**2.2 How do they learn?**

Designing learning interventions requires careful consideration of how information is perceived and cognitively processed by students. Perceptual preferences refer to the preferred way to receive information and include visual, auditory, and kinesthetic learners [23, 24]. It was observed that 73% of students learn effectively if the teacher combines visual, auditory, and kinesthetic activities, but the remaining students fail to understand the subject matter unless it is presented in their preferred way [25].

Visual students learn by watching, have a keen visual memory and are very imaginative. They are targeted by the presence of models and demonstrations, and extract detail from the background information, remembering faces rather than names. These students usually sit in front of the room and take notes or doodle. They understand better if they can see the facial expression and the body language of the teacher. Visual students normally prefer a quiet environment to study. Computer assisted learning (CAL) is an interesting option for these students, because it allows the schematic representations of information, through charts, graphs, diagrams, and flow charts [23, 24, 26].

Auditory learners prefer verbal instructional methods, such as lecture, discussion, work in groups, debates, games, and answering questions. They find it hard to study from notes and have difficulty with reading and writing tasks. Distinctions that are important to them include pitch, time, volume, rhythm, and resonance. These students often remember names but not faces, do not take notes in class, humor talk to themselves when bored or concentrating, and read aloud. They prefer to study in a noisy environment, as sounds can evoke memory of information [23, 24, 26].

Kinesthetic students also called as tactile learners require whole body movement and real-life experience to absorb and retain information, appreciating to manipulate models and role playing. They learn from external stimuli and movement and are often risk takers and disorganized. These students use highlighters and pictures to study. They learn best when there is music in the background and snacks are available. Kinesthetic learning methods include build, design, visit, interview, and play [23, 24, 26].

Thus, learning interventions need to incorporate the perceptual preferences of the students and help them to develop alternative modes of learning [23] through the incorporation of multisensory and diverse instructional methods (**Figure 3**).

### **2.3 Learning outcomes for 21st century**

The competitive workspace of the 21st century requires students to develop expertise across the four domains of knowledge, that includes the ability to think (cognitive skills), the capacity to valuing (affective skills), a skilled behavior (psychomotor skills), and strive to perform at highest levels (conative skills). However, the acquisition of expertise across all four domains of learning requires appropriate training [23, 27] and assessment [27].

**Figure 3.** *Learning preferences (visual, auditory, kinesthetic).*

Cognitive skills include six levels of complexity [28], ranging from lower-order skills (remember, understand, and apply) that require less cognitive processing to higher-order skills (analyze, evaluate, and create) that require greater degree of cognitive processing [29]. These cognitive skills can be contextualized into four types of knowledge (factual, conceptual, procedural and metacognitive) that need to be achieved in the learning activities [28]. Factual knowledge refers to the acquisition of basic elements (terminology and discrete facts) that will allow students to solve problems. Conceptual knowledge is related to the generalizable principles (categories, theories, principles, and models) that transcend the specific contexts of a task or procedure and is commonly described as "knowing why". Procedural knowledge refers to the technique, process, or methodology that allow executing a task or procedure proficiently and is described as "knowing how". Finally, metacognition includes self-assessment ability and knowledge of various learning skills and techniques [23, 29, 30].

Most instruction in higher education is focused on the cognitive learning skills [29, 31], however, the development of the affective and psychomotor domains are crucial to the success of health professionals [29]. The affective domain refers to emotions and feelings, especially in relationship to a set of values, and is related to the way in which we deal with things emotionally. This domain includes five categories listed from the simplest behaviors (receiving, responding and valuing a particular phenomenon) to the most complex ones, related to organizing and characterizing values [23, 27]. The development of affective skills is fundamental in the veterinary field. Veterinary health professionals face difficult situations on a daily basis. It is necessary to be empathic with clients, to deliver bad news, to deal with animal cruelty, and to see clients struggling to balance financial needs with the needs of their pets. It is imperative for these students, future professionals, to develop affective skills, to create a culture of wellbeing that will allow to deal with all difficult and stressful situations.

The psychomotor domain is related to the mastery of physical skills, including reflective movements, fundamental movement, perceptual skills, physical abilities, skilled movement, and non-discursive communication [23]. Psychomotor skills are important in the veterinary field, since professionals perform delicate/sensitive

#### **Figure 4.** *Comprehensive learning outcomes for the 21st century college graduates.*

physical tasks, handle sensitive medical equipment and frightened animals. The exhibition of an appropriate body language is also highly desired to efficiently communicate with colleagues/peers and clients.

The conative domain refers to the will, desire, drive, level of effort, mental energy, intention, striving, and self-determination to perform at the highest standards possible [27, 32]. It is important that students understand the importance of physiology for their professional career and have the internal desire to understand it, rather than memorizing concepts for assessment, which are soon forgotten and do not lead to effective learning (**Figure 4**) [23].

Learning outcomes that cut across the four domains of the knowledge include the capacity to access and use information, communicate using multiple media, demonstrate understanding, apply rules and procedures, be creative and curious, think critically, make sound judgments, solve problems, be committed to life-long learning, proactively seek to extend knowledge and exhibit an ethical behavior [27]. However, these meta-outcomes must be assessed to guarantee that they are learned, since students choose to focus their study efforts on subjects, they know that will be tested [27, 33].
