title: Learning approach among health sciences students in a medical college in Nepal: a cross-sectional study.
abstract: BACKGROUND
  Many factors shape the quality of learning. The intrinsically motivated students adopt a deep approach to learning, while students who fear failure in assessments adopt a surface approach to learning. In the area of health science education in Nepal, there is still a lack of studies on learning approach that can be used to transform the students to become better learners and improve the effectiveness of teaching. Therefore, we aimed to explore the learning approaches among medical, dental, and nursing students of Chitwan Medical College, Nepal using Biggs's Revised Two-Factor Study Process Questionnaire (R-SPQ-2F) after testing its reliability.
  
  
  METHODS
  R-SPQ-2F containing 20 items represented two main scales of learning approaches, deep and surface, with four subscales: deep motive, deep strategy, surface motive, and surface strategy. Each subscale had five items and each item was rated on a 5-point Likert scale. The data were analyzed using Student's t-test and analysis of variance. Reliability of the administered questionnaire was checked using Cronbach's alpha.
  
  
  RESULTS
  The Cronbach's alpha value (0.6) for 20 items of R-SPQ-2F was found to be acceptable for its use. The participants predominantly had a deep approach to learning regardless of their age and sex (deep: 32.62±6.33 versus surface: 25.14±6.81, P<0.001). The level of deep approach among medical students (33.26±6.40) was significantly higher than among dental (31.71±6.51) and nursing (31.36±4.72) students. In comparison to first-year students, deep approach among second-year medical (34.63±6.51 to 31.73±5.93; P<0.001) and dental (33.47±6.73 to 29.09±5.62; P=0.002) students was found to be significantly decreased. On the other hand, surface approach significantly increased (25.55±8.19 to 29.34±6.25; P=0.023) among second-year dental students compared to first-year dental students.
  
  
  CONCLUSIONS
  Medical students were found to adopt a deeper approach to learning than dental and nursing students. However, irrespective of disciplines and personal characteristics of participants, the primarily deep learning approach was found to be shifting progressively toward a surface approach after completion of an academic year, which should be avoided.
authors.affiliation: Department of Physiology, Chitwan Medical College, Bharatpur, Chitwan, Nepal.
authors.forename: Dev Kumar
authors.initials: DK
authors.lastname: Shah
authors.affiliation: Department of Physiology, Chitwan Medical College, Bharatpur, Chitwan, Nepal.
authors.forename: Ram Lochan
authors.initials: RL
authors.lastname: Yadav
authors.affiliation: Department of Physiology, Chitwan Medical College, Bharatpur, Chitwan, Nepal.
authors.forename: Deepak
authors.initials: D
authors.lastname: Sharma
authors.affiliation: Department of Physiology, Chitwan Medical College, Bharatpur, Chitwan, Nepal.
authors.forename: Prakash Kumar
authors.initials: PK
authors.lastname: Yadav
authors.affiliation: Department of Physiology, Chitwan Medical College, Bharatpur, Chitwan, Nepal.
authors.forename: Niraj Khatri
authors.initials: NK
authors.lastname: Sapkota
authors.affiliation: Department of Physiology, Chitwan Medical College, Bharatpur, Chitwan, Nepal.
authors.forename: Rajesh Kumar
authors.initials: RK
authors.lastname: Jha
authors.affiliation: Department of Physiology, Chitwan Medical College, Bharatpur, Chitwan, Nepal.
authors.forename: Md Nazrul
authors.initials: MN
authors.lastname: Islam
keywords: deep; motive; strategy; surface