Despite anecdotal evidence, substantiation of individual learning styles does not exist. Preference is a subjective measurement, but does exist. Depending on the number of classes taught, and the volume of students per class, instructors may have hundreds of students per semester. Based on the shortage of nurse educators, instructors may be teaching to larger classes than in the past. Therefore, it is not critical, or even plausible, for educators to adapt teaching to learning preferences in nursing education.

Because of the broad range of abilities of students in each classroom the most efficient method is evaluating the content and presenting lessons based on the material. For example, Daniel Williamgham of the University of Virginia states "if the goal is to teach student the geography of South America, the most effective way to do so across the board would be looking at a map instead of verbally describing the shape and relative location of each country" (Guteri, 2013). Presenting material that captures a concept for most students is the broadest way to impart a concept to the greatest number of students.

A second teaching technique is delivering content through "multiple formats to allow learners to choose which method is most conducive for them" (Mangold, Kunze, Quinonez, Taylor, & Tenison, 2018). Customizing all education to individual preferences would be impossible, so presenting several modes of engagement promotes understanding and retention of content.

Thirdly, encouraging communication among students with each other may enhance learning because each individual student experience and learning preference may create interactions that impart knowledge to other students. Zhu et al. (2018) write "every student acts as a demonstrator to share their learning experience to others (such as their notes, maps, patterns of information created by themselves, and cases, among other things). By communicating with each other, students can optimize the learning strategies and problem-solving methods, which are helpful in improving a student's academic performance".

Based on the above evidence it may be stated that rather than teaching to individual learning preferences, teaching the material in the most practical way, presenting multiple formats, and encouraging the exchange of student information is a broader, less cumbersome way to reach the greatest number of students. Zhu et al. (2018) suggest that as learners grow, they are mare adaptable to different teaching methods and have developed multiple sensory modalities. As nursing students are primarily adult learners this may be further evidence to support presentation of material in multiple formats designed to be absorbed by the greatest numbers of learners.

https://www.scientificamerican.com/article/is-teaching-to-a-students-learning-style-a-bogus- idea/

Mangold, K., Kunze, K., Quinonez, M., Taylor, L., & Tenison, A. (2018). Learning Style Preferences of Practicing Nurses. Journal for Nurses in Professional Development, 34(4), 212-218.

Zhu Hong-rui, Zeng Hui, Zhang Hua, Zhang Hong-yu, Wan Feng-jing, Guo Hong-hua, Zhang Cai-hong. The preferred learning styles utilizing

VARK among nursing students with bachelor degrees and associate degrees in China. Acta Paul Enferm. 2018;31(2):162-9.

My argument is to support the need for informed consent in some circumstances in which significant risk to the patient may be incurred. There are reasonable and legitimate exceptions. "In emergency settings, for example, it is even considered ethical to include patients in a randomized trial of an experimental treatment without consent, provided that appropriate safeguards are implemented" (Miller & Emanuel, 2008). However, a pillar of research and medicine is patient autonomy. This concept is deeply rooted in American culture if we examine fields outside of medicine such as gun control, democracy, and religion. "Researchers must provide information regarding the risks and benefits of participation and help people understand this information' (Melnyk & Fineout-Overholt, 2015) so each individual can weigh the options and elect based on their knowledge and values.

Melnyk, B. M., & Fineout-Overholt, E. (2015). Evidence-based practice in nursing & healthcare (3rd Ed.). Philadelphia, PA: Lippincott Williams & Wilkins.

Miller, F., & Emanuel, E. (2008). Quality-Improvement Research and Informed Consent. The New England Journal of Medicine, 358(8), 765-767.