., 2008). Rohrer and Pashler reiterated, in medical education, that the evidence for meshing does not appear where it should (Rohrer and Pashler, 2012).
Preference is not an effective style
Liking mind maps does not mean mind maps always beat text for your brain. It may mean only familiarity or less initial effort. Lasting learning usually requires desirable effort (retrieval, spacing), even when uncomfortable (Dunlosky et al., 2013).
Difference from active learning and TBL
Active learning and TBL ask the student to do something with the content in a team or individually. That does not depend on labeling visual versus auditory. You can (and should) be active without a styles questionnaire. Mixing the two debates creates the false conflict "either I respect styles or I do TBL."
What the evidence requires and what is missing
The decisive test of the meshing hypothesis
Imagine four cells: visual and auditory students, visual and auditory methods. Meshing predicts that the diagonal (style = method) wins. Classic reviews do not find that pattern convincingly (Pashler et al., 2008). Many studies measure only satisfaction ("I liked the class in my style better"), which is not learning.
Medical education
Newton documented the persistence of the myth in higher education and, with collaborators, in medical education (Newton, 2015; Newton et al., 2021). Cuevas and colleagues discuss why learning myths still circulate in teacher training and the value of bringing cognitive science into the teaching curriculum (Cuevas et al., 2023).
What this does not deny
- People differ in prior knowledge, motivation and time.
- Spatial content calls for a figure for almost everyone (not only "visual" learners).
- Dense verbal content calls for text and retrieval for almost everyone.
- Accessibility (captions, contrast, extra time) is a right, not a style.
| Popular claim | What the evidence suggests | Source |
|---|---|---|
| I am a visual learner, I need slides | Preference ≠ effectiveness of meshing | Pashler 2008; Rohrer 2012 |
| A questionnaire guides the ideal lesson | Persistent neuromyth | Newton 2015/2021 |
| Easy effort = good method | Useful techniques usually require effort | Dunlosky 2013 |
| Figure only for visual learners | Well-designed multimedia helps broadly | Mayer 2010 |
| TBL respects learning styles | TBL is a team activity, another axis | Active learning (blog) |
Why the myth survives in Medicine
Apparent warmth
Saying "everyone learns in their own way" sounds humane. The useful scientific version is: everyone arrives with different gaps; use gap diagnosis and feedback, not fragile typologies (knowledge or reasoning gap).
Confusion with multimodality
Good lessons mix speech, image and practice. That is multimedia design and active learning, not proof of styles. Mayer shows principles that benefit most people when working memory is respected (Mayer, 2010).
Market of questionnaires and workshops
Instruments that are easy to apply generate colorful charts. A chart is not evidence of meshing. Ask for the study with a style × method interaction before reorganizing the curriculum.
Subjective feeling
Studying in the preferred mode feels smoother. Immediate fluency can be an illusion of competence: confidence calibration and retrieval without looking correct it better than comfort.
What to use instead
Techniques of higher utility (Dunlosky)
- Retrieval practice (testing).
- Spacing.
- Elaboration and self-explanation.
- Interleaving of topics when appropriate.
- Specific feedback.
Larsen and Raupach show testing gains in medical learning and clinical reasoning (Larsen et al., 2013; Raupach et al., 2016). Knowledge retention on the blog goes deeper into the time and testing axis.
Multimedia design for everyone
Combine image and text with contiguity and without useless redundancy (dual encoding; Mayer, 2010). Do not reserve figures only for "visual" learners.
Active learning without typologies
Flipped classroom, TBL and peer instruction require preparation and application (active learning). The VARK label is not a prerequisite.
Cases and feedback
Fictional cases with a real clinical presentation, with explanatory feedback, train decision-making (case-based learning; feedback in cases).
How to redesign study and lesson
For the student
- Open the topic with a question, not with the styles questionnaire.
- Try to retrieve before rereading.
- Use a figure when the content is spatial; use text when it is a criterion; join the two.
- Space out reviews; do not rely only on the marathon in the preferred style.
- Mark errors by type in the error notebook.
- Calibrate confidence: what could I explain to a colleague right now?
- Prefer comfort only in the warm-up; reserve the core for useful effort.
For the preceptor
- Replace the styles workshop with a workshop on retrieval and feedback.
- Offer multimodality because of the content, not because of the student's label.
- Measure learning with transfer, not only with satisfaction.
- Explain the difference between accessibility and meshing.
- In TBL, focus on preparation, application and team accountability, not VARK.
Checklist for a week without styles
- Monday: a pre-test of ten questions.
- Tuesday: study with a figure + a mechanism sentence.
- Wednesday: short cases with feedback.
- Thursday: spaced retrieval of what failed.
- Friday: teach the topic to a peer in five minutes.
- Weekend: a new test and adjustment of the error notebook.
Teaching example (fictional)
Two colleagues review cranial nerves. A calls herself visual and only highlights atlases. B calls himself auditory and only listens to summaries. In the structure OSCE, both fail to locate and name under time pressure. In the next cycle, the two alternate: they cover captions, talk, draw, test. The gain comes from the method, not the label. The preference remains: A still prefers figures; B, listening. But the study plan is no longer a prisoner of the questionnaire.
What the preceptorship can answer in thirty seconds
"I respect preference in the warm-up. To truly learn, we retrieve, space and apply in a case. The styles questionnaire does not change that core." This sentence avoids the false dilemma between welcoming and science.
What to say when they ask for the questionnaire
In a student league group
Propose a two-week experiment: half follow the style; half follow spaced retrieval. Compare retention. Transparency beats a typology slide.
In a course
Ask for the reference that demonstrates meshing with Pashler's design. If there is none, offer Dunlosky and Rohrer as short required reading.
Accessibility first
A student who needs captions, enlarged font or extra time deserves an adjustment. That is inclusion. Do not mix it with VARK.
Tone
Do not mock those who believe the myth. Newton shows that it is common (Newton et al., 2021). Replace the myth with a practical alternative: a retrieval plan for the next exam.
Link with motivation
Autonomy and competence matter for motivation (self-determination theory appears in the blog's topic queue). Autonomy does not require VARK typology: it requires a choice of cases, clear goals and feedback. Competence is born from measurable practice.
What working memory asks for (and style does not solve)
When cognitive load rises, the bottleneck is not "lack of a visual style". It is too many new elements without support. Cognitive load and multimedia principles help most health students: segment, align figure and text, avoid noise (van Merriënboer and Sweller, 2010; Issa et al., 2011; Mayer, 2010). These principles do not ask for a VARK questionnaire. They ask for design.
If a "visual" student fails with a bad diagram and an "auditory" student succeeds with the same well-captioned diagram, the factor was the design, not the label. Invert the example and the conclusion holds: quality of material beats typification.
Sibling myths that often travel together
- Left brain versus right brain as a study rule.
- Magic phrases about "using only a fraction of the brain" (false and useless for studying).
- Styles as a fixed destiny throughout a career.
Dismantling one myth helps dismantle the others. The blog has already covered calibration of confidence and knowledge or reasoning gap: both ask for evidence of performance, not typologies.
How the preceptorship can measure without styles
- Short pre-test at the start of the block.
- Application task (case or structure OSCE).
- Spaced post-test in three to seven days.
- Error analysis by type (fact, mechanism, decision).
- Adjustment of the next block based on errors, not on VARK labels.
This cycle is cheap and aligned with enhanced testing (Larsen et al., 2013; Raupach et al., 2016).
Conversation guide with the class (ten-minute script)
- Minute 1-2: "Who has already taken a styles questionnaire?" (hands up, no judgment).
- Minute 3-5: Explain meshing in one sentence and show what Pashler would require as proof.
- Minute 6-8: Show a high-utility technique (retrieval) with an example from the course.
- Minute 9-10: Agree on a two-week experiment and the metric (retention, not just "I liked it").
Tone matters. Newton documents that the myth is common; confronting it with sarcasm generates resistance (Newton et al., 2021). Confronting it with an experiment generates curiosity.
Study at home: a four-block plan without VARK
- Block A (25 min): retrieval of the previous class topic, without looking.
- Block B (25 min): study with figure + text when the topic is spatial; text only + self-explanation when it is criterion-based.
- Block C (20 min): two short cases with decision and feedback.
- Block D (10 min): note errors in the error notebook.
Repeat on alternate days. Environment preference (silence, music) can go in Block B; the core method does not change.
What changes in the exam and on the ward
On the exam, the item does not ask whether you are visual. It asks whether you retrieve the criterion and apply it. On shift, the patient does not arrive with a VARK label. They arrive with a history, an exam and time. Training decisions under partial information is what cases and useful feedback do. Typological styles delay that training when they steal workshop hours.
A three-question filter
Before accepting a styles workshop, ask: is this a preference, accessibility or a promise of efficacy? Preference: fine in the warm-up. Accessibility: mandatory when there is a barrier. Promise of efficacy via meshing: ask for the study with style × method interaction. This filter cuts most unproductive discussions without humiliating anyone.
Relation to retention and diagnostic error
Knowledge retention improves with retrieval and spacing, not with a sensory label. On the diagnostic axis, the Improving Diagnosis report and the clinical reasoning literature call for deliberate practice and feedback (Eva, 2005; Norman and Eva, 2010). None of this requires VARK. It requires time for well-designed practice.
When preference still enters the plan
- Choosing the time when you are least tired.
- Choosing an environment with fewer interruptions.
- Choosing the first warm-up format (reading or listening to a summary) before retrieval.
- Choosing whom to study with, if the partner raises accountability.
None of these items is meshing. They are study hygiene. Keep them. Discard the promise that the visual/auditory label determines the only effective path.
Guided study: five common mistakes when abandoning the myth
- Throwing out all multimedia because "styles are a myth". Wrong: well-designed multimedia helps.
- Replacing VARK with another equally fragile typology. Wrong: measure performance.
- Confusing inclusion with meshing. Wrong: captions and contrast are a right; matching method to label is not.
- Expecting motivation only from comfort. Wrong: motivation also comes from visible progress after retrieval.
- Correcting a colleague with a tone of superiority. Wrong: the myth is common; offer an alternative.
Study shift script (two hours)
- 0-15 min: retrieval without material on the priority topic.
- 15-45 min: mixed study (text + figure) of the items you got wrong.
- 45-75 min: three cases with a decision and feedback.
- 75-90 min: teach the mechanism to a partner or record a three-minute audio.
- 90-120 min: a new short test and updating the error notebook.
This script does not ask about style. It asks about performance. It may seem less glamorous than a colorful VARK chart. It usually yields more in retention (Dunlosky et al., 2013; knowledge retention).
For academic league coordinators
If the league still offers a styles workshop, propose an upgrade:
- Replace the questionnaire with a pre-test on the month's topic.
- Replace the typologies slide with a slide on study techniques with documented usefulness.
- Keep the welcoming atmosphere: welcome doubts and different paces without typing people.
- Publish, at the end of the month, what the class got wrong and the collective recovery plan.
Leagues that already use active learning are one step away: they just need to not mix TBL with VARK on the same poster.
The hidden cost of the myth
Hours of the schedule spent on typologies are hours not spent on cases, feedback and retrieval. In a tight curriculum, this matters. The cost is not only cognitive: it is political and pedagogical. When the institution endorses the myth, the student reads preference as destiny and avoids methods that "don't match me", even when those methods are the ones science recommends.
Operational summary in six lines
- Preference exists; meshing does not hold up as a rule.
- Multimodality by content, not by label.
- Retrieval, spacing and feedback at the core.
- Accessibility without confusing it with VARK.
- TBL and active learning on another axis.
- Measure retention and transfer, not just satisfaction.
If the team follows only these six lines, it already leaves the neuromyth and enters practice aligned with Pashler, Rohrer, Dunlosky and Newton.
One last distinction: talent, preference and method
Talent and prior experience change the learning curve. Preference changes the comfort of the first contact. Method changes retention. Mixing the three into a single VARK label weakens the plan. Separate them in the conversation with the class: "what I already know", "what makes me most at ease at the start", "what the evidence recommends for remembering a week from now".
When the preceptorship makes this separation, the student stops treating the questionnaire as a destination and starts treating the error notebook as a map. It is a simple swap of metaphor, with a big practical consequence: less labeling, more retrieval.
In NEXO and in any case bank, the same principle holds. The next item does not ask your style. It asks your decision. Train for that question. If doubt remains after the league experiment, reread Pashler and Rohrer before reintroducing any typology. The burden of proof lies with those who claim meshing, not with those who ask for evidence. With this, the conversation leaves the terrain of opinion and enters the terrain of measurable method, which is where medical education needs to be.
How NEXO helps you train
NEXO does not ask whether you are visual or auditory. It offers fictional cases with a real clinical presentation and up to six clues, with the task of deciding. The method is retrieval and application, aligned with what the evidence on effective study recommends. Interface preferences may exist; the pedagogical core does not depend on meshing.
See the Economy. Those who coordinate a group can get to know NEXO Closer. Researchers and creators will find NEXO Researcher, NEXO Curator and NEXO Creators.
Frequently asked questions
Are learning styles a myth?
Popular labeling and the meshing hypothesis have no solid support; preferences exist, but matching teaching to a label does not hold up as a rule (Pashler et al., 2008; Rohrer and Pashler, 2012).
Why do they still teach VARK in college?
Out of tradition, apparent welcoming and lack of contact with the meshing literature; the neuromyth remains common (Newton et al., 2021).
So never use images?
Use images when the content is spatial or when multimedia design helps most people, not because the questionnaire said visual (Mayer, 2010).
Does this contradict active learning?
No. Active learning and TBL are different axes; they do not need VARK (active learning).
What should replace the questionnaire?
A diagnostic test of gaps, a retrieval plan, spacing and feedback (Dunlosky et al., 2013).
Does preference still matter?
Yes, for initial comfort and adherence. Not for dictating the only effective method.
How to deal with mandatory styles workshops?
Meet the institutional minimum and, in parallel, apply retrieval and cases; offer evidence with a respectful tone.
Does NEXO classify styles?
No. The training is by cases and decision, not by VARK typology.
Play the case of the day on NEXO and practice retrieval without asking the questionnaire which style you are.
References
- Pashler H, McDaniel M, Rohrer D, Bjork R. Learning Styles: Concepts and Evidence. Psychol Sci Public Interest. 2008. PMID: [26162104](https://pubmed.ncbi.nlm.nih.gov/26162104/)
- Rohrer D, Pashler H. Learning styles: where's the evidence? Med Educ. 2012. PMID: [22691144](https://pubmed.ncbi.nlm.nih.gov/22691144/)
- Newton PM. The Learning Styles Myth is Thriving in Higher Education. Front Psychol. 2015. PMID: [26696947](https://pubmed.ncbi.nlm.nih.gov/26696947/)
- Newton PM, Najabat-Lattif HF, Santiago G, Salvi A. The Learning Styles Neuromyth Is Still Thriving in Medical Education. Front Hum Neurosci. 2021. PMID: [34456698](https://pubmed.ncbi.nlm.nih.gov/34456698/)
- Dunlosky J, Rawson KA, Marsh EJ, Nathan MJ, Willingham DT. Improving Students' Learning With Effective Learning Techniques: Promising Directions From Cognitive and Educational Psychology. Psychol Sci Public Interest. 2013. PMID: [26173288](https://pubmed.ncbi.nlm.nih.gov/26173288/)
- Mayer RE. Applying the science of learning to medical education. Med Educ. 2010. PMID: [20604850](https://pubmed.ncbi.nlm.nih.gov/20604850/)
- Larsen DP, Butler AC, Roediger HL 3rd. Comparative effects of test-enhanced learning and self-explanation on long-term retention. Med Educ. 2013. PMID: [23746156](https://pubmed.ncbi.nlm.nih.gov/23746156/)
- Raupach T, Andresen JC, Meyer K, et al. Test-enhanced learning of clinical reasoning: a crossover randomised trial. Med Educ. 2016. PMID: [27295475](https://pubmed.ncbi.nlm.nih.gov/27295475/)
- Cuevas JA, Childers G, Dawson BL. A rationale for promoting cognitive science in teacher education: Deconstructing prevailing learning myths and advancing research-based practices. Trends Neurosci Educ. 2023. PMID: [38049287](https://pubmed.ncbi.nlm.nih.gov/38049287/)
- van Merriënboer JJG, Sweller J. Cognitive load theory in health professional education: design principles and strategies. Med Educ. 2010. PMID: [20078759](https://pubmed.ncbi.nlm.nih.gov/20078759/)
- Issa N, Schuller M, Santacaterina S, et al. Applying multimedia design principles enhances learning in medical education. Med Educ. 2011. PMID: [21752078](https://pubmed.ncbi.nlm.nih.gov/21752078/)
- Eva KW. What every teacher needs to know about clinical reasoning. Med Educ. 2005. PMID: [15612906](https://pubmed.ncbi.nlm.nih.gov/15612906/)
- Norman GR, Eva KW. Diagnostic error and clinical reasoning. Med Educ. 2010. PMID: [20078760](https://pubmed.ncbi.nlm.nih.gov/20078760/)
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