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Abstract

Learning anatomy is influenced by many factors including sociocultural and education background. We aim to: (a) compare the academic stress, learning styles, and learning strategies of Pasifika (Indigenous peoples of the Pacific Islands) and Pākehā (New Zealanders with European ethnicity) anatomy students and (b) investigate how learning strategies are associated with academic stress. Using an online survey, we gathered data from 43 Pasifika and 42 Pākehā students in 2022–2023 in New Zealand. Pasifika students reported higher levels of academic stress than Pākehā students. Learning styles and preferences for most assessed learning strategies were similar between both ethnic groups. Preferences of reading online materials and group study were associated with academic stress levels, after controlling for age, ethnicity, and gender. Despite the disparities in academic stress levels, Pākehā and Pasifika anatomy students have similar learning styles and learning strategies. Other factors are likely to contribute to their academic stress.

Keywords

academic stress anatomy education ethnic differences learning strategies Pākehā students Pasifika students

Introduction

Anatomy education is a critical component of health care professional programmes, including medical, dental, nursing, and allied health programmes. Many institutions offering such programmes teach anatomy to students of various cultural backgrounds. To enhance the student learning experience, anatomy educators need to understand the preferred learning styles and strategies of their students.

Students’ approaches to learning anatomy can vary across different cultural backgrounds. For example, a previous study by Mitchell et al. (2009) found that British medical students preferred to learn anatomy by using revision cards, asking questions in and after class, reciting definitions, and utilizing web-based resources. In contrast, Chinese students in the same study preferred to learn anatomy by studying a whole area before studying smaller areas and performing hands-on dissection, and they also were more likely to find cross-sectional anatomy easy to learn. Both groups of students, however, had similar preferences for using prosections and rote learning in studying anatomy. Similarly, Mustafa et al. (2013) found that Malaysian medical students were more inclined to use cadavers, cross-sectional images and revision cards for learning anatomy compared to Jordanian medical students. Both Jordanian and Malaysian students showed similar preferences for studying anatomy using plastinated models and online resources, as well as engaging in rote learning and reviewing clinical cases. Another study (Zurada et al., 2011) further showed that Taiwanese students had a lower preference to study anatomy using prosections compared to American and Polish students, whereas Polish students preferred using plastic models less than Taiwanese and American students.

Many health sciences educators have used the VARK^® questionnaire—an acronym for four types of learning styles namely visual, aural, read/write, or kinaesthetic—to determine students’ preferred learning modalities (Childs-Kean et al., 2020). The questionnaire can indicate if a student has one or more preferences of these learning styles. Past studies have used the VARK questionnaire to gain insights into how students learn anatomy. For instance, Meyer et al. (2016) found that the majority of students in their cohort were multimodal learners with visual and kinaesthetic preferences. However, they did not find a significant association between learning style preferences and the time students spent using mobile anatomy apps. Similarly, Husmann and O’Loughlin (2019) reported that the majority of their sample were also multimodal learners.

Anatomy is unique among the branches of the health sciences, as students can employ various styles that incorporate the four components of VARK. These styles include using visual - for example using anatomy atlases or schematic diagrams of anatomical structures - aural - for example listening to lectures, discussions with peers or academics - read/write - for example reading textbooks or lecture notes - and kinaesthetic - for example performing dissections on body donors or handling prosections. In a previous study on first-year medical students, most students are either bimodal or trimodal learners (Kharb et al., 2013). To our knowledge, no study has examined cultural differences in VARK learning styles among anatomy students.

Studies in other areas suggest the possibility of cultural differences in VARK learning styles. For example, McKean et al. (2009) found that 3% of students at a Hong Kong university and 13.9% of students at an American university had the A-R-K trimodal style. In addition, they found that 17.4% of students at the Hong Kong University and 26.7% of students at the American university had the quadmodal V-A-R-K style. However, the authors did not indicate whether the differences were statistically significant. Other studies have also found differences in raw VARK scores between students of various cultural backgrounds, such as between Chinese and Malay students (Wong et al., 2017) or between English and non-English speakers (James et al., 2011). However, these findings must be interpreted with caution, as the developer of the VARK questionnaire does not recommend analysing raw scores due to the ability of participants to select more than one answer per question (VARK Learn Limited, 2024a).

Overall, these findings underscore the potential for cultural differences in learning styles within a diverse student cohort. New Zealand universities host students from various ethnic and cultural backgrounds, with the majority being Pākehā, and also significant numbers of students from other ethnicities and cultures, such as Māori, Pacific Islands, and Asian students. It is possible that students from different ethnic backgrounds in New Zealand may have varying styles of learning anatomy. Thus, anatomy curricula should be designed with consideration for ethnic diversity to ensure that they are culturally appropriate and responsive.

Pasifika students in New Zealand

According to the 2023 New Zealand Census of Population and Dwellings, approximately 8% of the New Zealand population consists of Pacific peoples (Stats NZ Tatauranga Aotearoa, 2024). The term “Pasifika” in New Zealand refers to people who have migrated from the Pacific Islands or descendants of those who migrated from the Pacific Islands to New Zealand (Airini et al., 2010). The various Pacific regions have similarities and differences in their cultures, languages, and experiences.

In New Zealand universities, Pasifika students are an ethnic minority. Internal data from the University of Otago indicate that Pasifika students make up around 9% of the medical student population. Furthermore, there are approximately 90–100 Pasifika students each year who are enrolled in anatomy courses at the University of Otago (Time et al., 2023). Past studies have shown that there are disparities in academic outcomes between Pasifika and Pākehā (New Zealander with European ethnicity) students in New Zealand universities, including among health care professional programmes (Wikaire et al., 2017), undergraduate science courses (Sopoaga et al., 2013), and first-year undergraduate anatomy (Brown et al., 2018) courses. More recently, our team found that there are disparities in academic performance in anatomy courses between Pasifika and Pākehā students in the University of Otago (Time et al., 2023). Furthermore, male Pasifika students appear to have more stresses related to academic expectation than female Pasifika students (Fakapulia et al., 2023).

Various factors may contribute to the disparity in academic outcomes between Pākehā and Pasifika students in New Zealand. Cultural and religious factors may potentially affect the anatomy learning of Pasifika students. For example, deceased human bodies are considered tapu (sacred or taboo) in Pacific cultures (Fakapulia et al., 2024), which may influence Pasifika student engagement in anatomy labs where they need to handle prosections or perform body dissections. In addition, given that most Pacific peoples are religious (Stats NZ Tatauranga Aotearoa, 2024), Pasifika students may feel uncomfortable in viewing nudity in lectures - for example from surface anatomy content - or laboratories - for example deceased body donors (Fakapulia et al., 2024). While the University of Otago also has an anatomy museum, which provides study spaces but also hosts many dissected human materials (Neuman, 1993), it is currently unknown if Pasifika students are more or less likely to study there than Pākehā students. Since these cultural and religious factors may affect Pasifika student engagement in anatomy classes, their anatomy learning strategies may differ from those of Pākehā students. As an example, if students do not prefer to study using prosections, they may use alternative study tools like anatomy apps, textbooks, or plastic models.

In this study, we aim to (a) compare the academic stress, learning styles, and learning strategies of Pasifika and Pākehā anatomy students at the University of Otago and (b) investigate how learning strategies are associated with academic stress levels. Findings from this research should provide new insights into ethnic differences in learning strategies. The information can be used by anatomy academics to develop strategies for delivering anatomy content to a diverse cohort of students.

Method

Kakala methodology

In this study, we were guided by the kakala methodology as previously described (Johansson-Fua, 2023; Thaman, 1993), which is a research framework modelled after the creation of kakala (Tongan fragrant plants used in garlands). The kakala has three main aspects:

Toli—Toli is the process of collecting and selecting fragrant flowers, and metaphorically represents the data collection phase. During this stage, we identified our target group which comprised second- and third-year Pasifika and Pākehā anatomy students. This phase also encompasses the development of research questions, gathering questions for the survey, and securing ethical approval. The protocol for this research was approved by the University of Otago Human Ethics Committee (D23/212). In addition, we also secured funding for this research from the School of Biomedical Sciences of our institution.

Tui—Tui represents the process of crafting the garland. This phase symbolizes the stage of data analysis phase. Upon the completion of the survey, our team analysed the data and summarized the findings. This stage also includes the manuscript preparation process.

Luva—Luva represents the act of gifting a completed kakala to someone else with genuine humility. In our study, each participant received a koha of $30 gift card. In addition, this phase symbolizes our intention to use our findings to inform our department about how to better support their Pasifika students in their academic journey.

Recruitment

We launched an online survey that lasted for the duration of September 2023. Using a convenience sampling strategy, the survey was sent via email to a total of 74 Pasifika students and 176 randomly selected Pākehā students who took anatomy courses at second- and third-year undergraduate levels at the University of Otago. First-year undergraduate students were excluded because first-year courses were not solely taught by the Department of Anatomy, and the anatomy content they learn in first-year studies was not extensive.

To avoid confounding ethnic variables, we only recruited Pākehā students who solely identified as “New Zealand European/Pākehā” in the University of Otago’s database. The term “New Zealand European” refers to New Zealanders who are of European descent. Students who identified as “Australian”, “British/Irish”, “Dutch”, “German”, or “Other European” were not invited to join the study.

To recruit Pasifika students, the survey was sent to students who identified at least one of the following Pacific ethnicities: “Samoan”, “Cook Islands Māori”, “Tongan”, “Niuean”, “Tokelauan”, “Fijian”, or “Pacific peoples, not further defined”. Pasifika students who also identified as “New Zealand European/Pākeha” or other ethnicities were categorized as Pasifika. Considering the small proportion of Pasifika students at the University of Otago, Pasifika students with more than one ethnicity were also recruited to reach a sample size large enough for comparison with Pākehā students.

In the invitation email, we included a brief description of the study and the survey link. The landing page of the survey had the Participant Information Sheet and Consent Form. Participants could only access the survey after they consented to the study. We built the survey on the Research Electronic Data Capture database. Participants needed around 15 minute to fill in the survey.

Questionnaires

The survey included questions on:

Demographics

Participants answered questions on age, ethnicity, gender, place of birth, place of upbringing, first language, high school equity index, anatomy courses they had taken, and whether they completed the university’s foundation programme. The University of Otago offers a foundation programme that is designed to prepare students for their future university studies. The foundation programme is not mandatory for all students. However, students who complete the foundation programme may potentially be better prepared for university studies than those who do not enrol in the foundation programme.

Perception of academic stress scale

Academic stress was assessed using the Perception of Academic Stress Scale (Bedewy & Gabriel, 2015). This questionnaire consists of 18 items related to academic stress. These items can be categorized into stresses related to academic expectations, academic work and examination, and students’ academic self-perception. Each item can be rated on a scale ranging from “strongly disagree” (1) to “strongly agree” (5). The internal consistency in our study was α = .779.

VARK learning styles

Permission was granted for the research team to use Version 8.01 of the VARK Questionnaire (VARK Learn Limited, 2024b) to examine the preferred learning styles of the anatomy students. Our survey included instructions for participants to complete the VARK questionnaire on a separate website. After they completed the VARK questionnaire, they could enter their learning preferences on our survey.

The VARK questionnaire consists of 16 questions, with four answer options for each question. Once participants completed these questions, they received information on their learning style preferences. This could be V (Visual), A (Aural), R (Read or Write), K (Kinaesthetic), or any combination of 2–4 of these preferences. We chose to use this questionnaire because it is easy to use, publicly available, and allows us to detect one or more learning style preferences.

Learning strategies

Participants rated statements about 20 anatomy learning strategies on a scale from 0 (not at all) to 10 (all the time). Each statement began with “In learning anatomy, generally I prefer to [xx]”, and xx is replaced with the different strategies. For each strategy, the statement can be rated from 0 (not at all) to 10 (all the time). The 20 strategies were: “read textbooks”, “read online materials (e.g. from a website)”, “read lecture notes”, “read lab manuals”, “review past exam questions”, “listen to lecture recordings”, “watch online videos”, “use plastic models”, “use real human bodies”, “use an anatomy learning app”, “use flashcards”, “use colouring book”, “draw or make diagrams”, “talk to academic staff”, “study alone”, “study in a group or with friend(s)”, “study at home”, “study in libraries”, “study in the anatomy museum”, and “study in the anatomy labs”. These 20 strategies were determined by our research team based on commonly observed and reported student practices.

Data analyses

Statistical analyses were performed using the Statistical Package for the Social Sciences (SPSS) (IBM, version 29) software. Categorical and continuous variables were compared between ethnicities using the chi-square and t-test, respectively. Principal component analyses (PCAs) with direct oblimin rotation were performed to construct factor scores that underlie the 20 learning strategies assessed in this study. Preference for all 20 strategies loaded onto the identified factor scores. Multiple linear regressions were performed to determine how preferences for different learning strategies were associated with academic stress while adjusting for age, ethnicity, and gender. In the first step, age, ethnicity, and gender were entered into the model. In the second step, preferences for the 20 learning strategies were entered using the stepwise method. Statistical significance was set at p < .05.

Results

Demographics

Table 1 compares the demographics of our participants based on their ethnicities. Pasifika students were, on average, significantly older than Pākehā participants, t(92) = 3.792, p < .001. The top three ethnicities among Pasifika participants were Tongan (30.2%), Fijian (23.3%), and Cook Island Māori (18.6%). Proportionally, there were significantly more Pasifika participants who had completed four of the 12 anatomy courses compared to Pākehā participants. Significant differences were observed in the birth location, χ²(3) = 11.006, p = .012, but not in the place of growing up, χ²(3) = 7.076, p = .070. Significantly fewer Pasifika participants (62.8%) had English as their first language than Pākehā participants, 100%; χ²(1) = 19.252, p < .001. A higher proportion of Pasifika students (23.3%) had attended the University’s Foundation Programme compared to Pākehā students, 4.8%; χ²(1) = 5.994, p = .014, prior to the start of their first-year university studies. In addition, Pasifika participants, on average, came from high schools with higher equity index numbers than Pākehā participants, t(69) = 3.323, p = .001.

Table 1.

Demographic data of Pasifika (Indigenous peoples of Pacific Islands) and Pākehā (New Zealanders who identified with European ethnicity) participants.

	Pasifika	Pākehā	p-values
Age	21.6 (2.1)	20.2 (0.8)	< .001
Ethnicities
Pākehā	12 (27.9)	42 (100)
Māori	6 (14)
Samoan	7 (16.3)
Fijian	10 (23.3)
Tongan	13 (30.2)
Cook Island Māori	8 (18.6)
Niuean	3 (7)
Tokelauan	1 (2.3)
Kiribati	1 (2.3)
Asian	4 (9.3)
Middle Eastern/Latin American/African	1 (2.3)
Other ethnicities	5 (11.6)
Gender			.296
Male	18 (41.9)	13 (31)
Female	25 (58.1)	29 (69)
Had completed
Second year
General anatomy	30 (69.8)	23 (54.8)	.153
Neuroscience	37 (86.0)	24 (57.1)	.003
Reproductive biology	22 (51.2)	14 (33.3)	.096
Biological anthropology	18 (41.9)	8 (19.0)	.022
Third year
Functional anatomy	13 (30.2)	6 (14.3)	.078
Cell biology	10 (23.3)	1 (2.4)	.004
Reproductive biology	8 (18.6)	4 (9.5)	.229
Developmental biology	10 (23.3)	5 (11.9)	.170
Neurobiology	14 (32.6)	4 (9.5)	.009
Neuroscience Research 1	6 (14.0)	3 (7.1)	.308
Neuroscience Research 2	4 (9.3)	4 (9.5)	.972
Biological anthropology	8 (18.6)	3 (7.1)	.115
Birth location			.012
North Island	30 (69.8)	31 (73.8)
South Island	3 (7)	9 (21.4)
Pacific Island	8 (18.6)	0
Outside of NZ	2 (4.7)	2 (4.8)
Primary place of growing up			.070
North Island	28 (65.1)	28 (67.7)
South Island	9 (20.9)	14 (33.3)
Pacific Island	5 (11.6)	0
Outside of NZ	1 (2.3)	0
Attended a Foundation Programme	10 (23.3)	2 (4.8)	.014
English as first language	27 (62.8)	42 (100)	< .001
High school equity index	457.2 (44.1)	427.7 (29.6)	.001

Data are presented as mean (standard deviation) for continuous variables and number (percentage) for categorical variables.

Perception of academic stress

As shown in Figure 1, the total score for academic stress was significantly higher in Pasifika than in Pākehā students, t(83) = 2.624, p = .010. More specifically, stresses related to academic work, t(83) = 2.791, p = .007, and academic self-perception, t(83) = 2.436, p = .017, were significantly higher in Pasifika than in Pākehā students. Stresses related to academic expectation were comparable between the two ethnic groups.

Figure 1.

The average scores of total academic stress and its subscales between Pasifika (grey bars) and Pākehā (white bars) students. Perception of academic stress, particularly stresses related to academic works and self-perception, was higher in Pasifika than in Pākehā students. Significantly different from Pākehā students, *p < .05; **p < .01.

VARK learning styles

Figure 2 illustrates a similar distribution of VARK learning styles between Pasifika and Pākehā students. The proportions for visual, aural, read/write, and kinaesthetic preferences were 67.7%, 71%, 58.1%, and 96.8% for Pasifika students and 53.7%, 68.5%, 59.3% and 87% for Pākehā students -as Figure 2(a) shows. In addition, the proportions for mono-, bi-, tri-, and quad-modal styles were 16.1%, 25.8%, 6.5%, and 51.6% for Pasifika students and 27.8%, 16.7%, 14.8%, and 40.7% for Pākehā students - as shown in Figure 2(b). Neither the preference for any of these learning styles nor the number of preferred learning style modalities was associated with students’ academic stress.

Figure 2.

The proportions of Pasifika (grey bars) and Pākehā (white bars) students with visual, aural, read/write and kinaesthetic learning preferences (a), and mono-, bi-, tri-, and quad-modal learning preferences (b). Students of both ethnicities had similar learning preferences.

PCA

In the final PCA (Supplementary Material), the Kaiser–Meyer–Olkin measure of sampling adequacy was .589, and the Bartlett’s test of sphericity was significant, χ²(190) = 498.850, p < .001. Eight latent constructs were identified, and they accounted for 72.8% of variance in the data. The identified latent constructs were “studying using 3D materials”, “private learning”, “studying in libraries”, “studying using recall methods”, “studying visually”, “drawing and colouring”, “interpersonal learning”, and “studying using provided resources”.

Comparison of learning strategies

Table 2 compares the factor scores for the learning strategies between our participants based on their ethnicities. Pākehā participants showed a higher factor score in “studying in libraries”, t(80) = −2.64, p = .010, d = −.562. The other factor scores were similar between ethnicities. The rating scores for individual learning strategies are shown in Figure 3.

Table 2.

Comparison of factor scores for the learning strategies between Pasifika and Pākehā students.

Factors scores	Pasifika	Pākehā	p-values
Studying using 3D materials	−.041 (1.11)	.039 (.90)	.722
Private learning	−.005 (1.04)	.004 (.971)	.968
Studying in libraries	−.288 (1.04)	.274 (.886)	.010
Studying using recall methods	−.167 (1.14)	.159 (.834)	.141
Studying visually	.157 (.95)	−.15 (1.03)	.166
Drawing and colouring	.036 (1.09)	−.034 (.917)	.753
Interpersonal learning	.118 (1.04)	−.113 (.959)	.298
Studying using provided resources	−.072 (0.983)	.069 (1.02)	.528

Data are presented as mean (standard deviation).

Figure 3.

The average scores of preferring various learning strategies between Pasifika (grey bars) and Pākehā (white bars) students. Pasifika students reported a higher preference for studying at home but a lower preference for studying in libraries than Pākehā students (d). Students of both ethnicities had similar ratings on the other 18 learning strategies (a-d). Significantly different from Pākehā students, *p < .05; **p < .01.

Association between learning strategies and academic stress

From our regression analyses (Table 3), we found that preferences for “reading online materials” (β = −.298, p = .016) and “studying in a group” (β = .269, p = .025) were associated with their academic stress levels, after controlling for age, ethnicity, and gender. In the regression model, the Pākehā ethnicity was associated with a lower academic stress level (β = −.343, p = .014).

Table 3.

Linear regression analyses determining how learning strategies are associated with perceived academic stress, after controlling for age, gender, and ethnicity.

Variables	B	SE	β	p	R ²	F	Model P
Step 1					.082	F(3,61) = 1.808	.155
Age	.004	.042	.013	.926
Gender	.029	.142	.026	.837
Ethnicity	−.305	.148	−.284	.044
Step 2					.166	F(4,60) = 2.994	.026
Age	−.019	.041	−.061	.648
Ethnicity	.047	.136	.042	.732
Gender	−.410	.148	−.382	.008
Reading online materials	−.060	.024	−.306	.016
Step 3					.235	F(5,59) = 3.633	.006
Age	−.028	.040	−.090	.489
Gender	.038	.132	.034	.772
Ethnicity	−.367	.144	−.343	.014
Reading online materials	−.058	.023	−.298	.016
Studying in a group	.057	.025	.269	.025

Preferences for 20 learning strategies were entered using a stepwise method. Gender was coded as 1 = male, 2 = female; ethnicity was coded as 1 = Pasifika, 2 = Pākehā.

Discussion

In this study, we found that Pasifika students reported experiencing higher levels of academic stress than Pākehā students. However, they had similar learning styles, that is, there were comparable proportions of Pasifika and Pākehā students who were visual, aural, reader, and kinaesthetic learners. In addition, students from both ethnic groups had similar preferences for most learning strategies, except for the study location. Pasifika students reported a lower preference for studying in libraries than Pākehā students. We also found that preferences for reading online materials and group study were associated with students’ academic stress, after controlling for age, ethnicity, and gender.

Perception of academic stress

The difference in academic stress levels between Pasifika and Pākehā students is consistent with previous findings (Time et al., 2023) that there are disparities in academic performances of Pasifika and Pākehā students in anatomy courses. The reasons for these disparities are likely to be complex. Universities in New Zealand are established upon Western values that put emphasis on individuality and independence (Uskanbaevna, 2021). On the contrary, relationship building and collectivism are valued in Pacific cultures, including in education (Reynolds, 2016). Consequently, Pasifika students must negotiate cultural values to adapt to Western pedagogies, which can be a challenging process for many (Siope, 2011). In addition, Pasifika students may have additional challenges that are unrelated to academic factors, such as social anxiety as an ethnic minority (Fakapulia et al., 2023) and mental health (Time et al., 2024). This may partially be related to the fact that few academics at NZ universities are Pasifika (Naepi, 2019). Consequently, few staff are competent in Pacific cultures or may not know how to respond to Pacific student matters in culturally sensitive ways.

Comparison of learning styles and strategies

Here, we found that the VARK learning styles and anatomy learning strategies were comparable between Pasifika students and Pākehā students. Most students were kinaesthetic learners - 96.8% and 87% among Pasifika and Pākehā, respectively. In addition, 51.6% of Pasifika students and 40.7% of Pākehā students were quadmodal. The similar proportions of VARK preferences contrast with by McKean et al. (2009), which found cultural differences in the proportions of students from Hong Kong and the USA with trimodal (A-R-K) and quadmodal (V-A-R-K) learning style preference. Similarly, past studies have indicated different anatomy learning style preferences between students of various cultures (Mitchell et al., 2009; Mustafa et al., 2013; Zurada et al., 2011). However, we did not observe any significant differences in learning style preferences between Pasifika and Pākehā anatomy students.

One potential explanation for our results is that over 85% of Pasifika students in our cohort grew up in New Zealand and were educated in the New Zealand education system, so they may have developed similar learning style preferences and strategies to their Pākehā counterparts. In addition, the students in our cohort are either second- or third-year biomedical sciences students, so the majority had completed the same first-year undergraduate studies, which may contribute to their similar strategies for learning anatomy courses.

One unexpected finding was the similar preference levels for studying anatomy using real human bodies - for example cadavers or prosections - and for studying in the anatomy museum in the Department of Anatomy, where the study space features many displays of deceased human body parts (Neuman, 1993). Deceased human bodies are considered tapu in Pacific cultures (Fakapulia et al., 2024), so we anticipated that Pasifika students would have a lower preference for studying using deceased human materials or studying in close proximity to prosections in the anatomy museum. However, we recognize that Pasifika students in our cohort had been regularly exposed to human body donors in the teaching spaces. In addition, the survey was distributed in the second half of the second semester, rather than in the first semester, so the participants may have become accustomed to viewing human body donors.

We observed that Pasifika students preferred studying at home rather than in libraries compared to Pākehā students. Both venues – home vs. libraries – have their own advantages and disadvantages. Studying at home allows students more control over their environment, but they may also face distractions such as watching television or preparing food. A study conducted in the Netherlands indicated that students preferred to study at home or quiet learning spaces in their university (Beckers et al., 2016a). Another study found that students favoured home study for its proximity and comfort (Beckers et al., 2016b). Conversely, studying in libraries requires students to travel, even though it provides students with a quiet learning space and opportunities for group study. While studying with friends may facilitate discussion, it may also lead to distractions if conversations shift away from academic matters. In the current study, learning space preference was not associated with academic stress, highlighting the need for further research to determine how learning space preference relates to academic performance.

Our findings suggest that the difference in learning styles and strategies may not account for the disparity in their academic stresses, because students of both ethnic groups have similar learning styles and strategies. Other factors are likely to contribute to their academic stress. For example, Pasifika and Pākehā students have different preferences in completing some academic tasks, assessment types, and perceptions of anatomy learning (Time et al., 2025). In addition, there is also evidence that students’ high school background may be related to their performance at university levels (Uhi et al., 2025). Future studies could explore how these factors are associated with students’ academic stress in their studies at university levels.

Learning strategies and academic stress

Our analyses revealed that a preference for reading online materials was associated with lower academic stress. This relationship may be due to students’ motivation to independently study and better understand a topic. It will be interesting to explore in the coming years how the use of generative artificial intelligence impacts academic stress, particularly in anatomy education.

We also found that a preference for studying in a group or with friends was associated with a higher academic stress. One possible explanation for this relationship is that students may realize that they need to study more after discussing academic topics with others, becoming aware that there are areas they have not yet revised. Alternatively, students experiencing elevated academic stress may be more inclined to seek support from others, for example, from joining group studies.

In this study, we found that Pasifika and Pākehā students had a similar preference of talking to academic staff for their anatomy learning, and that this preference was not related to their academic stress. We did not expect these findings because sociocultural factors can influence students’ behaviour regarding question-asking, such as whether it is considered socially appropriate to question teachers in certain cultures (Dillon, 1982). For instance, a study in Japan indicated that 48% of students felt uncomfortable asking questions in class (Okada, 2017). Furthermore, in a previous study (Fakapulia et al., 2025), there were some feedback that Pasifika students were uncomfortable to approach staff for academic help. In addition, past reports indicated that Pasifika students may sometimes be perceived as shy, unassertive, or lacking in confidence (Davidson-Toumu’a & Dunbar, 2009). This is in contrasts to the Western characteristic of being assertive in academic settings (Chu et al., 2013). While our data indicate a similar preference of talking to staff, we did not assess the frequency of students in approaching staff for academic help. Thus, we do not know whether there is in fact a difference in academic help-seeking frequencies, for example asking questions, between the two ethnic groups, or if the frequency of approaching staff for help is related to their academic stress.

Asking questions is an important aspect of learning, as it stimulates student thinking (Dillon, 1982). In a previous study (Rubin et al., 1990), communication competence in university students correlates negatively with communication apprehension; for example, students with better communication skills were less likely to experience communication apprehension. As educators, academic staff should find ways to encourage students to ask questions. In courses with underrepresented ethnic minority students, such as Pasifika students, academics need to recognize the cultural sensitivities and cultural humility involved when approaching them. For example, in Pacific cultures, students appreciate teachers who are warm, welcoming, and show genuine care (Alkema, 2014). This may involve creating an environment where students feel comfortable asking questions without fear of judgement. One supportive learning space at the University of Otago is the Pacific Islands Centre, which organizes tutorials, including for anatomy courses, specifically for Pasifika students (The University of Otago, 2024). In this setting, Pasifika students can engage in further discussion with their tutor in a small-group environment.

Limitations

There are several limitations to this study. As Pasifika students in our Department are ethnic minority, their numbers are relatively smaller compared to Pākehā students. For this reason, we were unable to perform sub-analyses on the learning preferences of specific Pacific ethnicities. In addition, we recruited Pasifika students who had multiple ethnic backgrounds, which may potentially confound the results, as their learning experience might differ from those of Pasifika students with a single ethnicity. However, due to the much smaller number of Pasifika students in our Department, recruiting Pasifika students with multiple ethnicities was necessary. We also acknowledge our recruitment involved a convenience sampling strategy. Given that many students are familiar with our team, there may be sampling bias. However, aside from sending email invitations and reminders, we did not approach the participants in person. Furthermore, there is a possibility that our findings may not be generalizable to students from other departments or universities.

Conclusion

In conclusion, Pasifika and Pākehā anatomy students have disparities in their academic stress levels. However, differences in learning styles and strategies may not explain this disparity. We also found that a preference to learn by reading online materials was associated with lower academic stress, whereas a preference of studying in a group or with friends was associated with higher academic stress. These findings emphasize the complexity of factors that contribute to students’ academic stress, and how some of them may be related to any ethnic difference in academic stress.

Academic institutions should explore ways to support underrepresented ethnic minority students throughout their educational journey, particularly when there are disparities in their academic performance and academic stress. In anatomy education, cultural factors are likely to play a significant role because attitudes towards using deceased human donors as learning tool may vary between cultures. Therefore, anatomy educators need to approach their teaching with sensitivity, recognizing that cultural factors may influence student engagement.

Supplemental Material

sj-docx-1-aln-10.1177_11771801251405563 – Supplemental material for Ethnic differences in academic stress and learning preferences in anatomy between Pasifika and Pākehā students

Supplemental material, sj-docx-1-aln-10.1177_11771801251405563 for Ethnic differences in academic stress and learning preferences in anatomy between Pasifika and Pākehā students by Ravikash Rajveer Prasad, Latika Samalia and Erik Wibowo in AlterNative: An International Journal of Indigenous Peoples

Footnotes

Authors’ note

Ravikash Rajveer Prasad (BSc(Hons)) is a Bachelor of Science with Honours student of Fijian descent in the Department of Anatomy at the University of Otago. At the time of study recruitment, Ravi was completing his undergraduate degree, and this research study was his first research experience. He has completed his BSc(Hons) with the award of 1st Class Honours, in which he investigated the effects of neurofeedback using a brain-computer interface on pain outcomes.

Latika Samalia (DSM, PGDipSci) is a Senior Professional Practice Fellow in the Department of Anatomy at the University of Otago. Dr. Samalia is originally from Fiji. She is currently a Pacific student liaison within the department. Her research interests focus on the educational experiences of Pasifika students, aiming to promote academic excellence among this group.

Erik Wibowo (PhD) is an Associate Professor at the University of Sydney. At the time of study recruitment, he was a Senior Lecturer in the Department of Anatomy at the University of Otago and was a Pacific student liaison. His research interests include student wellbeing and anatomy education.

ORCID iDs

Ravikash Rajveer Prasad

Erik Wibowo

Ethical considerations

The protocol for this research was approved by the University of Otago Human Ethics Committee (D23/212).

Author contributions

Study concept and design: E.W., L.S., and R.R.P.

Acquisition of data: E.W., L.S., and R.R.P.

Analysis and interpretation: E.W., L.S., and R.R.P.

Critical revision of the manuscript for important intellectual content: E.W., L.S., and R.R.P.

Study supervision: E.W.

Funding

The authors disclosed receipt of the following financial support for the research, authorship and publication of this article: The Kickstarter Fund from the School of Biomedical Sciences to Dr E.W.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and publication of this article.

Supplemental material

Supplemental material for this article is available online.

Glossary

kakala Garlands in Tonga made from flowers, fruits, and leaves that are worn at special events or given to respected people to show love and honour

luva A heartfelt gift to honour another person, given with humility and sincerity

Pākehā New Zealanders who identifies with the European ethnicity

Pasifika Indigenous peoples of the Pacific Islands, who either were born in or migrated to New Zealand

tapu sacred or taboo

toli Picking materials, for example, flowers and leaves, for making a kakala

tui The process of making a kakala

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