Impact of resilience, learning styles, and clinical instructors on medical students’ experiences in microsurgical suturing training: A web-based questionnaire study

Impact of resilience, learning styles, and clinical instructors on medical students’ experiences in microsurgical suturing training: A web-based questionnaire study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Impact of resilience, learning styles, and clinical instructors on medical students’ experiences in microsurgical suturing training: A web-based questionnaire study Nana Yamakita, Kohei Kanaya, Masahiro Agata, Takumi Maruyama, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8121680/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 31 Mar, 2026 Read the published version in BMC Medical Education → Version 1 posted 15 You are reading this latest preprint version Abstract Background Previous research has noted that resilience, learning styles, and clinical instructors are crucial determinants of medical students’ academic outcomes and motivation during clinical clerkship. However, no study has investigated these factors in their relationship with students’ accomplishment and satisfaction in modules involving substantial hands-on training. This study aimed to examine the associations between resilience, learning styles, the quality of clinical instructors, and undergraduate medical students’ accomplishment and satisfaction in areas of practical training such as microsurgical suturing. Methods A total of 109 undergraduate medical students who participated in microsurgical suturing training during their clinical clerkship between October 2024 and June 2025 were included. Resilience was assessed using the 10-item Tachikawa Resilience scale, and learning styles were evaluated using the Honey and Mumford Learning Styles Questionnaire. Students’ accomplishment and satisfaction with the training and the quality of clinical instructors were measured using a questionnaire designed for this study after the training. Results Medical students’ resilience was not significantly associated with either accomplishment or satisfaction. By contrast, effective clinical instructors contributed to making practical training more enjoyable and fulfilling. Furthermore, a stronger activist learning preference was found to be significantly associated with higher levels of accomplishment in microsurgical suturing. Conclusions These findings indicate that enhancing the quality of clinical instructors and incorporating diverse learning approaches may improve medical students’ accomplishment and satisfaction in practical training. Further studies are warranted to identify other factors influencing their accomplishment, satisfaction, and practical performance. Resilience Tachikawa resilience scale Learning styles Honey and Mumford questionnaire Clinical instructors Clinical Clerkship Microsurgical suturing training Figures Figure 1 Figure 2 Figure 3 Figure 4 Background Microsurgical suturing plays an indispensable role in the field of neurosurgical procedures, such as revascularization surgery and nerve reconstruction [ 1 , 2 ]. We conducted microsurgical suturing training as part of the clinical clerkship in the Department of Neurosurgery at Shinshu University School of Medicine (Fig. 1 ). Our previous questionnaire survey revealed that, due to the technical difficulty and unique characteristics of this training, medical students’ accomplishment and satisfaction varied considerably. We aimed to examine three factors—students’ resilience, learning styles, and the quality of clinical instructors—and how these relate to students’ accomplishment and satisfaction with the training. The first factor is resilience, which has been described in psychology as the capacity to cope effectively with and adapt to adversity or stress, including exposure to such challenges and the attainment of positive outcomes [ 3 , 4 ]. In recent years, resilience has attracted much attention in the field of medical education [ 5 , 6 ]. Students with high resilience can manage stress, thrive when facing challenges and continue to develop [ 7 , 8 ]. Previous studies have reported associations between resilience and academic burnout, life satisfaction, and academic performance among medical students [ 6 , 9 – 11 ]. However, to the best of our knowledge, no study has explored its relationship with students’ accomplishment and satisfaction in practical training, such as in microsurgical suturing. The second factor is students’ learning preferences, which may influence how they receive and process information [ 12 ]. In 1982, Honey and Mumford developed the Learning Styles Questionnaire to categorize learners into four types: Activist, Reflector, Theorist, and Pragmatist [ 13 ]. This model is grounded in Kolb’s experiential learning cycle, which conceptualized students’ learning preferences along two axes (with processing on the horizontal axis and perception on the vertical axis) [ 14 ] (Fig. 2 ). Learners are classified into these styles based on their learning preferences and approaches to learning. Activists are defined as experimental learners who often dive into tasks without sufficient preparation. They enjoy trying new things and favor learning through trial and error rather than mere observation. Reflectors are thoughtful and introspective learners who analyze situations carefully before making decisions. They learn most effectively when provided with sufficient time and space to process information independently. Theorists are logical and rational learners who seek to understand fundamental principles. They favor organizing information into systematic frameworks and avoid subjective or intuitive approaches. Pragmatists are practical learners who emphasize the practical application of knowledge over abstract theory or principles. They learn most effectively through tasks that require the direct use of newly acquired skills and knowledge [ 14 ]. Some studies reported no significant association between learning styles and academic performance among medical students [ 12 , 15 ]. However, these studies relied on written examination results, without examining learning styles in relation to performance in modules with large practical components. The third factor is the quality of clinical instructors. Previous studies have demonstrated that clinical instructors play a crucial role in making the clinical environment more attractive for students and have a significant influence on the maintenance of their motivation [ 16 – 20 ]. Therefore, our study aimed to evaluate the impact of resilience, learning styles and the quality of clinical instructors on medical students’ experiences in practical training. To this end, we evaluated resilience levels, the learning preferences of medical students, and the quality of clinical instructors, and investigated associations with their accomplishment and satisfaction in microsurgical suturing training. Methods Study design The study was conducted among undergraduate medical students who participated in microsurgical suturing training during their clinical clerkship in the Department of Neurosurgery of Shinshu University School of Medicine between October 2024 and June 2025. Before the training, the participants completed an online survey using Google Forms. The questionnaire collected information on various characteristics of the practitioners, including their gender, department of interest (surgical fields, medical fields, or undecided), and resilience. After completing the training, they were asked to voluntarily evaluate their accomplishment and satisfaction and the quality of their clinical instructor. A total of 109 students completed the survey. Students who selected the same option for all questions (n = 2), those who did not complete responses (n = 11), and those whose predominant learning style could not be determined due to equally balanced preferences (n = 8) were excluded. Finally, 88 students were included in the study. This study was approved by the Institutional Ethics Committee on Clinical Investigation of Shinshu University (IRB number 6661), and informed consent was obtained from all the participants. Microsurgical suturing training At the start of the microsurgical training, participants watched a 3-min video showing a neurosurgeon performing microsurgical suturing. During the video, the clinical instructor explained key suturing techniques and critical points for high-quality suturing (1. The length of the cut thread, 2. The suture pitch, and 3. The suture bite) (Fig. 3 ). Subsequently, each student performed microsurgical suturing using forceps, microscissors, and 10 − 0 nylon under the microscope (Zeiss Stemi 305, Carl Zeiss, Germany) for 20 min. Throughout the practice, the clinical instructor provided individualized instruction tailored to each student’s needs. On completion of the 20-min practice, the clinical instructor provided feedback, marking the conclusion of the training session. Resilience Medical students’ resilience levels were assessed using the 10-item Tachikawa Resilience Scale (TRS) [ 4 ]. Each item was rated on a 7-point Likert scale, with students selecting how well each statement described them from 1 (strongly disagree) to 7 (strongly agree), based on their self-assessment. A total score (range, 10–70) was used as an indicator of resilience, and higher total scores reflect higher resilience. Learning styles The Honey and Mumford Learning Styles Questionnaire—translated into Japanese—was used to assess students’ learning styles, namely, Activist, Reflector, Theorist, and Pragmatist [ 21 ]. The questionnaire comprised 80 items, and students judged independently whether each item applied to their own experiences or characteristics (responding “yes” or “no”). Each learner’s predominant learning style was defined as the style with the greatest number of “yes” responses, while the strength of each learning preference was quantified by the total number of “yes” responses corresponding to each learning style. Based on the total scores, the strength of each learning preference was categorized into five levels: very strong, strong, moderate, low, and very low. In particular, the ranges were defined as follows: Activist (13–20: very strong, 11–12: strong, 7–10: moderate, 4–6: low, 0–3: very low), Reflector (18–20: very strong, 15–17: strong, 12–14: moderate, 9–11: low, 0–8: very low), Theorist (16–20: very strong, 14–15: strong, 11–13: moderate, 8–10: low, 0–7: very low), and Pragmatist (17–20: very strong, 15–16: strong, 12–14: moderate, 9–11: low, 0–8: very low). This classification enabled us to analyze not only the predominant learning style of each student but also the strength of their learning preferences across the four domains. Medical students’ accomplishment and satisfaction and the quality of clinical instructors Data were collected using a self-administered questionnaire completed by the participants. Medical students’ sense of accomplishment was assessed using the following eight items: (1) microscope operation, (2) forceps operation, (3) scissors operation, (4) needle control, (5) passing needle through artificial vascular graft, (6) tying the thread, (7) cutting the thread with scissors, and (8) microsurgical suturing skill after the training. Items 1–7 were rated on a 5-point Likert scale from 1 (cannot do it at all) to 5 (able to teach others), while item 8 was rated from 1 (did not improve at all) to 5 (improved greatly). The total score (range, 8–40) was calculated, with higher total scores indicating a higher sense of accomplishment. Their satisfaction with the training and the quality of their clinical instructors were assessed using separate 5-point Likert scales from 1 (not satisfied at all) to 5 (very satisfied), and from 1 (not careful teaching at all) to 5 (taught very carefully) (Supplementary File 1). Statistical Analysis Data were presented as mean ± standard deviation (SD). Categorical variables were analyzed using the chi-square test, while continuous variables were analyzed using the two-sided paired t-test. When comparing accomplishment and satisfaction scores across students’ characteristics, resilience, and the quality of clinical instructors, the accomplishment scores were categorized into three groups: high (scores equal to or above the mean), intermediate (scores below the mean but not more than one SD below the mean), and low (scores exceeding one SD below the mean). Satisfaction scores were categorized into two groups: high (scores of ≥ 4) and low (scores of ≤ 3). All statistical analyses were conducted using Microsoft Excel (Microsoft Corp., Redmond, WA, USA), and a p value of < 0.05 was adjudged to indicate statistical significance. Results A total of 88 medical students were enrolled in our study comprising 53 (60.2%) male and 35 (39.8%) female. Among them, 29 students (33.0%) expressed interest in surgical fields, 38 (43.2%) in medical fields, and the remaining 21 (23.9%) expressed no specific departmental preference. The number of students classified as Activist, Reflector, Theorist, and Pragmatist were 13 (14.8%), 38 (43.2%), 19 (21.6%), and 18 (20.5%), respectively. The medical students’ resilience score was 47.9 ± 9.64, while the accomplishment score, satisfaction score, and quality of clinical instructors score evaluated by trainees were 23.8 ± 2.94, 4.09 ± 0.86, and 4.60 ± 0.58, respectively. No significant differences were observed between male and female students in the resilience score ( p = 0.86), accomplishment score ( p = 0.60), satisfaction score ( p = 0.48), or the quality of clinical instructors ( p = 0.25) (Table 1 ). Table 1 Participant Characteristics and overall mean of resilience, sense of accomplishment and satisfaction, and instructor quality. Variables No. (Male/Female) % No. of medical students 88 (53/35) Department of interest Surgical Field 29 (20/9) 33.0 Medical Field 38 (23/15) 43.2 Undecided 21 (10/11) 23.9 Learning Style Activist Style 13 (8/5) 14.8 Reflector Style 38 (22/16) 43.2 Theorist Style 19 (11/8) 21.6 Pragmatist Style 18 (12/6) 20.5 Mean ± SD Total Male Female p-Value* Resilience (Scale 7–70) 47.9 ± 9.64 47.8 ± 10.4 48.2 ± 8.32 0.86 Accomplishment score (Scale 8–40) 23.8 ± 2.94 23.9 ± 2.97 23.5 ± 2.89 0.60 Satisfaction score (Scale 1–5) 4.09 ± 0.86 4.04 ± 0.87 4.17 ± 0.84 0.48 Quality of clinical instructors evaluated by trainees (Scale 1–5) 4.60 ± 0.58 4.66 ± 0.51 4.51 ± 0.65 0.25 *The two-sided paired t-test SD: standard deviation Table 2 shows the strength of participants’ learning preferences, analyzed according to the scoring patterns of the four learning styles described by Honey and Mumford. A total of 30 students (34.1%) showed a “strong” or “very strong” preference for the Activist learning style, while the largest group fell into the “moderate” preference (33 students, 37.5%). Only 6 students demonstrated a “very low” preference (6.8%). In case of the Reflector learning style, 27 students (30.6%) showed a “strong” or “very strong” preference, while 24 (27.3%) and 27 (30.7%) expressed “moderate” and “low” preferences, respectively. A “strong” or “very strong” preference for the Theorist learning style was observed in 23 students (26.1%). However, a larger proportion of students (42 students, 47.7%) showed a “low” or “very low” preference. Furthermore, only 16 students (18.1%) showed a “strong” or “very strong” preference and more than half of the participants (49 students, 55.7%) fell into the “low” or “very low” preference for the Pragmatist learning style. Table 2 The strength of participants’ learning preferences. Learning Style Very strong preference Strong preference Moderate preference Low preference Very low preference Activist (%) 16 (18.2%) 14 (15.9%) 33 (37.5%) 19 (21.6%) 6 (6.8%) Reflector (%) 4 (4.5%) 23 (26.1%) 24 (27.3%) 27 (30.7%) 10 (11.4%) Theorist (%) 9 (10.2%) 14 (15.9%) 23 (26.1%) 23 (26.1%) 19 (21.6%) Pragmatist (%) 4 (4.5%) 12 (13.6%) 23 (26.1%) 25 (28.4%) 24 (27.3%) Table 3 shows that regarding the point about the sense of accomplishment, no significant differences were observed in terms of sex ( p = 0.90), department of interest ( p = 0.63), learning style ( p = 0.73), resilience ( p = 0.15), and quality of their clinical instructors ( p = 0.07). However, with respect to the satisfaction, the quality of their clinical instructors score in the group with a satisfaction rating above 4 points (4.74 ± 0.44) was significantly higher than that in the group with a satisfaction rating below 3 points (4.15 ± 0.73) ( p < 0.01). No significant differences in satisfaction were found in terms of sex ( p = 0.98), department of interest ( p = 0.47), learning style ( p = 0.42), and resilience ( p = 0.53). Table 3 Comparison of accomplishment score and satisfaction score across students’ characteristics, resilience, and instructors’ quality. Variables Accomplishment score p-Value Satisfaction score p-Value ≧Mean n = 58 (%) Mean> ≧Mean - SD n = 19 (%) Mean - SD> n = 11 (%) ≧ 4 n = 68 (%) 3≧ n = 20 (%) Sex Male 35 (60.3%) 12 (63.2%) 6 (54.5%) 0.90** 41 (60.3%) 12 (60.0%) 0.98** Female 23 (39.7%) 7 (36.8%) 5 (45.5%) 27 (39.7%) 8 (40.0%) Department of interest Surgical Field 22 (37.9%) 5 (26.3%) 2 (18.2%) 0.63** 24 (35.3%) 5 (25.0%) 0.47** Medical Field 24 (41.2%) 8 (42.1%) 6 (54.5%) 27 (39.7%) 11 (55.0%) Undecided 12 (20.9%) 6 (31.6%) 3 (27.3%) 17 (25.0%) 4 (20.0%) Learning Style Activist Style 9 (15.5%) 3 (15.8%) 1 (9.1%) 0.73** 12 (17.6%) 1 (5.0%) 0.42** Reflector Style 27 (46.6%) 7 (36.8%) 4 (36.4%) 30 (44.1%) 8 (40.0%) Theorist Style 12 (20.7%) 3 (15.8%) 4 (36.4%) 13 (19.1%) 6 (30.0%) Pragmatist Style 10 (17.2%) 6 (31.6%) 2 (18.2%) 13 (19.1%) 5 (25.0%) Resilience (Mean ± SD) 47.2 ± 10.0 51.5 ± 8.34 45.4 ± 7.74 0.15* 48.3 ± 10.2 46.8 ± 7.48 0.53* Quality of clinical instructors evaluated by trainees (Mean ± SD) 4.69 ± 0.53 4.53 ± 0.60 4.27 ± 0.62 0.07* 4.74 ± 0.44 4.15 ± 0.73 <0.01* *The two-sided paired t-test and ** the chi-square test SD: standard deviation Furthermore, Table 4 shows that students with a “strong” or “very strong” preference for the activist learning style had significantly higher sense of accomplishment scores (24.9 ± 2.43) than those with “moderate,” “low,” or “very low” Activist preferences (23.1 ± 3.00) ( p < 0.01) (Fig. 4 ). The satisfaction score among students with a “strong” or “very strong” preference for the Activist learning style (4.23 ± 0.88) was higher than among those with “moderate,” “low,” or “very low” Activist preferences (4.02 ± 0.84), although the difference was not statistically significant ( p = 0.27). No significant associations were found between either sense of accomplishment or satisfaction and the strength of students’ learning preferences, except in the case of the Activist style. Table 4 Associations between the strength of learning preferences and accomplishment score and satisfaction score. No. (%) Accomplishment score (Mean ± SD) p-Value* Satisfaction score (Mean ± SD) p-Value* Activist ≧Strong Preference (20 − 11) 30 (34.1) 24.9 ± 2.43 <0.01 4.23 ± 0.88 0.27 Moderate (10 − 0) ≧ 58 (65.9) 23.1 ± 3.00 4.02 ± 0.84 Reflector ≧Strong Preference (20 − 11) 27 (30.7) 23.6 ± 2.41 0.68 4.15 ± 0.80 0.68 Moderate (14 − 0) ≧ 61 (69.3) 23.8 ± 3.15 4.07 ± 0.88 Theorist ≧Strong Preference (20 − 11) 23 (26.1) 23.4 ± 3.00 0.50 3.96 ± 0.69 0.39 Moderate (13 − 0) ≧ 65 (73.9) 23.9 ± 2.91 4.14 ± 0.91 Pragmatist ≧Strong Preference (20 − 11) 16 (18.2) 23.4 ± 2.39 0.58 4.13 ± 0.70 0.86 Moderate (14 − 0) ≧ 72 (81.8) 23.8 ± 3.05 4.08 ± 0.89 *The two-sided paired t-test SD: standard deviation Discussion Microsurgical suturing training is a practical module in which students suture an artificial blood vessel ~ 2 mm in diameter under a microscope, and for most participants, it represents their first such experience. Given its technical difficulty, some students experienced a strong sense of accomplishment and satisfaction, whereas others did not. This study aimed to evaluate the impact of resilience, learning styles, and the quality of clinical instructors on medical students’ sense of accomplishment and satisfaction in practical training. Resilience Our findings indicated that medical students’ resilience did not influence their sense of accomplishment or satisfaction in microsurgical suturing training. By contrast, previous studies have reported significant associations between resilience and outcomes such as academic performance, academic burnout, life satisfaction, and stress among medical students [ 6 , 9 – 11 ]. Possible explanations for this finding include the limited impact of resilience on short-term challenges or difficulties encountered in specific training sessions, and the use of different resilience scales among medical students across studies. A previous study has identified mechanisms through which resilience exerts its effects, demonstrating that university students with higher resilience achieved better academic outcomes through self-management behaviors. This mediating pathway was further reinforced by grit (i.e., perseverance in the face of challenges) and sufficient social support, ultimately contributing to improved academic performance over time [ 22 ]. Similarly, Moshe et al. proposed that resilience can be conceptualized as a dynamic process, beginning with the identification of accessible coping resources and the acceptance of situational reality, followed by the constructive reinterpretation of stressors, and culminating in the flexible adjustment of coping strategies to contextual demands [ 23 ]. These studies indicated that resilience operates through several sequential stages and exerts its effects over the long term. In this study, microsurgical suturing training was limited to a single 20-min session, which may have been insufficient for students to demonstrate resilience. From a cultural perspective, widely used measures such as the 14-item Resilience Scale (RS-14) and the Connor–Davidson Resilience Scale (CD-RISC) may not be optimal for a Japanese population owing to the tendency to suppress positive emotional expression [ 4 , 24 , 25 ]. Accordingly, the TRS was developed as a culturally sensitive measure of resilience in Japanese populations. To date, however, applications of the TRS have been restricted to company workers and patients with psychiatric disorders, and no study has validated its use specifically in student populations. Further research is needed to determine the appropriate timeframe in which resilience demonstrates its effects on medical students’ accomplishment and satisfaction, and to establish the most appropriate resilience scale for evaluating resilience in Japanese populations. Quality of the clinical instructor Our study identified a significant association between the quality of clinical instructors and medical students’ satisfaction. Previous research has shown that effective clinical educators make clinical learning an enjoyable experience for their students by serving as role models who guide them in managing professional challenges [ 19 ]. The current results are consistent with this previous report. Guzman et al. noted that one of the most distinctive characteristics of effective clinical instructors is their thorough knowledge of the training content coupled with advanced technical proficiency [ 20 ]. In our training program, medical students received instruction from a neurosurgeon with advanced expertise in microsurgical techniques, which may have contributed to their high level of satisfaction. These results indicate the importance of instructors accumulating similar practical teaching experiences and developing more refined instructional skills. Furthermore, Valiee et al. reported that the essential characteristics of effective clinical instructors include fostering students’ independence and confidence, providing active support, maintaining effective communication, and assisting them in identifying and managing their problems [ 18 ]. However, it remains unclear which specific characteristics most strongly influenced students’ satisfaction, as the quality of the clinical instructor was assessed only through individual 5-point Likert scales. Therefore, further research is warranted to elucidate the specific clinical instructor-related factors that influence students’ satisfaction. Strength of learning preferences In this study, no significant differences based on medical students’ predominant learning styles were observed in their accomplishment and satisfaction. However, when an individual’s learning characteristics are regarded as the strength of learning preferences rather than as a distinct style, students with a high Activist learning preference demonstrated a greater sense of accomplishment than those with a low Activist learning preference. These findings indicate that in the Honey and Mumford Questionnaire, if learning preferences with the highest number of corresponding items are regarded as an individual’s learning style, it fails to evaluate those other learning tendencies that they may possess. The Honey and Mumford Questionnaire assumes that students prefer a unimodal learning style and does not account for the possibility that they may have multimodal learning preferences. Previous studies have shown that students acquire multiple learning styles through the process of knowing how to learn and adapting to various approaches [ 24 , 25 ]. Our study identified the factors influencing students’ sense of accomplishment by evaluating the strength of the four learning preferences within each individual. Our findings indicate that with undergraduate medical students undergoing clinical clerkship, evaluating the strength of their learning styles provides a more accurate analysis than categorizing them into a single learning style. Furthermore, these results indicate that microsurgical suturing training was more consistent with the learning approaches favored by the activist learning style, which emphasizes direct experience. In this training exercise, slides and textbooks were not utilized; instead, learners engaged in hands-on practice guided by instructional videos and verbal guidance from clinical instructors. This experiential approach may have enabled students with strong Activist preferences to learn most effectively and, consequently, to experience a greater sense of accomplishment. Some studies have reported the importance of incorporating various types of modalities into the curriculum to develop students’ academic outcomes [ 12 , 24 ]. Building on these previous findings, the present findings further indicate that the integration of learning methods appropriate to the four learning styles, including in the context of practical training, may allow a greater number of students to achieve a sense of accomplishment. These insights highlight the importance of designing curricula that integrate diverse learning approaches, particularly in practical training, to maximize students’ sense of accomplishment and educational outcomes. Limitations There are several limitations to this study. First, only a small number of medical students from a single medical university were enrolled, which limits the generalization of the findings of the research. Second, all items in this study were assessed based on the students’ self-reported evaluations, therefore, their responses and emotional biases could not be excluded. Finally, the association observed between the strength of activist learning preference and students’ sense of accomplishment may reflect subjective perceptions rather than objective outcomes in microsurgical suturing. To the best of our knowledge, there have been no previous studies on the relationship between resilience, learning styles, and the sense of accomplishment and satisfaction among medical students in practical training in an area such as microsurgical suturing. Our study can provide insights into how practical training programs can be designed to support medical students with diverse backgrounds and characteristics more effectively by identifying the factors that influence their accomplishment and satisfaction. Further studies are needed to elucidate additional factors that may also influence medical students’ sense of accomplishment, satisfaction, and practical performance. Conclusion In conclusion, we found that effective clinical instruction and a strong Activist learning preference were related to medical students’ accomplishment and satisfaction during practical training, whereas their resilience showed no such relationship. These findings indicated that enhancing the quality of clinical instruction and designing curricula that incorporate diverse learning approaches may facilitate a greater sense of accomplishment and satisfaction among medical students in practical training settings, such as microsurgical suturing. Abbreviations TRS, Tachikawa Resilience scale; SD, Standard Deviation; RS-14, 14-item Resilience Scale; CD-RISC, Connor–Davidson Resilience Scale Declarations Ethics approval and consent to participate This study was approved by the Institutional Ethics Committee on Clinical Investigation of Shinshu University (IRB number 6661). This study was conducted in accordance with the principles of the Declaration of Helsinki. Informed consent was obtained from all participants. Consent for publication Written informed consent for publication was obtained from the individual shown in Figure 1. Availability of data and materials The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding This study was supported by the Japan Medical Education Foundation (Medical Education Research Grant) . The funder had no role in the design of the study, data collection, analysis, interpretation of data, or writing the manuscript. Authors’ contributions YN contributed to study conception, data collection, statistical analysis, and drafting of the manuscript. KK supervised the study, contributed to the study design, interpretation of data, and the critical revision of the manuscript. AM, MT, KY, YA, and NT contributed to data acquisition and interpretation. HT provided overall supervision, critical feedback, and final approval of the manuscript. All authors read and approved the final manuscript. 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Problem-based learning (PBL): Assessing students’ learning preferences using vark. Nurse Educ Today. 2008;28:572–9. https://doi.org/10.1016/j.nedt.2007.09.012. Ahmad Chaudhry N, Ashar A, Amina Ahmad S. Kinesthetic Learning Styles Pak Armed Forces Med. 2020. Additional Declarations No competing interests reported. Supplementary Files SupplementaryFile1Questionnaire.docx Cite Share Download PDF Status: Published Journal Publication published 31 Mar, 2026 Read the published version in BMC Medical Education → Version 1 posted Editorial decision: Revision requested 04 Dec, 2025 Reviews received at journal 02 Dec, 2025 Reviews received at journal 30 Nov, 2025 Reviews received at journal 27 Nov, 2025 Reviewers agreed at journal 26 Nov, 2025 Reviewers agreed at journal 26 Nov, 2025 Reviewers agreed at journal 26 Nov, 2025 Reviewers agreed at journal 26 Nov, 2025 Reviewers agreed at journal 26 Nov, 2025 Reviewers agreed at journal 25 Nov, 2025 Reviewers invited by journal 25 Nov, 2025 Editor assigned by journal 25 Nov, 2025 Editor invited by journal 24 Nov, 2025 Submission checks completed at journal 22 Nov, 2025 First submitted to journal 22 Nov, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8121680","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":551528184,"identity":"9330b227-6d63-4845-bd44-9bfd77975ad6","order_by":0,"name":"Nana Yamakita","email":"","orcid":"","institution":"Shinshu University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Nana","middleName":"","lastName":"Yamakita","suffix":""},{"id":551528185,"identity":"fc086a51-8d37-48e2-bb9e-10911c28cdaa","order_by":1,"name":"Kohei 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09:19:24","extension":"html","order_by":21,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":109909,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8121680/v1/e0a5bd02a86c669cc2264c5b.html"},{"id":97388760,"identity":"526b5955-ba85-4d42-ac8f-d29c59957599","added_by":"auto","created_at":"2025-12-03 21:23:12","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":2074667,"visible":true,"origin":"","legend":"\u003cp\u003e(a) 10-0 nylon and (b) Microscope used in this study. (c) Microscopic photographs taken during microsurgical suturing training. (d) Photograph of the first author during microsurgical suturing training.\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-8121680/v1/4519338f32418c393528b5c1.png"},{"id":97665525,"identity":"44f5a559-e7ec-4336-a26e-2cbcf01a131f","added_by":"auto","created_at":"2025-12-08 09:18:55","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":352057,"visible":true,"origin":"","legend":"\u003cp\u003eHoney and Mumford Learning Styles Model. This model is based on Kolb’s experiential learning cycle and classifies individual learning styles into four categories according to the two dimensions of the processing continuum and the perception continuum.\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-8121680/v1/142f77a358bf4b8e20629221.png"},{"id":97388765,"identity":"fc66cba7-1eee-4d34-9e34-278f29010cd5","added_by":"auto","created_at":"2025-12-03 21:23:13","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":402178,"visible":true,"origin":"","legend":"\u003cp\u003eCritical points for high-quality suturing (the most desirable value). “T” means the artificial blood vessel thickness (blue arrow). Point 1 is the length of the cut thread (0.3–0.5 mm) (red dashed double-headed arrow), point 2 is the suture pitch (1 mm) (red dash-dot double-headed arrow), and point 3 is the suture bite (2T) (red double-headed arrow).\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-8121680/v1/d4e6d24986031d0152ec4960.png"},{"id":97388778,"identity":"0974977b-f62f-48fa-ac24-7bbd6fbadc1f","added_by":"auto","created_at":"2025-12-03 21:23:13","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":535696,"visible":true,"origin":"","legend":"\u003cp\u003eBox-and-whisker plot for the sense of accomplishment in the high activist learning preference (11–20) group and the low activist learning preference (0–10) (\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.01) (a), in the high reflector learning preference (15–20) group and the low reflector learning preference (0–14) (\u003cem\u003ep\u003c/em\u003e = 0.68) (b), in the high Theorist learning preference (14–20) group and the low activist learning preference (0–13) (\u003cem\u003ep\u003c/em\u003e = 0.50) (c), in the high Pragmatist learning preference (15–20) group and the low activist learning preference (0–14) (\u003cem\u003ep\u003c/em\u003e = 0.58) (d). \u003cem\u003ep\u003c/em\u003evalue was calculated using the two-sided paired t-test.\u003c/p\u003e","description":"","filename":"Figure4.png","url":"https://assets-eu.researchsquare.com/files/rs-8121680/v1/898c23a7dd268fff8a790827.png"},{"id":106344323,"identity":"5170fe30-6e8a-409e-a9d8-2b71c2ec939c","added_by":"auto","created_at":"2026-04-07 16:13:26","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":5013777,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8121680/v1/87b1cf08-278e-4305-a570-b1b912694ee5.pdf"},{"id":97388809,"identity":"08e691b1-a556-4ecf-900e-5ac8341f538e","added_by":"auto","created_at":"2025-12-03 21:23:14","extension":"docx","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":17028,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFile1Questionnaire.docx","url":"https://assets-eu.researchsquare.com/files/rs-8121680/v1/948ac3e2fe534a2390901616.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Impact of resilience, learning styles, and clinical instructors on medical students’ experiences in microsurgical suturing training: A web-based questionnaire study","fulltext":[{"header":"Background","content":"\u003cp\u003eMicrosurgical suturing plays an indispensable role in the field of neurosurgical procedures, such as revascularization surgery and nerve reconstruction [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. We conducted microsurgical suturing training as part of the clinical clerkship in the Department of Neurosurgery at Shinshu University School of Medicine (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Our previous questionnaire survey revealed that, due to the technical difficulty and unique characteristics of this training, medical students\u0026rsquo; accomplishment and satisfaction varied considerably. We aimed to examine three factors\u0026mdash;students\u0026rsquo; resilience, learning styles, and the quality of clinical instructors\u0026mdash;and how these relate to students\u0026rsquo; accomplishment and satisfaction with the training.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe first factor is resilience, which has been described in psychology as the capacity to cope effectively with and adapt to adversity or stress, including exposure to such challenges and the attainment of positive outcomes [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In recent years, resilience has attracted much attention in the field of medical education [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Students with high resilience can manage stress, thrive when facing challenges and continue to develop [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Previous studies have reported associations between resilience and academic burnout, life satisfaction, and academic performance among medical students [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. However, to the best of our knowledge, no study has explored its relationship with students\u0026rsquo; accomplishment and satisfaction in practical training, such as in microsurgical suturing.\u003c/p\u003e\u003cp\u003eThe second factor is students\u0026rsquo; learning preferences, which may influence how they receive and process information [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In 1982, Honey and Mumford developed the Learning Styles Questionnaire to categorize learners into four types: Activist, Reflector, Theorist, and Pragmatist [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. This model is grounded in Kolb\u0026rsquo;s experiential learning cycle, which conceptualized students\u0026rsquo; learning preferences along two axes (with processing on the horizontal axis and perception on the vertical axis) [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Learners are classified into these styles based on their learning preferences and approaches to learning. Activists are defined as experimental learners who often dive into tasks without sufficient preparation. They enjoy trying new things and favor learning through trial and error rather than mere observation. Reflectors are thoughtful and introspective learners who analyze situations carefully before making decisions. They learn most effectively when provided with sufficient time and space to process information independently. Theorists are logical and rational learners who seek to understand fundamental principles. They favor organizing information into systematic frameworks and avoid subjective or intuitive approaches. Pragmatists are practical learners who emphasize the practical application of knowledge over abstract theory or principles. They learn most effectively through tasks that require the direct use of newly acquired skills and knowledge [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Some studies reported no significant association between learning styles and academic performance among medical students [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. However, these studies relied on written examination results, without examining learning styles in relation to performance in modules with large practical components.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe third factor is the quality of clinical instructors. Previous studies have demonstrated that clinical instructors play a crucial role in making the clinical environment more attractive for students and have a significant influence on the maintenance of their motivation [\u003cspan additionalcitationids=\"CR17 CR18 CR19\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eTherefore, our study aimed to evaluate the impact of resilience, learning styles and the quality of clinical instructors on medical students\u0026rsquo; experiences in practical training. To this end, we evaluated resilience levels, the learning preferences of medical students, and the quality of clinical instructors, and investigated associations with their accomplishment and satisfaction in microsurgical suturing training.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy design\u003c/h2\u003e\u003cp\u003e The study was conducted among undergraduate medical students who participated in microsurgical suturing training during their clinical clerkship in the Department of Neurosurgery of Shinshu University School of Medicine between October 2024 and June 2025. Before the training, the participants completed an online survey using Google Forms. The questionnaire collected information on various characteristics of the practitioners, including their gender, department of interest (surgical fields, medical fields, or undecided), and resilience. After completing the training, they were asked to voluntarily evaluate their accomplishment and satisfaction and the quality of their clinical instructor. A total of 109 students completed the survey. Students who selected the same option for all questions (n\u0026thinsp;=\u0026thinsp;2), those who did not complete responses (n\u0026thinsp;=\u0026thinsp;11), and those whose predominant learning style could not be determined due to equally balanced preferences (n\u0026thinsp;=\u0026thinsp;8) were excluded. Finally, 88 students were included in the study. This study was approved by the Institutional Ethics Committee on Clinical Investigation of Shinshu University (IRB number 6661), and informed consent was obtained from all the participants.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eMicrosurgical suturing training\u003c/h3\u003e\n\u003cp\u003eAt the start of the microsurgical training, participants watched a 3-min video showing a neurosurgeon performing microsurgical suturing. During the video, the clinical instructor explained key suturing techniques and critical points for high-quality suturing (1. The length of the cut thread, 2. The suture pitch, and 3. The suture bite) (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Subsequently, each student performed microsurgical suturing using forceps, microscissors, and 10\u0026thinsp;\u0026minus;\u0026thinsp;0 nylon under the microscope (Zeiss Stemi 305, Carl Zeiss, Germany) for 20 min. Throughout the practice, the clinical instructor provided individualized instruction tailored to each student\u0026rsquo;s needs. On completion of the 20-min practice, the clinical instructor provided feedback, marking the conclusion of the training session.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\n\u003ch3\u003eResilience\u003c/h3\u003e\n\u003cp\u003eMedical students\u0026rsquo; resilience levels were assessed using the 10-item Tachikawa Resilience Scale (TRS) [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Each item was rated on a 7-point Likert scale, with students selecting how well each statement described them from 1 (strongly disagree) to 7 (strongly agree), based on their self-assessment. A total score (range, 10\u0026ndash;70) was used as an indicator of resilience, and higher total scores reflect higher resilience.\u003c/p\u003e\n\u003ch3\u003eLearning styles\u003c/h3\u003e\n\u003cp\u003eThe Honey and Mumford Learning Styles Questionnaire\u0026mdash;translated into Japanese\u0026mdash;was used to assess students\u0026rsquo; learning styles, namely, Activist, Reflector, Theorist, and Pragmatist [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. The questionnaire comprised 80 items, and students judged independently whether each item applied to their own experiences or characteristics (responding \u0026ldquo;yes\u0026rdquo; or \u0026ldquo;no\u0026rdquo;). Each learner\u0026rsquo;s predominant learning style was defined as the style with the greatest number of \u0026ldquo;yes\u0026rdquo; responses, while the strength of each learning preference was quantified by the total number of \u0026ldquo;yes\u0026rdquo; responses corresponding to each learning style.\u003c/p\u003e\u003cp\u003eBased on the total scores, the strength of each learning preference was categorized into five levels: very strong, strong, moderate, low, and very low. In particular, the ranges were defined as follows: Activist (13\u0026ndash;20: very strong, 11\u0026ndash;12: strong, 7\u0026ndash;10: moderate, 4\u0026ndash;6: low, 0\u0026ndash;3: very low), Reflector (18\u0026ndash;20: very strong, 15\u0026ndash;17: strong, 12\u0026ndash;14: moderate, 9\u0026ndash;11: low, 0\u0026ndash;8: very low), Theorist (16\u0026ndash;20: very strong, 14\u0026ndash;15: strong, 11\u0026ndash;13: moderate, 8\u0026ndash;10: low, 0\u0026ndash;7: very low), and Pragmatist (17\u0026ndash;20: very strong, 15\u0026ndash;16: strong, 12\u0026ndash;14: moderate, 9\u0026ndash;11: low, 0\u0026ndash;8: very low). This classification enabled us to analyze not only the predominant learning style of each student but also the strength of their learning preferences across the four domains.\u003c/p\u003e\n\u003ch3\u003eMedical students’ accomplishment and satisfaction and the quality of clinical instructors\u003c/h3\u003e\n\u003cp\u003eData were collected using a self-administered questionnaire completed by the participants. Medical students\u0026rsquo; sense of accomplishment was assessed using the following eight items: (1) microscope operation, (2) forceps operation, (3) scissors operation, (4) needle control, (5) passing needle through artificial vascular graft, (6) tying the thread, (7) cutting the thread with scissors, and (8) microsurgical suturing skill after the training. Items 1\u0026ndash;7 were rated on a 5-point Likert scale from 1 (cannot do it at all) to 5 (able to teach others), while item 8 was rated from 1 (did not improve at all) to 5 (improved greatly). The total score (range, 8\u0026ndash;40) was calculated, with higher total scores indicating a higher sense of accomplishment. Their satisfaction with the training and the quality of their clinical instructors were assessed using separate 5-point Likert scales from 1 (not satisfied at all) to 5 (very satisfied), and from 1 (not careful teaching at all) to 5 (taught very carefully) (Supplementary File 1).\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eData were presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD). Categorical variables were analyzed using the chi-square test, while continuous variables were analyzed using the two-sided paired t-test. When comparing accomplishment and satisfaction scores across students\u0026rsquo; characteristics, resilience, and the quality of clinical instructors, the accomplishment scores were categorized into three groups: high (scores equal to or above the mean), intermediate (scores below the mean but not more than one SD below the mean), and low (scores exceeding one SD below the mean). Satisfaction scores were categorized into two groups: high (scores of \u0026ge;\u0026thinsp;4) and low (scores of \u0026le;\u0026thinsp;3). All statistical analyses were conducted using Microsoft Excel (Microsoft Corp., Redmond, WA, USA), and a \u003cem\u003ep\u003c/em\u003e value of \u0026lt;\u0026thinsp;0.05 was adjudged to indicate statistical significance.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 88 medical students were enrolled in our study comprising 53 (60.2%) male and 35 (39.8%) female. Among them, 29 students (33.0%) expressed interest in surgical fields, 38 (43.2%) in medical fields, and the remaining 21 (23.9%) expressed no specific departmental preference. The number of students classified as Activist, Reflector, Theorist, and Pragmatist were 13 (14.8%), 38 (43.2%), 19 (21.6%), and 18 (20.5%), respectively. The medical students\u0026rsquo; resilience score was 47.9\u0026thinsp;\u0026plusmn;\u0026thinsp;9.64, while the accomplishment score, satisfaction score, and quality of clinical instructors score evaluated by trainees were 23.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.94, 4.09\u0026thinsp;\u0026plusmn;\u0026thinsp;0.86, and 4.60\u0026thinsp;\u0026plusmn;\u0026thinsp;0.58, respectively. No significant differences were observed between male and female students in the resilience score (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.86), accomplishment score (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.60), satisfaction score (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.48), or the quality of clinical instructors (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.25) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eParticipant Characteristics and overall mean of resilience, sense of accomplishment and satisfaction, and instructor quality.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eNo. (Male/Female)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo. of medical students\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e88 (53/35)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eDepartment of interest\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSurgical Field\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e29 (20/9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e33.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMedical Field\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e38 (23/15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e43.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUndecided\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e21 (10/11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e23.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eLearning Style\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eActivist Style\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e13 (8/5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e14.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReflector Style\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e38 (22/16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e43.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTheorist Style\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e19 (11/8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e21.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePragmatist Style\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e18 (12/6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e20.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep-Value*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eResilience (Scale 7\u0026ndash;70)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e47.9\u0026thinsp;\u0026plusmn;\u0026thinsp;9.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e47.8\u0026thinsp;\u0026plusmn;\u0026thinsp;10.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e48.2\u0026thinsp;\u0026plusmn;\u0026thinsp;8.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.86\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eAccomplishment score (Scale 8\u0026ndash;40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e23.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e23.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.60\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eSatisfaction score (Scale 1\u0026ndash;5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.09\u0026thinsp;\u0026plusmn;\u0026thinsp;0.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.04\u0026thinsp;\u0026plusmn;\u0026thinsp;0.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.17\u0026thinsp;\u0026plusmn;\u0026thinsp;0.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.48\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eQuality of clinical instructors evaluated by trainees (Scale 1\u0026ndash;5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.60\u0026thinsp;\u0026plusmn;\u0026thinsp;0.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.66\u0026thinsp;\u0026plusmn;\u0026thinsp;0.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.51\u0026thinsp;\u0026plusmn;\u0026thinsp;0.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.25\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e*The two-sided paired t-test\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003eSD: standard deviation\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the strength of participants\u0026rsquo; learning preferences, analyzed according to the scoring patterns of the four learning styles described by Honey and Mumford. A total of 30 students (34.1%) showed a \u0026ldquo;strong\u0026rdquo; or \u0026ldquo;very strong\u0026rdquo; preference for the Activist learning style, while the largest group fell into the \u0026ldquo;moderate\u0026rdquo; preference (33 students, 37.5%). Only 6 students demonstrated a \u0026ldquo;very low\u0026rdquo; preference (6.8%). In case of the Reflector learning style, 27 students (30.6%) showed a \u0026ldquo;strong\u0026rdquo; or \u0026ldquo;very strong\u0026rdquo; preference, while 24 (27.3%) and 27 (30.7%) expressed \u0026ldquo;moderate\u0026rdquo; and \u0026ldquo;low\u0026rdquo; preferences, respectively. A \u0026ldquo;strong\u0026rdquo; or \u0026ldquo;very strong\u0026rdquo; preference for the Theorist learning style was observed in 23 students (26.1%). However, a larger proportion of students (42 students, 47.7%) showed a \u0026ldquo;low\u0026rdquo; or \u0026ldquo;very low\u0026rdquo; preference. Furthermore, only 16 students (18.1%) showed a \u0026ldquo;strong\u0026rdquo; or \u0026ldquo;very strong\u0026rdquo; preference and more than half of the participants (49 students, 55.7%) fell into the \u0026ldquo;low\u0026rdquo; or \u0026ldquo;very low\u0026rdquo; preference for the Pragmatist learning style.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThe strength of participants\u0026rsquo; learning preferences.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLearning Style\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVery strong preference\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStrong preference\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eModerate preference\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eLow preference\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eVery low preference\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eActivist (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16 (18.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14 (15.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33 (37.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e19 (21.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e6 (6.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eReflector (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (4.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23 (26.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e24 (27.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e27 (30.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e10 (11.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTheorist (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9 (10.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14 (15.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e23 (26.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e23 (26.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e19 (21.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePragmatist (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (4.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12 (13.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e23 (26.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e25 (28.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e24 (27.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows that regarding the point about the sense of accomplishment, no significant differences were observed in terms of sex (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.90), department of interest (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.63), learning style (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.73), resilience (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.15), and quality of their clinical instructors (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.07). However, with respect to the satisfaction, the quality of their clinical instructors score in the group with a satisfaction rating above 4 points (4.74\u0026thinsp;\u0026plusmn;\u0026thinsp;0.44) was significantly higher than that in the group with a satisfaction rating below 3 points (4.15\u0026thinsp;\u0026plusmn;\u0026thinsp;0.73) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). No significant differences in satisfaction were found in terms of sex (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.98), department of interest (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.47), learning style (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.42), and resilience (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.53).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of accomplishment score and satisfaction score across students\u0026rsquo; characteristics, resilience, and instructors\u0026rsquo; quality.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003eAccomplishment score\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep-Value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003eSatisfaction score\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003ep-Value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e≧Mean\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;58 (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMean\u0026gt; ≧Mean - SD\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;19 (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMean - SD\u0026gt;\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;11 (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e≧\u0026thinsp;4\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;68 (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3≧\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;20 (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e35 (60.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12 (63.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6 (54.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.90**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e41 (60.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e12 (60.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.98**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23 (39.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7 (36.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5 (45.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e27 (39.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e8 (40.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eDepartment of interest\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSurgical Field\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22 (37.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5 (26.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2 (18.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.63**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e24 (35.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e5 (25.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.47**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMedical Field\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24 (41.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8 (42.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6 (54.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e27 (39.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e11 (55.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUndecided\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12 (20.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6 (31.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3 (27.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e17 (25.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e4 (20.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eLearning Style\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eActivist Style\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9 (15.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (15.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1 (9.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e0.73**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e12 (17.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1 (5.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e0.42**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReflector Style\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e27 (46.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7 (36.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4 (36.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e30 (44.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e8 (40.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTheorist Style\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12 (20.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (15.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4 (36.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e13 (19.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e6 (30.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePragmatist Style\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10 (17.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6 (31.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2 (18.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e13 (19.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e5 (25.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eResilience (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e47.2\u0026thinsp;\u0026plusmn;\u0026thinsp;10.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e51.5\u0026thinsp;\u0026plusmn;\u0026thinsp;8.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e45.4\u0026thinsp;\u0026plusmn;\u0026thinsp;7.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.15*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e48.3\u0026thinsp;\u0026plusmn;\u0026thinsp;10.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e46.8\u0026thinsp;\u0026plusmn;\u0026thinsp;7.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.53*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eQuality of clinical instructors\u003c/p\u003e\u003cp\u003eevaluated by trainees (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.69\u0026thinsp;\u0026plusmn;\u0026thinsp;0.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.53\u0026thinsp;\u0026plusmn;\u0026thinsp;0.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.27\u0026thinsp;\u0026plusmn;\u0026thinsp;0.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.07*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4.74\u0026thinsp;\u0026plusmn;\u0026thinsp;0.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e4.15\u0026thinsp;\u0026plusmn;\u0026thinsp;0.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;0.01*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"9\"\u003e*The two-sided paired t-test and ** the chi-square test\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"9\"\u003eSD: standard deviation\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eFurthermore, Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e shows that students with a \u0026ldquo;strong\u0026rdquo; or \u0026ldquo;very strong\u0026rdquo; preference for the activist learning style had significantly higher sense of accomplishment scores (24.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.43) than those with \u0026ldquo;moderate,\u0026rdquo; \u0026ldquo;low,\u0026rdquo; or \u0026ldquo;very low\u0026rdquo; Activist preferences (23.1\u0026thinsp;\u0026plusmn;\u0026thinsp;3.00) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01) (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). The satisfaction score among students with a \u0026ldquo;strong\u0026rdquo; or \u0026ldquo;very strong\u0026rdquo; preference for the Activist learning style (4.23\u0026thinsp;\u0026plusmn;\u0026thinsp;0.88) was higher than among those with \u0026ldquo;moderate,\u0026rdquo; \u0026ldquo;low,\u0026rdquo; or \u0026ldquo;very low\u0026rdquo; Activist preferences (4.02\u0026thinsp;\u0026plusmn;\u0026thinsp;0.84), although the difference was not statistically significant (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.27). No significant associations were found between either sense of accomplishment or satisfaction and the strength of students\u0026rsquo; learning preferences, except in the case of the Activist style.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAssociations between the strength of learning preferences and accomplishment score and satisfaction score.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo. (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAccomplishment score (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep-Value*\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSatisfaction score (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep-Value*\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eActivist\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e≧Strong Preference (20\u0026thinsp;\u0026minus;\u0026thinsp;11)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30 (34.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u0026lt;0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.23\u0026thinsp;\u0026plusmn;\u0026thinsp;0.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.27\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModerate (10\u0026thinsp;\u0026minus;\u0026thinsp;0) ≧\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e58 (65.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23.1\u0026thinsp;\u0026plusmn;\u0026thinsp;3.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.02\u0026thinsp;\u0026plusmn;\u0026thinsp;0.84\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eReflector\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e≧Strong Preference (20\u0026thinsp;\u0026minus;\u0026thinsp;11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e27 (30.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23.6\u0026thinsp;\u0026plusmn;\u0026thinsp;2.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.15\u0026thinsp;\u0026plusmn;\u0026thinsp;0.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.68\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModerate (14\u0026thinsp;\u0026minus;\u0026thinsp;0) ≧\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e61 (69.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.07\u0026thinsp;\u0026plusmn;\u0026thinsp;0.88\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTheorist\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e≧Strong Preference (20\u0026thinsp;\u0026minus;\u0026thinsp;11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23 (26.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23.4\u0026thinsp;\u0026plusmn;\u0026thinsp;3.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.96\u0026thinsp;\u0026plusmn;\u0026thinsp;0.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.39\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModerate (13\u0026thinsp;\u0026minus;\u0026thinsp;0) ≧\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e65 (73.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.14\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePragmatist\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e≧Strong Preference (20\u0026thinsp;\u0026minus;\u0026thinsp;11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16 (18.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.13\u0026thinsp;\u0026plusmn;\u0026thinsp;0.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.86\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModerate (14\u0026thinsp;\u0026minus;\u0026thinsp;0) ≧\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e72 (81.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.08\u0026thinsp;\u0026plusmn;\u0026thinsp;0.89\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e*The two-sided paired t-test\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003eSD: standard deviation\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eMicrosurgical suturing training is a practical module in which students suture an artificial blood vessel\u0026thinsp;~\u0026thinsp;2 mm in diameter under a microscope, and for most participants, it represents their first such experience. Given its technical difficulty, some students experienced a strong sense of accomplishment and satisfaction, whereas others did not. This study aimed to evaluate the impact of resilience, learning styles, and the quality of clinical instructors on medical students\u0026rsquo; sense of accomplishment and satisfaction in practical training.\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eResilience\u003c/h2\u003e\u003cp\u003eOur findings indicated that medical students\u0026rsquo; resilience did not influence their sense of accomplishment or satisfaction in microsurgical suturing training. By contrast, previous studies have reported significant associations between resilience and outcomes such as academic performance, academic burnout, life satisfaction, and stress among medical students [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Possible explanations for this finding include the limited impact of resilience on short-term challenges or difficulties encountered in specific training sessions, and the use of different resilience scales among medical students across studies. A previous study has identified mechanisms through which resilience exerts its effects, demonstrating that university students with higher resilience achieved better academic outcomes through self-management behaviors. This mediating pathway was further reinforced by grit (i.e., perseverance in the face of challenges) and sufficient social support, ultimately contributing to improved academic performance over time [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Similarly, Moshe et al. proposed that resilience can be conceptualized as a dynamic process, beginning with the identification of accessible coping resources and the acceptance of situational reality, followed by the constructive reinterpretation of stressors, and culminating in the flexible adjustment of coping strategies to contextual demands [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. These studies indicated that resilience operates through several sequential stages and exerts its effects over the long term. In this study, microsurgical suturing training was limited to a single 20-min session, which may have been insufficient for students to demonstrate resilience.\u003c/p\u003e\u003cp\u003eFrom a cultural perspective, widely used measures such as the 14-item Resilience Scale (RS-14) and the Connor\u0026ndash;Davidson Resilience Scale (CD-RISC) may not be optimal for a Japanese population owing to the tendency to suppress positive emotional expression [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Accordingly, the TRS was developed as a culturally sensitive measure of resilience in Japanese populations. To date, however, applications of the TRS have been restricted to company workers and patients with psychiatric disorders, and no study has validated its use specifically in student populations. Further research is needed to determine the appropriate timeframe in which resilience demonstrates its effects on medical students\u0026rsquo; accomplishment and satisfaction, and to establish the most appropriate resilience scale for evaluating resilience in Japanese populations.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eQuality of the clinical instructor\u003c/h2\u003e\u003cp\u003eOur study identified a significant association between the quality of clinical instructors and medical students\u0026rsquo; satisfaction. Previous research has shown that effective clinical educators make clinical learning an enjoyable experience for their students by serving as role models who guide them in managing professional challenges [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The current results are consistent with this previous report. Guzman et al. noted that one of the most distinctive characteristics of effective clinical instructors is their thorough knowledge of the training content coupled with advanced technical proficiency [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. In our training program, medical students received instruction from a neurosurgeon with advanced expertise in microsurgical techniques, which may have contributed to their high level of satisfaction. These results indicate the importance of instructors accumulating similar practical teaching experiences and developing more refined instructional skills. Furthermore, Valiee et al. reported that the essential characteristics of effective clinical instructors include fostering students\u0026rsquo; independence and confidence, providing active support, maintaining effective communication, and assisting them in identifying and managing their problems [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. However, it remains unclear which specific characteristics most strongly influenced students\u0026rsquo; satisfaction, as the quality of the clinical instructor was assessed only through individual 5-point Likert scales. Therefore, further research is warranted to elucidate the specific clinical instructor-related factors that influence students\u0026rsquo; satisfaction.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eStrength of learning preferences\u003c/h2\u003e\u003cp\u003eIn this study, no significant differences based on medical students\u0026rsquo; predominant learning styles were observed in their accomplishment and satisfaction. However, when an individual\u0026rsquo;s learning characteristics are regarded as the strength of learning preferences rather than as a distinct style, students with a high Activist learning preference demonstrated a greater sense of accomplishment than those with a low Activist learning preference. These findings indicate that in the Honey and Mumford Questionnaire, if learning preferences with the highest number of corresponding items are regarded as an individual\u0026rsquo;s learning style, it fails to evaluate those other learning tendencies that they may possess. The Honey and Mumford Questionnaire assumes that students prefer a unimodal learning style and does not account for the possibility that they may have multimodal learning preferences. Previous studies have shown that students acquire multiple learning styles through the process of knowing how to learn and adapting to various approaches [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Our study identified the factors influencing students\u0026rsquo; sense of accomplishment by evaluating the strength of the four learning preferences within each individual. Our findings indicate that with undergraduate medical students undergoing clinical clerkship, evaluating the strength of their learning styles provides a more accurate analysis than categorizing them into a single learning style.\u003c/p\u003e\u003cp\u003eFurthermore, these results indicate that microsurgical suturing training was more consistent with the learning approaches favored by the activist learning style, which emphasizes direct experience. In this training exercise, slides and textbooks were not utilized; instead, learners engaged in hands-on practice guided by instructional videos and verbal guidance from clinical instructors. This experiential approach may have enabled students with strong Activist preferences to learn most effectively and, consequently, to experience a greater sense of accomplishment. Some studies have reported the importance of incorporating various types of modalities into the curriculum to develop students\u0026rsquo; academic outcomes [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Building on these previous findings, the present findings further indicate that the integration of learning methods appropriate to the four learning styles, including in the context of practical training, may allow a greater number of students to achieve a sense of accomplishment. These insights highlight the importance of designing curricula that integrate diverse learning approaches, particularly in practical training, to maximize students\u0026rsquo; sense of accomplishment and educational outcomes.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eLimitations\u003c/h2\u003e\u003cp\u003eThere are several limitations to this study. First, only a small number of medical students from a single medical university were enrolled, which limits the generalization of the findings of the research. Second, all items in this study were assessed based on the students\u0026rsquo; self-reported evaluations, therefore, their responses and emotional biases could not be excluded. Finally, the association observed between the strength of activist learning preference and students\u0026rsquo; sense of accomplishment may reflect subjective perceptions rather than objective outcomes in microsurgical suturing. To the best of our knowledge, there have been no previous studies on the relationship between resilience, learning styles, and the sense of accomplishment and satisfaction among medical students in practical training in an area such as microsurgical suturing. Our study can provide insights into how practical training programs can be designed to support medical students with diverse backgrounds and characteristics more effectively by identifying the factors that influence their accomplishment and satisfaction. Further studies are needed to elucidate additional factors that may also influence medical students\u0026rsquo; sense of accomplishment, satisfaction, and practical performance.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, we found that effective clinical instruction and a strong Activist learning preference were related to medical students\u0026rsquo; accomplishment and satisfaction during practical training, whereas their resilience showed no such relationship. These findings indicated that enhancing the quality of clinical instruction and designing curricula that incorporate diverse learning approaches may facilitate a greater sense of accomplishment and satisfaction among medical students in practical training settings, such as microsurgical suturing.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eTRS, Tachikawa Resilience scale; SD, Standard Deviation; RS-14, 14-item Resilience Scale; CD-RISC, Connor\u0026ndash;Davidson Resilience Scale\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Institutional Ethics Committee on Clinical Investigation of Shinshu University (IRB number 6661).\u0026nbsp;This study was conducted in accordance with the principles of the Declaration of Helsinki.\u0026nbsp;Informed consent was obtained from all participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent for publication was obtained from the individual shown in Figure 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the \u003cem\u003eJapan Medical Education Foundation (Medical Education Research Grant)\u003c/em\u003e. The funder had no role in the design of the study, data collection, analysis, interpretation of data, or writing the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYN contributed to study conception, data collection, statistical analysis, and drafting of the manuscript. KK supervised the study, contributed to the study design, interpretation of data, and the critical revision of the manuscript. AM, MT, KY, YA, and NT contributed to data acquisition and interpretation. HT provided overall supervision, critical feedback, and final approval of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank all the medical students who participated in this study and the staff of the Department of Neurosurgery, Shinshu University School of Medicine, for their support.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eByvaltsev VA, Akshulakov SK, Polkin RA, Ochkal S V., Stepanov IA, Makhambetov YT, et al. Microvascular Anastomosis Training in Neurosurgery: A Review. Minimally Invasive Surgery. 2018;2018. https://doi.org/10.1155/2018/6130286.\u003c/li\u003e\n\u003cli\u003eGrosu-Bularda A, Vancea CV, Hodea FV, Cretu A, Bordeanu-Diaconescu EM, Dumitru CS, et al. Optimizing Peripheral Nerve Regeneration: Surgical Techniques, Biomolecular and Regenerative Strategies\u0026mdash;A Narrative Review. 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Understanding the persona of clinical instructors: The use of students\u0026rsquo; doodles in nursing research. Nurse Educ Today. 2008;28:48\u0026ndash;54. https://doi.org/10.1016/j.nedt.2007.02.012.\u003c/li\u003e\n\u003cli\u003eHoney P, Mumford A. The Manual of Learning Styles. Peter Honey Publications;, 3 1992.\u003c/li\u003e\n\u003cli\u003eLi K, Wang H, Siu OL, Yu H. How and When Resilience can Boost Student Academic Performance: A Weekly Diary Study on the Roles of Self-Regulation Behaviors, Grit, and Social Support. J Happiness Stud. 2024;25. https://doi.org/10.1007/s10902-024-00749-4.\u003c/li\u003e\n\u003cli\u003eFarchi MU, Peled-Avram M. The ART of resilience: a theoretical bridge across resilience perspectives. Front Psychol. 2025;16. https://doi.org/10.3389/fpsyg.2025.1556047.\u003c/li\u003e\n\u003cli\u003eWagnild GM, Young HM. Development and psychometric evaluation of the Resilience Scale. J Nurs Meas. 1993;1(2):165\u0026ndash;78.\u003c/li\u003e\n\u003cli\u003eConnor KM, Davidson JRT. Development of a new Resilience scale: The Connor-Davidson Resilience scale (CD-RISC). Depress Anxiety. 2003;18:76\u0026ndash;82. https://doi.org/10.1002/da.10113.\u003c/li\u003e\n\u003cli\u003eAlkhasawneh IM, Mrayyan MT, Docherty C, Alashram S, Yousef HY. Problem-based learning (PBL): Assessing students\u0026rsquo; learning preferences using vark. Nurse Educ Today. 2008;28:572\u0026ndash;9. https://doi.org/10.1016/j.nedt.2007.09.012.\u003c/li\u003e\n\u003cli\u003eAhmad Chaudhry N, Ashar A, Amina Ahmad S. Kinesthetic Learning Styles Pak Armed Forces Med. 2020.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Resilience, Tachikawa resilience scale, Learning styles, Honey and Mumford questionnaire, Clinical instructors, Clinical Clerkship, Microsurgical suturing training","lastPublishedDoi":"10.21203/rs.3.rs-8121680/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8121680/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003ePrevious research has noted that resilience, learning styles, and clinical instructors are crucial determinants of medical students\u0026rsquo; academic outcomes and motivation during clinical clerkship. However, no study has investigated these factors in their relationship with students\u0026rsquo; accomplishment and satisfaction in modules involving substantial hands-on training. This study aimed to examine the associations between resilience, learning styles, the quality of clinical instructors, and undergraduate medical students\u0026rsquo; accomplishment and satisfaction in areas of practical training such as microsurgical suturing.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA total of 109 undergraduate medical students who participated in microsurgical suturing training during their clinical clerkship between October 2024 and June 2025 were included. Resilience was assessed using the 10-item Tachikawa Resilience scale, and learning styles were evaluated using the Honey and Mumford Learning Styles Questionnaire. Students\u0026rsquo; accomplishment and satisfaction with the training and the quality of clinical instructors were measured using a questionnaire designed for this study after the training.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eMedical students\u0026rsquo; resilience was not significantly associated with either accomplishment or satisfaction. By contrast, effective clinical instructors contributed to making practical training more enjoyable and fulfilling. Furthermore, a stronger activist learning preference was found to be significantly associated with higher levels of accomplishment in microsurgical suturing.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eThese findings indicate that enhancing the quality of clinical instructors and incorporating diverse learning approaches may improve medical students\u0026rsquo; accomplishment and satisfaction in practical training. Further studies are warranted to identify other factors influencing their accomplishment, satisfaction, and practical performance.\u003c/p\u003e","manuscriptTitle":"Impact of resilience, learning styles, and clinical instructors on medical students’ experiences in microsurgical suturing training: A web-based questionnaire study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-03 21:23:08","doi":"10.21203/rs.3.rs-8121680/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-04T11:12:57+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-03T01:50:56+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-30T23:42:32+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-28T03:01:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"336730707989897310249040626053929454596","date":"2025-11-26T23:33:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"53495601181516232044086499528195734403","date":"2025-11-26T21:56:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"226497031711631676744491453239638127628","date":"2025-11-26T15:54:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"115613442397244976165357942633905217306","date":"2025-11-26T15:38:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"69951314341994147119576348841413183840","date":"2025-11-26T13:33:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"75013824117215178850513960614427875631","date":"2025-11-26T03:17:29+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-25T05:46:08+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-25T05:31:54+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-11-24T06:49:05+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-22T12:55:39+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-11-22T12:52:48+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"81d9ba7c-cbf8-4138-b6aa-d996e2c2547e","owner":[],"postedDate":"December 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-04-07T16:08:47+00:00","versionOfRecord":{"articleIdentity":"rs-8121680","link":"https://doi.org/10.1186/s12909-026-09099-6","journal":{"identity":"bmc-medical-education","isVorOnly":false,"title":"BMC Medical Education"},"publishedOn":"2026-03-31 15:59:49","publishedOnDateReadable":"March 31st, 2026"},"versionCreatedAt":"2025-12-03 21:23:08","video":"","vorDoi":"10.1186/s12909-026-09099-6","vorDoiUrl":"https://doi.org/10.1186/s12909-026-09099-6","workflowStages":[]},"version":"v1","identity":"rs-8121680","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8121680","identity":"rs-8121680","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}