An Assessment of Learning Styles of Undergraduate Medical Students in Three Different Types of Curriculum

Abstract

Background: Research in academia suggests that types of school may have an impact on learning styles. The study is aimed to examine the learning styles of students from medical institutions using different types of curriculum.
Methods: This descriptive cross-sectional study was conducted in the three largest public-sector medical colleges using conventional, hybrid, and a problem-based learning-based curriculum in Saudi Arabia. By using convenient sampling, we collected 316 responses. The questionnaire consisted of sociodemographic data and index of learning style instrument. The categorical data were presented as percentages and descriptive data were analyzed using the Chi-square test. Value of P < 0.05 level was considered statistically significant.
Results: Of the 316 participants, the male-to-female ratio was 1:1. Gender was associated with a significant difference in the visual/verbal dimension (P = 0.034). Irrespective of college, most of the participants are primarily balanced in active/reflective (67.2%), visual (51.1%), and sequential (68.8%) with slight shift toward sensing (47.6%). Significant differences between colleges were found in sensing/intuitive (P = 0.005) and sequential/global (P = 0.012) dimensions. There was no significant association between academic years with learning styles in the three medical colleges from public sector universities.
Conclusion: Irrespective of college, most of the participants’ preferred style was visual illustrations supported by hands-on teaching in a stepwise process. Although, medical students in different universities possessed different learning styles. It has also been shown that students in a single university tend to develop the same learning styles as they advance through the years. The collaboration between institutions using different types of the curriculum may increase the quality of education by developing effective teaching and learning methods that correspond with the learning styles of students

Full text

© 2021 Journal of Nature and Science of Medicine | Published by Wolters Kluwer - Medknow 267
Original Article
IntroductIon
Recently, medical education has shifted from traditional,
teacher-focused learning into a student-centered approach.
Knowledge of the favorable student learning style can
enhance the learning process as well as student performance,
and provide a better understanding of the learning difculties
that learners may encounter.[1,2] Learning style refers to how
students prefer to receive, process, and recall information In
general, student learning can be enhanced when the medical
curriculum teaching methods are suitable for different learning
styles.[3] A study on the effect of the types of curriculum
reported that an integrated lecture-based, which consists of
lectures include basic and clinical knowledge are as effective
as problem-based learning (PBL) curriculums in developing
students deeper approach to learning.[4] Furthermore, it has
been shown that PBL-based curriculums can accommodate
broader range of different learning styles in comparison to
the traditional teaching method. Both students and instructors
enjoy multimodal approach to learning.[5] It can be argued,
however, that the inuence of the medical curriculum type on
students’ learning is not well studied.
An Assessment of Learning Styles of Undergraduate Medical
Students in Three Different Types of Curriculum
Abdulrahman Alfawzan1, Moeber Mahzari1,2,3, Sajida Agha1, Aamir Omair1, Omar Alfawzan4, Reema Alessa1, Abdulaziz Alturki5, Kholoud Alshiha5
1College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia, 2Department of Medicine, Ministry of National Guard‑Health
Affairs, Riyadh, Saudi Arabia, 3King Abdullah International Medical Research Center, Riyadh, Saudi Arabia, 4College of Medicine, King Saud University, 5College of
Medicine, Imam Muhammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
Background: Research in academia suggests that types of school may have an impact on learning styles. The study is aimed to examine the
learning styles of students from medical institutions using different types of curriculum. Methods: This descriptive cross-sectional study was
conducted in the three largest public-sector medical colleges using conventional, hybrid, and a problem-based learning-based curriculum in
Saudi Arabia. By using convenient sampling, we collected 316 responses. The questionnaire consisted of sociodemographic data and index
of learning style instrument. The categorical data were presented as percentages and descriptive data were analyzed using the Chi-square test.
Value of P < 0.05 level was considered statistically signicant. Results: Of the 316 participants, the male-to-female ratio was 1:1. Gender was
associated with a signicant difference in the visual/verbal dimension (P = 0.034). Irrespective of college, most of the participants are primarily
balanced in active/reective (67.2%), visual (51.1%), and sequential (68.8%) with slight shift toward sensing (47.6%). Signicant differences
between colleges were found in sensing/intuitive (P = 0.005) and sequential/global (P = 0.012) dimensions. There was no signicant association
between academic years with learning styles in the three medical colleges from public sector universities. Conclusion: Irrespective of college,
most of the participants’ preferred style was visual illustrations supported by hands-on teaching in a stepwise process. Although, medical
students in different universities possessed different learning styles. It has also been shown that students in a single university tend to develop
the same learning styles as they advance through the years. The collaboration between institutions using different types of the curriculum may
increase the quality of education by developing effective teaching and learning methods that correspond with the learning styles of students.
Keywords: Curriculum type, learning style, medical students, public sector
Address for correspondence: Dr. Abdulrahman Alfawzan,
King Abdullah International Medical Research Center, College of Medicine,
King Saud Bin Abdulaziz University for Health Sciences, National Guard
Health Affairs Ar Rimayah, Riyadh 14611, Saudi Arabia.
E‑mail: alfawzan.job@gmail.com
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DOI:
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How to cite this article: Alfawzan A, Mahzari M, Agha S, Omair A,
Alfawzan O, Alessa R, et al. An assessment of learning styles of undergraduate
medical students in three different types of curriculum. J Nat Sci Med
2021;4:267-73.
Abstract
Submission: 10-10-2020 Revision: 06-12-2020
Acceptance: 23-12-2020 Published: 26-07-2021
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The student-centered approach focuses on delivering
information in various ways to different students. It is crucial
to use effective tools that help identify specic types of learning
styles. Many instruments have been invented to determine
students’ learning styles to make the most of their abilities.[6,7]
Another widely used learning style instrument is the index
of learning styles (ILS), invented by Felder and Soloman.[8]
ILS has been recently validated for research in the medical
eld,[9-11] and several studies utilized ILS due to its simplicity
and accessibility.[12-14] It has four dimensions: Active/reective,
sensing/intuitive, visual/verbal and sequential/global. Every
dimension has two categories, and learners could be strong in
one category or balanced. In Saudi Arabia, several studies have
been conducted to determine the learning style preferences of
medical students.[15-18] However, none compared the different
learning styles of medical students in colleges with different
curriculum types.
Considering the suggestions to investigate the learning values
of learning styles of students from institutions using different
curriculum types, some questions raise in mind: Does a
curriculum type have an impact on students’ learning styles?
Is there any difference of learning styles among male and
female students? Does learning style have an impact on student
performance? To answer these questions, this descriptive
cross-sectional research intends to explore the learning
styles of medical students in three public sector universities,
namely King Saud bin Abdulaziz University for Health
Sciences (KSAUHS), King Saud University (KSU), and Imam
Mohammad Ibn Saud Islamic University (IMSIU). This study
results will guide the institutions in the selection of teaching
strategies that may improve the quality of teaching and learning
process. The ndings will approve the collaborative role of
institutions in achieving greater learning outcomes for students
with different learning styles.
Methods
This descriptive cross-sectional study was conducted
on preclinical year students in three medical colleges of
KSAU-HS, KSU, and Al-Imam Mohammad Ibn Saud Islamic
University (IMSIU), the largest public sectors accredited
universities in Riyadh, Saudi Arabia. IMSIU has a medical
program that consists of three basic medical years (preclinical)
while KSU and KSAU-HS have two basic medical years. Each
university follows a distinct curriculum and mode of delivery.
In KSAU-HS, the main principle is self-directed learning
represented by PBL during the preclinical phase where students
are innovative and active throughout the learning process.
KSU adopts an approach to teaching in which lectures are
the primary focus. Finally, IMSIU uses a hybrid approach to
teach strategies, focusing on lectures, and student-centered
learning such as PBL. Prior to data collection, an institutional
review board approval was obtained with the reference number
RC19/080/R from King Abdullah International Medical
Research Center (KAIMRC) on April 2019. Informed consent
was secured before participants’ enrollment in the study.
The sample size was calculated at the 95% condence level.
The expected response for the main outcome variable, which
is the learning style, was kept at 50%. The number of basic
years medical student is estimated to be 1743 according to the
student’s affairs from each university. The minimum required
sample size for margin of accuracy of 5% is estimated to be
315. By using nonprobability convenient sampling techniques,
we collected data from 334 preclinical year medical students
in three institutions. Only those who consented to participate
were included. Students in the preparatory year and clinical year
programs, interns, and incomplete ILS responses were excluded.
We used a self-administered ILSs questionnaire (English
version) to assess the different learning styles, developed by
Felder and Soloman.[8] This instrument is widely used for the
educational purpose which helps teachers in identifying the
learning styles of students and providing a basis to design a
teaching method that full the needs of all students. The ILS
has four dimensions: active/reective, sensing/intuitive, visual/
verbal, and sequential/global. Each dimension consists of 11
statements (a total of 44 statements) and has two options: (A)
which score for active, sensing, visual, and sequential, and (B)
which corresponds to other categories in the dimensions. The
highest score in A or B determines the participant’s inclination
toward that learning style. The ILS further divides the learners
into categories. A score on the scale from 1 to 3 for one
dimension reects a well-balanced learning style. If scores
are between 5–7 and 9–11 this shows a moderate to strong
preference for one dimension. The questionnaire is valid and
reliable tool to measure learning preferences.[9-11]
The learner’s styles in each dimension are represented in
Table 1.
The students were approached in their respective colleges
by coauthors after taking permission from the colleges’
administration. The ILSs were distributed among students
along with sociodemographic data, including age, gender,
university, basic medical year, and grade point average (GPA).
We utilized excel sheets for data entry and SPSS version 22
for data analysis. We presented categorical data as percentages
and frequencies and used Chi-squared test to compare students’
learning styles. A P < 0.05 is considered statistically signicant.
results
Out of 334 students, we excluded 18 questionnaires with
missing data. A total of 316 responses were found eligible.
The male-to-female ratio was 1:1. Most of the students were in
the 20-year-old age group. The most received responses were
from IMSIU (36%), as 40% of the participants have a 5-4.75
GPA. The complete demographic information is illustrated
in Table 2. Comparing the learning style prevalent among
colleges, most of the participants are primarily balanced in
active/reective (n = 213, 67.2%), visual (n = 162, 51.1%),
and sequential (n = 218, 68.8%) with slight shift toward
sensing (n = 151, 47.6%).
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Alfawzan, et al.: Learning style in three universities
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Table 3 represents the association of participants’ learning
styles with gender, age, and GPA. A signicant difference
between males and females was shown in the visual/verbal
dimension (P = 0.034). Females (9.5%) were slightly more
verbal than males (2.5%). Other demographic characteristics
such as GPA and age showed no association with learning
styles.
The comparative assessment of medical students’ learning
styles in the three institutions revealed similar patterns among
students, in particular the active/reective and visual/verbal
dimensions. Negative mean indicates the preference of learning
toward active, sensing, sequential, and visual, whereas positive
mean indicates preference toward reective, intuitive, global,
and verbal. The mean of active/reective is 0.9, 0.6, and 0.6
for KSAU-HS, KSU, and IMSIU, respectively. The equal
mean is shown in visual/verbal category −3.6, −3, and −3.2 for
KSAU-HS, KSU, and IMSIU, while the mean (−2.5) is slightly
less sensing in KSU than KSAU-HS (−3.3) and IMSIU (−3.7)
participants. Furthermore, KSU students have a more balanced
mean (−1) in sequential/global dimension compared with
KSAU-HS (−1.7) and IMSIU (−2.2) students. In sensing/
intuitive and sequential/global categories, there was a marked
difference in the median, minimum, and maximum results, as
shown in Graph 1. The median (−3) of IMSIU was shifted
to sequential in comparison to KSAU-HS and KSU, while
KSU participants had narrower quartiles than KSAU-HS and
IMSIU. KSU median was less in sensing (−3) in comparison
to KSAU-HS (−4) and IMSIU (−5) [Figure 1].
The comparative assessment also showed no significant
association in the active/reflective and visual/verbal
dimensions. However, a significant association between
universities in sensing/intuitive (P = 0.005) and sequential/
global (P = 0.012) categories was reported. In the active/
reflective dimension, two-quarters of each college are
balanced. KSAU-HS (50%) and IMSIU (57.9%) participants
shifted toward sensing while most KSU participants were
balanced. In visual/verbal and sequential/global categories,
most of the participants were balanced [Table 4].
There was no significant association between academic
years in each university, but it should be noted that a slight
signicance (P = 0.064) was found in the visual/verbal category
in IMSIU. The visual/verbal domain in IMSIU showed that
as students’ progress toward the last year of basic science;
they become more balanced (74.1%) in comparison with the
rst (43.5%) and second (48.8) years, respectively [Table 5].
dIscussIon
One of the most effective ways to achieve quality education in
student-centered learning is to identify and adapt the learning
Table 1: Four dimensions of learning style
Knowledge procession Knowledge perception Knowledge input Knowledge comprehension
A. Active: Works by discussing,
applying, and explaining to others
A. Sensing: Perceives facts and solve
problems by making practical plans
A. Visual: Gains knowledge
through pictures, graphs, reading
A. Sequential: Process of
learning is stepwise
Versus Versus Versus Versus
B. Reective: Works by thinking
through before conducting anything
B. Intuitive: Perceives ideas and
theories
B. Verbal: Gains knowledge
through speaking and listening.
B. Global: process of learning is
to, rst; collect information, then
study the subject all together
Table 2: Participants’ characteristics
Variables Frequency (%)
Gender
Male 158 (50)
Female 158 (50)
Age (years)
18-19 71 (22.6)
20 103 (32.8)
21 90 (28.7)
22+ 50 (15.9)
University
KSAUHS 90 (28.4)
KSU 113 (35.6)
IMSIU 114 (36.0)
Year
First year 134 (42.3)
Second year 156 (49.2)
Third year 27 (8.5)
GPA
5-4.75 117 (39.9)
4.74-4.50 98 (33.5)
4.49-4.25 77 (26.2)
Learning style
Active/reective
Active 38 (12.0)
Balanced 213 (67.2)
Reective 66 (20.8)
Sensing/intuitive
Sensing 151 (47.6)
Balanced 138 (43.5)
Intuitive 28 (8.8)
Visual/verbal
Visual 136 (42.9)
Balanced 162 (51.1)
Verbal 19 (6.0)
Sequential/global
Sequential 81 (25.6)
Balanced 218 (68.8)
Global 18 (5.7)
KSAUHS: King Saud bin Abdulaziz University for Health Sciences,
KSU: King Saud University, IMSIU: Imam Mohammad ibn Saud Islamic
University, GPA: Grade Point Average
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styles to the education system, which can ultimately improve
students’ learning performance. To this end, we identied the
learning styles of basic science year medical students and
found discrepancies in the learning styles between the three
universities.
Most of the participants are primarily balanced in active/
reflective with a slight shift toward sensing, visual, and
sequential, which means they can learn effectively from active
discussions in groups, or independently, and think the situation
through before acting. Furthermore, they slightly prefer facts
and use visual materials such as pictures, graphics, and books
for stepwise learning. A study conducted on undergraduate
health education students (n = 505) showed similar results.[19]
Out of 505 participants, 72 Premedicine students are more
likely to be reective (56.9%), sensing (83.4%), visual (76.4%),
and sequential (70.8).[19] First-year medical students’
learning preferences were sensing (54.9%), active (50.9%),
sequential (60.5%), and visual (80.8%) with medians
equal −0.9, 0.7, −0.8, and −5.1, respectively.[12] Two studies
revealed that participants were mainly more visual (81.2% and
90%) and sensing (85.1% and 64%).[19,20]
The current study reported a signicant difference between
colleges and information perception P = 0.005 (sensing/
intuitive dimension). About 90% of the participants shifted
toward sensing and balanced. Only KSU had more balanced
participants than sensing. The higher number of sensing
learners in IMSIU could be attributed to the diverse teaching
sessions, as sensing learners prefer to learn facts, solve
problems, and perform hands-on tasks and dislike being tested
on materials that have not been fully explained during the
sessions. On the other hand, KSAUHS delivers less lectures
and provides more PBL’s and case discussions. The sessions
conducted in KSAUHS offer general information about the
subject and depend mostly on self-learning. For example,
case-discussions and PBL are introduced to encourage
students to become more active and articulate when sharing
their thoughts and ideas with colleagues, while the tutor, i.e.,
supervisor, corrects mistakes and directs the session with
limited interference. In general, KSAUHS and IMSIU have
PBL case every week. KSU curriculum has lower number of
PBL in comparison for the other universities.
It is usually assumed that medical students are more
sequential (learning stepwise) than global (gaining knowledge
by covering a lot of ground). Medical students learn
step-by-step because the nature of subjects studied, for
example, microbiology, anatomy, and embryology, requires a
process of incremental phases that reect the sequential aspect.
However, KSU students tend to be more global than KSAU-HS,
and IMSIU with signicant difference (P = 0.012). Similarly,
a study conducted in 2014 to identify the differences between
learning styles in Indian versus Malaysian medical schools
showed no difference between the students.[21] However, the
study includes only two categories, for example, sensing and
global without including balanced learners. In this study, the
Table 3: Association of participants’ learning styles according to participants’ characteristics
Active/reflective Sensing/intuitive Visual/verbal Sequential/global
Active Balanced Reflective Sensing Balanced Intuitive Visual Balanced Verbal Sequential Balanced Global
Gender
Male 18 (11.4) 103 (65.2) 37 (23.4) 79 (50) 66 (41.8) 13 (8.2) 70 (44.3) 84 (53.2) 4 (2.5) 40 (25.3) 112 (70.9) 6 (3.8)
Female 20 (12.7) 109 (69) 29 (18.4) 72 (45.6) 71 (44.9) 15 (9.5) 66 (41.8) 77 (48.7) 15 (9.5) 41 (25.9) 105 (66.5) 12 (7.6)
P0.537 0.723 0.034 0.327
Age (years)
18-19 9 (12.7) 43 (60.6) 19 (26.8) 34 (47.9) 32 (45.1) 5 (7) 34 (47.9) 33 (46.5) 4 (5.6) 14 (19.7) 51 (71.8) 6 (8.5)
20 14 (13.6) 69 (67) 20 (19.4) 44 (42.7) 51 (49.5) 8 (7.8) 42 (40.8) 54 (52.4) 7 (6.8) 30 (29.1) 68 (66) 5 (4.9)
21 10 (11.1) 61 (67.8) 19 (21.1) 48 (53.3) 33 (36.7) 9 (10) 37 (41.1) 48 (53.3) 5 (5.6) 27 (30) 60 (66.7) 3 (3.3)
22+ 5 (10) 37 (74) 8 (16) 24 (48) 20 (40) 6 (12) 22 (44) 26 (52) 2 (4) 10 (20) 37 (74) 3 (6)
P0.794 0.646 0.96 0.517
GPA
5-4.75 9 (7.7) 80 (68.4) 28 (23.9) 53 (45.3) 53 (45.3) 11 (9.4) 49 (41.9) 57 (48.7) 11 (9.4) 27 (23.1) 81 (69.2) 9 (7.7)
4.74-4.25 17 (17.3) 61 (62.2) 20 (20.4) 49 (50) 40 (40.8) 9 (9.2) 40 (40.8) 53 (54.1) 5 (5.1) 25 (25.5) 69 (70.4) 4 (4.1)
<4.25 10 (13) 55 (71.4) 12 (15.6) 35 (45.5) 36 (46.8) 6 (7.8) 37 (48.1) 39 (50.6) 1 (1.3) 24 (31.2) 51 (66.2) 2 (2.6)
P0.182 0.932 0.18 0.411
GPA: Grade Point Average
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Journal of Nature and Science of Medicine ¦ Volume 4 ¦ Issue 3 ¦ July-September 2021 271
residents on their performance in the American Board of
Surgery In-Training Examination.[28] These ndings suggest
that medical students’ from different learning styles have
preferred ways of preparing for the examination which they
use to perform better irrespective of the types of curriculum.
The study highlights the importance of learning preferences
among medical students. Educators are advised to incorporate
discussions and hands-on activities into the classroom,
and students should be given enough time to grasp new
information. Through visual illustrations, step-by-step learning
could be highly benecial. Educators should also evaluate
their teaching methods to determine whether the instructional
materials complement students’ learning preferences. For
example, some educators tend to give lectures in a disjointed
manner, where they jump from one point to another, then return
to the previous point. In this class, students with sequential
learning style, most of whom are medical students, may nd
it difcult to keep up with the progress of the lesson.
Despite the pedagogical benets of the study, it has some
limitations. The cross-sectional design was one of the
drawbacks that proved inadequate to determine a causal
relationship. Another bias might be related to the comparability
of the subjects. We tried to ensure the homogeneity of the
learning styles of junior medical students were comparable to
those of the seniors. The lack of distinctiveness between the
two groups indicates that if medical students failed to adapt
or improve their learning styles, they would likely develop a
static form of learning throughout college.
In this data, gender was not associated with the learning styles
of medical students, except in the visual/verbal category.
Although both have low verbal preference, it was slightly higher
in females than in males. Females are more likely to learn from
listening, writing, and reading than males. A study that uses
the ILS instrument showed that there is a gender difference
in learning, where females are more sequential than males.[12]
Two studies carried out in Saudi Arabia, which adopt the VARK
questionnaire, showed that gender affects learning preferences
among medical and dental students, consecutively (P = 0.019
and P = 0.04).[22,23] In contrast, a study on dental students
concluded that there is no gender difference.[24] In the present
study, GPA was not associated with the learning styles. The
results correspond with the findings of other studies that
reported a similar conclusion.[24-26] The results are in contrast to
a study that reported signicantly better performance of students
who have a visual learning style preference than without.[27]
There was also a study that showed a similar result for surgery
Figure 1: Box whisker plot of participants’ learning styles according to participants’ university
Table 4: Association of participants’ learning styles according to participants’ university
Institution Active/reflective Sensing/intuitive Visual/verbal Sequential/global
Active Balanced Reflective Sensing Balanced Intuitive Visual Balanced Verbal Sequential Balanced Global
KSAUHS 7 (7.8) 68 (75.6) 15 (16.7) 45 (50) 38 (42.2) 7 (7.8) 40 (44.4) 45 (50) 5 (5.6) 24 (26.7) 63 (70) 3 (3.3)
KSU 15 (13.3) 73 (64.6) 25 (22.1) 40 (35.4) 64 (56.6) 9 (8) 48 (42.5) 57 (50.4) 8 (7.1) 20 (17.7) 81 (71.7) 12 (10.6)
IMSIU 16 (14) 72 (63.2) 26 (22.8) 66 (57.9) 36 (31.6) 12 (10.5) 48 (42.1) 60 (52.6) 6 (5.3) 37 (32.5) 74 (64.9) 3 (2.6)
P0.371 0.005 0.973 0.012
KSAUHS: King Saud bin Abdulaziz University for Health Sciences, KSU: King Saud University, IMSIU: Imam Mohammad ibn Saud Islamic University
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Journal of Nature and Science of Medicine ¦ Volume 4 ¦ Issue 3 ¦ July-September 2021
272
students from three institutions of conventional, hybrid, and
PBL-based curriculum, however generalization of the results
to the specic medical students should need to be taken with
caution. Further, the sample was considerably small and only
examined the preclinical years. It is recommended to opt for
longitudinal studies on a larger sample, including clinical-year
students, which will provide more reliable data on the learning
preferences among medical students in Saudi Arabia.
conclusIon
Irrespective of college, most of the participants can learn alone,
and/or in groups, and prefer visual illustrations supported by
hands-on teaching in a stepwise process. Medical students in
different universities have different learning styles. It has also
been shown that students in a single university tend to develop
the same learning styles as they advance through the years.
Acknowledgment
The completion of our great project could not have been
possible without the participation and assistance of these
people, and we gratefully acknowledge their contributions.
We would like to express our deep appreciation for the
following: Ms. Maysoon AlTameem for her contribution with
data collection.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conicts of interest.
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Variables Active/reflective Sensing/intuitive Visual/verbal Sequential/global
Active Balanced Reflective Sensing Balanced Intuitive Visual Balanced Verbal Sequential Balanced Global
KSAUHS
First year 2 (7.4) 21 (77.8) 4 (14.8) 14 (51.9) 11 (40.7) 2 (7.4) 12 (44.4) 13 (48.1) 2 (7.4) 9 (33.3) 17 (63) 1 (3.7)
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P0.943 0.974 0.876 0.628
KSU
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P0.451 0.499 0.727 0.487
IMSIU
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Second year 20 (24.4) 22 (53.7) 9 (22) 25 (61) 11 (26.8) 5 (12.2) 20 (48.8) 20 (48.8) 1 (2.4) 12 (29.3) 29 (70.7) 0 (0)
Third year 3 (11.1) 18 (66.7) 6 (22.2) 14 (51.9) 9 (33.3) 4 (14.8) 5 (18.5) 20 (74.1) 2 (7.4) 9 (33.3) 16 (59.3) 2 (7.4)
P0.19 0.737 0.064 0.401
KSAUHS: King Saud bin Abdulaziz University for Health Sciences, KSU: King Saud University, IMSIU: Imam Mohammad ibn Saud Islamic University
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