11Nursing Research Center, Golestan University of Medical Sciences, Gorgan, IRAN
2Education Development Center, Golestan University Of Medical Sciences, Gorgan, IRAN
3Student Research Committee, Golestan University of Medical Sciences, Gorgan, Iran
4Student Research Committee, Golestan University of Medical Sciences, Gorgan, IRAN
5Faculty of Nursing and
Midwifery of Amol, Mazandaran University of Medical Sciences,
Background: the inappropriate use of handouts and notes is a common academic problem among students. Students' notes are too brief and incomplete in compare with references; hence they may not cover the required content for the courses. The aim of this paper is to analyze students' attitude toward reading handouts and notes instead of references. Methods: In this analytical and descriptive study a representative sample of 201participants, including medical, paramedical, nursing and midwifery students of Golestan University of Medical Sciences, has been drawn. The data derived from this research has been collected by a valid and reliable questionnaire. There have been 39 questions in the questionnaire ranging from 1 to 5, based on Likert scale; five represents that students are proponent of reading notes. The sum of scores was 20; the 16th version of SPSS, T-test, one-way and two-way variance analysis at significance level pFindings: 66.7% of participants were female. ANOVA test showed that there were significant differences among the mean of attitudes of medical students (18.15±1.37), nursing (17.15±1.46), and paramedical (17.67±1.35) (P=0.008). The overall results revealed that the huge amount of content of references is the main factor for students' tendency to use notes instead of references. Conclusion: the final result was that students have got positive attitude to note-taking during courses and use their notes as their direct reference material, while the class notes are not reasonably efficient, particularly when used as the main learning strategy.
There are some important factors to achieve academic success, including an organized and integrated program of study, an appropriate use of reference materials and sources, great perseverance, regular class-attendance, and good study habits. Learning motivation, learning style, time and place of study are mentioned as influential factors on learning, as well (1).
Textbooks and class handout materials are two frequent and main sources of information for the students. The privileges of references to classroom notes are as follow: the students can clarify their misunderstandings, complete their notes, and cover the missing information; while the class notes are taken quickly, are brief in details, or even sometime completely different from the presented lectures in the class (2).
One of very common educational problems is using notes, taken in classes, as the main reference instead of textbooks at universities. Class notes or handouts cannot cover all required content of a course for the students. A study has revealed that students devote fifteen thousand hours each year to note-taking which gradually leads to the loss of scientific sensitivity among them. That would have deep harmful effects on educational motivation and learning (3).
Although note-taking helps students to have a quick review of lessons, one of the main problems is that they may not be sure which parts of class presentations are the most important. Some of the students have complains that there is a degree of ambiguity in teachers' lectures or they speak very fast, so they cannot take notes along with teacher's presentation. These sorts of scattered notes are not often helpful for a good learning (4).
In a study, conducted by Rashidian, the effectiveness of different types of learning materials, used by students in courses of basic medical sciences, was evaluated. The class notes had the most influence while materials such as English or Persian references had the least (5).
There are various factors that reinforce students' tendency for note-taking instead of reading references. For instance they think that reading textbooks is time consuming; moreover they do not have enough proficiency in English. Also some of faculty members' teaching methods make students take notes (6).
A survey on student's attitudes to e-learning was administered among dentistry scholars. It revealed that 96 percent of them used both books and class notes together. The majority of students mentioned that electronic materials are useful when used along with traditional methods such as note-taking (2). According to medical students' perspective, a mixed content that consist of class notes, electronic materials and textbooks would strongly enhance students' learning (7).
A comparison of National Basic Science Exams' results, set in Hamadan Medical University, revealed that students have got better results among the other universities. In 6th exam, in which students took the courage to read references instead of their own notes, the results were even better than 4th exam (8).
Having a study plan, an appropriate learning style, and reading required learning materials are necessary factors for the students to succeed in education. In a study, 83 percent of students stated that they always study their notes during semester, and 91 percent of them mentioned that their notes are their main source of study for final exams (1). Tendency for note-taking in classes and using them instead of books would have negative effect on the learning process, as well as research interests and stimulation (6). Lack of good learning materials and study guides were some of the problems that mentioned by the students who couldn’t pass academic courses. Holding specific learning skills or study skills workshops and providing educational consultation, provide positive feedbacks and outcomes (9).
This study is conducted with regard to the students' motivation and attitude toward note-taking and using it instead of textbooks.
In this analytical and descriptive study a representative sample of 201participants, including medical, paramedical, nursing and midwifery students of Golestan University of Medical Sciences, has been drawn. The estimated sample size is based on two way significance, α=0.05, and testing power 80% (d=0.4). Data have been collected by a self-administrated tool, composed of 39 closed questions and 6 questions originated from Ghazavi's study (2008). The questionnaire included three parts; 1) demographic-educational items such as; age, sex, marital status, ethnicity, school, major of study and semester; 2) specific questions about attitude toward reading handouts and notes; 3) questions about reading text books. Content validity of the questionnaire was confirmed by 10 faculty members; and the reliability (coefficient of internal consistency) was 0.92, based on Cronbach's alpha (6). Attitude scores were measured on a Likert scale ranging from 1 to 5; five indicates that participants are proponents of note-taking. The sum of scores was 20. With University and Research Deputies' permission, the questionnaires were distributed at the end of classes in Medical, Nursing and Paramedical schools and immediately gathered after they were filled out by the students. Participants were students of Golestan University of Medical Sciences.
Data were analyzed by SPSS (ver. 6) and statistical tests; T-Test, one-way and two-way analysis variance at significance level p
The mean age of students was 21.31±2.01; 66.7% (134) of them were female; 82.1% (165) of the participants were single. In terms of ethnicity 51.7% (104) of the students were Fars. 50.7% (102) of the students were from paramedical school and 92.5% (186) were at bachelorette level programs.
The mean of students' scores from 20 was 17.48±1.4 (CI 95%: 17.28±17.68). The result of Kolmogorov–Smirnov test confirmed the normality of students' attitudes scores. There was a statistical significant difference in mean of attitude's scores in female students 17.58±1.32 in compare with male students 17.29±1.60 (P=0.2).
There was no significant difference between the mean of students' attitude scores related to using hand outs instead of reading textbooks between single students (17.5±1.40) and married ones (17.42±1.53), (P=0.7).
One-way analysis variance test showed a significant difference among mean of medical students' attitude (18.15±1.37), with nursing (17.15±1.35), and paramedical students (17.67±1.35), (P=0.008). The Scheffe Follow-up test confirmed the difference among the medical, nursing and paramedical students too.
According to two-way analysis variance (Table 1) there was no significant difference between major of study, gender and score of attitude (P=0.2). Table 2 shows the frequency of the studied variables and its relationship with mean of attitude scores.
Table 1: The Relationship among Sex, Major of Study, and Attitudes to Note-taking
Major of study
Nursing & Midwifery
Nursing & Midwifery
Table 2: The relationship among the studied variables and mean of students' attitudes scores
Major of study
Nursing & Midwifery
level of study
Nursing & Midwifery
The findings of the study revealed that students have great interest in note-taking and handout reading instead of reading books. Some evidences indicate that lack of references in libraries, particularly specific books required for some courses, is a significant factor that actuates students to read hand-out and notes.
The study by Safi and her colleagues (2010) showed that the amount of available sources in the library of school is on average (1). Providing updated and enough educational materials at universities' libraries might change students' tendency from reading handout to reading books or textbooks. Ghazavi (2009) also reported that students of Arak University have great interest in note- taking during courses and do not study the references that instructors recommend. The huge amount of content of textbooks in compare with brief and short notes has been a primary factor that motivates students to read notes instead of references (6). In a study 83% of the students stated that they mostly used their notes as the main source for the learning (1). Shariati' study (1996) showed that 83% of the students studied only their notes for final exams (3), which is similar to our finding. To solve this problem, students should be guided into a plan that enables them to study the textbooks during the semester and also have appropriate leaning styles. Some authors believe that students' interest in getting university certification and also easy access to manuals and abstracts of textbook are two factors that attract students to read their notes. Without any doubt, applying new methods of teaching by instructors would decrease this problem and actuates students to study references instead of notes (6).
Also lack of English proficiency to read original textbooks predisposes students to note-taking. In a study 84% of students, 76% of interns and 90% of medical residents stated that they study translated books (10). The results of another study showed that only 2.7% of students studied original books (1). Although, the translated books make reading easier, the medical students should have enough English knowledge and could make use of it practically. As mastery in reading textbooks depends on medical students' foreign language skills, a reform in English teaching methods might be necessary at universities. Amin and her colleagues' study (2012) showed that as students' levels of education improve there is wider trend towards surface approach to learning. The authors suggested that medical students should be encouraged to adopt deep approach to learning, with a problem-based learning strategy and group work activities, and spend much of their time reading (11).
There has been a strong relationship between students attitude' scores and demographic data, while other studies reported no relationship among sex, level of study, school and note-taking (6, 12, 13). There is also close relationship between level of education and the trend toward reading notes (10, 14). Although we could not find any relationship between students' average and note-taking, there are other findings against ours (3). Perhaps, using different data gathering tools and methodology is the reason for the controversy findings.
The major limitation of the study was the sampling method. Perhaps convenience sampling is not representative of all students of university. Conducting mixed methodology (qualitative and quantitative) provides better and deeper understanding of this phenomenon. As a final point, there are few studies on educational strategies and behaviors; we hope the findings of this research provide some clues and ideas for educators and education policymakers in order to re-think the challenges of the current teaching-learning strategies.
The students had positive attitudes to note-taking in classes and used them as their main source of educational materials. Since students' notes are often brief, they do not cover all necessary and required content. Moreover, providing extra learning materials by instructors, such as study guides, are very important.
We would like to express our deep appreciation to the students participated in the study. Also we would like to thank Research Committee of Students and Research & Technology Deputy of Golestan University of Medical Sciences for confirmation of the proposal and budget support.
1. Salem Safi R, AshrefRazaee N, Sheikhi N, Khosh klam M, Makhdoomi K, Nabilo B, et al. Investigation of studying styles of Urmia medical science university’s students. Journal of Urmia Nursing and Midwifery Faculty 2010; 8(2): 76-82 (Persian)
2. Gupta B, White DA, Walmsley AD. The attitudes of undergraduate students and staff to the use of electronic learning. British Dental Journal 2004; 196(8): 487 - 492.
3.Shariati B, Javadi H, Habibi GR, Soleymani F. Attitudes and Practice medical students about lesson resources, Tehran, Iran. Tehran University of Medical Sciences Publications 1996 (Persian).
4. Hull C, Rawlins K. Effective note-taking. NT Learn Curve 1997; 1(3):14-5.
5. Rashidian M. Effectiveness of different types of learning materials used by students in courses of basic medical sciences. Abstracts of 5th National Congress on Medical Education. Iranian Journal of Medical Education 2002; 2(8):45 (Persian).
6. Ghazavi A, Rafiei A, Mosayebi G, Abtahi H. The attitude of Arak Medical University student’s about reasons of tendency to use the lecture notes instead of textbooks 2008. Arak Medical University Journal 2010; 12(4, Supp 1): 73-80 (Persian).
6. Southwick FS. Theodore E. Woodward Award: spare me the PowerPoint and bring back the medical textbook. Transactions of the American Clinical and Climatological Association 2007;118:115-122.
7. Sadjadi SM, Saba MS, Ameri E. Evaluation of the results of two successive comprehensive examinations of basic sciences of the medical students of Hamadan University of Medical Sciences and survey of qualitative changes. Scientific Journal of Hamadan University of Medical Sciences & Health Services 1993; 1(1): 76-63 (Persian).
8. Shams B, Farshidfar M, Sanzade A. Effects of counseling on improvement of students. Iranian Journal of Medical Education 2000; 1(1):35-39 (Persian).
9. Mardanian F, Kazerouni zadeh M. Study Styles of Students, Interns and Residents of Obstetrics and Gynecology in Shahid Beheshti Hospital in Isfahan Iranian Journal of Medical Education 2003; 3 (2) :73-77(Persian)
10 . Amini M; Tajamul S; Lotfi F; karimia Z. A Survey on Study Habits of Medical Students in Shiraz Medical School. Future Of Medical Education Journal 2012; 2(3): 28-34
11. Tidwell DL, Heston ML, Fitzgerald LM. Self-Study of Teaching and Teacher Education Practices: New York, US; Springer 2009.
12. Watkins C, Carnell E, Lodge C. Effective Learning in classrooms. London, UK: Paul Chapman Publishing 2007.
13. Nourian A, Shah Mohammadi F, Mousavi Nasab SN, Nourian A. Study Skills and Habits of the Students in Tehran Islamic Azad University of Medical Sciences in the Academic Year 2008-2009. Strides in Development of Medical Education 2010; 7(2): 101-111(Persian).