A time of innovations in medical curricula requires evaluation of the current educational activities, especially when planning major changes from traditional teacher-centered programs to modern student-centered models. Teachers in higher education need to (re)examine their traditional assumptions on education, in order to foster the desirable incorporation of new learning and teaching strategies [1,2].

Among the aspects that should be examined in this evaluation process are the students’ approaches to learning and the teachers’ approaches to teaching. It is important to determine if education is conceived as a transmission or accumulation of information or as a restructuring of the gained information to elicit conceptual changes [3]. The results of the evaluations can serve several purposes: inform policy makers and academic staff about current teaching and learning approaches, suggest improvements in practice and apply adequate methods and changes to become more effective professionals [4]. Teaching and learning activities need to be properly aligned in order to optimize the learning environment and thus, assure a high quality program [5]. This alignment consists in achieving optimal congruence between clear learning objectives and appropriate educational interventions to reach these objectives [6]. Supporting this statement are the papers by De Vita and Cook demonstrating that incongruence between teaching and learning styles constitute an impediment for meaningful learning [7,8].

A congruent alignment between approaches of both students and teachers is necessary for the most effective educational gain [1]. In order to guide and stimulate students towards becoming self-directed, reflective, and life-long learning professionals, teachers need to focus on supporting and guiding students in their development of knowledge, skills and attitudes and in achieving their goals, instead of focusing on transmitting enormous amounts of factual knowledge. In addition, educators need to make sure that the context of the educational environment does stimulate and guide students towards the adoption of these learning abilities or habits [3,9].

During the last four decades, several authors have conducted research in the field of students’ perceptions and the activities related to their learning, as the focus point of the teaching/learning system [10,11,12,13,14]. This served as framework for what is known as the Student Approach to Learning (SAL) theory. Learning Approach (LA) makes reference to the student’s perspective of the educational context and the intentions in relation to his/her learning activities. Students who possess knowledge of different learning approaches and are made conscious of their own choices can apply various cognitive strategies to enhance their learning and their level of academic satisfaction [15].

SAL theory states that the learning approach of students depends on the complex relationship between their motives for learning, their perceptions of the demands required by the task at hand, the teaching methods of their educators and the educational context in which they are enrolled [5]. Learning is considered a process that is susceptible to shaping, where dynamic interactions occur among the student, his/her motives and the perceived learning environment [16].

As a way of depicting this complex and dynamic process in a simplified manner, Biggs designed the 3-P Model: Presage-Process-Product [10,17]. Within this model, to be explained next, all factors addressed in the SAL theory have a place in one of the levels.

Research has identified two approaches to learning: the surface and the deep approach. The first study to identify these two approaches was conducted by Marton and Säljö among students in a reading assignment, but these findings have been further confirmed across other subject area by different authors [10,12,18,19]. The learning approach taken by students primarily addresses aspects of the process level in the 3-P model, but it is highly influenced by factors from the presage and product levels.

Since students’ learning approaches are strongly influenced by the teaching context, a close evaluation of the approaches taken by educators to fulfill their responsibilities within the educational process is needed. The teaching approach taken is mostly related to the process level of the 3-P Model, but it is significantly influenced by factors from the presage and product levels as well. For optimal educational outcomes, the approaches of both the teachers and the students should be aligned as closely as possible. One should strive for congruence within the program, considering the elements of the 3P Model. This “fit” provides an educational environment that encourages students’ engagement in applying the best learning approach, identified as the deep approach [5].

The challenge of good teaching is to stimulate students to apply higher-level cognitive processes instead of seeing the lower-degree academic commitment of some students as an obstacle to teaching [3]. The focus should be on aspects of the learning environment identified by the learners themselves as being most related to their approaches to learning [33]. Teachers have the responsibility of fulfilling their professional responsibilities with the approach identified as being the one most likely to be associated with higher quality learning outcomes [33]. This can best be accomplished if educators are made aware of and possess knowledge regarding learning and teaching approaches, since they will then be able to design/adjust their course for their learners [15].

Richardson states that appropriate educational interventions (such as teaching approaches and assessment methods) steer learners towards desirable responses of studying and learning [40]. In order to establish the most adequate interventions, difference in approaches have to be identified to tailor the changes in the curriculum accordingly, and to succeed in stimulating students towards the deep approach [20,25].

Authors who have studied the teachers’ approaches to teaching have identified that these choices of actions are related to the conceptions educators have about teaching and learning and the perception they have of the teaching environment [19,41]. Prosser and Trigwell identified two conceptions of teaching: teacher-focused and student-focused [14].

Students’ approach can be explored by means of the Revised Two-Factor Study Process Questionnaire (R- SPQ-2F), composed of 20 items answered on a 1-5 Likert scale which reflect the approach to learning (surface or deep) that students take in a given educational context [5].

The scores of this questionnaire can be used to assess if elements of the educational system (e.g. 3-P Model) are working appropriately in producing the desired results [5]. They also help define/monitor the learning approach of students to a specific context, in response to a specific teaching approach and towards a given task (i.e., approach to learning is context specific and dependent on the perception of each student of that context). The results obtained are not to be interpreted as defining the characteristics of the individual, his/her personality nor his/her capacities and abilities [5].

The R-SPQ-2F has been translated into the Spanish language and validated by several authors in Spanish speaking countries and Latin American settings obtaining similar psychometric values as those obtained by Biggs et al. [16]. The studies used as reference for this paper were conducted in the following settings:

In Argentina and Spain [44].

Buendia and Olmedo found that the Cronbach’s alpha of the overall questionnaire was 0.83 [44]. The Cronbach’s alpha value of the surface subscale ranged from 0.57 in Montealegre and Nuñez, to 0.81 in Gargallo et al. and the Cronbach’s alpha of the deep subscale ranged from 0.63 in Montealegre and Nuñez to 0.87 in Recio and Cabero [45,46,47].

Teachers’ approaches towards their task was measured with the Approaches to Teaching Inventory (ATI) [48]. It consists of 16 items to be answered on a 1-5 Likert. This instrument is aimed at defining how teachers approach their profession in relation to their perceptions of the circumstances surrounding their teaching. The ATI was developed in conjunction with Bigg’s Study Process Questionnaire, to study the relation between students’ and teachers’ approaches to their corresponding educational activity [49]. Another use it has been given is to serve as motivator for discussion among various groups of teachers, in order to raise awareness of qualitative variations in teaching approaches [50]. The ATI has been translated and validated in Spain with a Cronbach’s alpha value of 0.66 for the information transmission/ teacher-focused subscale and a value of 0.74 for the conceptual change/student-focused subscale [51].

The use of these two instruments in conjunction is considered appropriate to evaluate the educational environment, providing a view of the relationship between the components of the complex system of student-context-task. The combination of these tools helps educators gain better understanding of the learning/teaching process in a particular context, to serve the purpose of assessing and enhancing the experience of students in a particular course [40]. These results, in turn, inform the making of adjustments to a program, most suitable to reach the best possible congruent alignment between teaching/learning activities in a given context. The literature clearly demonstrates the importance of making adjustments in to-be-introduced educational interventions in congruence to the preferences and factors identified by students themselves as being the ones exerting the greatest effect on their learning approach [13,15,20,25,33,40,52]. In so forth, this proper alignment will optimize the learning processes and academic outcomes of the students.

In the light of the evidence and supported by authors in this field, programs need to motivate teaches and expect from them the application of educational methods that have shown to steer students towards a deep approach to learning. Teaching staff, in turn, need to make students aware of and reflect on the learning approach they are adopting and encourage them to apply higher cognitive strategies to enhance their educational processes. Findings should serve the purpose of informing staff in the making of evidenced-based adjustments or introduction of innovations and as a stimulus for teachers to reflect, evaluate and reshape their teaching activities and strategies in concordance.

Being student-centered education the main aim of modern innovations, teachers should not only be encouraged to reflect on their activities and improve them, but they must also be properly prepared to affront the new challenges with greater confidence. The importance of working with the staff to encourage the application of higher quality approaches to teaching, conducive to students developing and/or adopting higher quality approaches to learning has been demonstrated. This strategy is expected to steer the program towards the intended goal of providing and ensuring a student-centered education.

Studies of this kind provide valuable information for all higher education institutions planning mayor changes, to design them with care on details towards proper alignment. Numerous programs across the world, where major curricular reforms towards student-centered education have taken longer to set it, can benefit from the findings of these studies on SAL theory, to plan, design and implement curricular reforms with emphasis on informed details and considering the perceptions of students, which are not regularly considered in traditional curricula.