Evaluation of a blended learning course for teaching oral radiology to undergraduate dental students

Aims: The purpose of this study was to develop and implement a blended course (a combined face‐to‐face and online instruction) on undergraduate oral radiology and evaluate it by comparing its educational effectiveness (derived from students’ performance and answers to questionnaires) to a conventional course’s. Students’ attitudes concerning the blended methodology were also registered. Methodology: An original course was developed and implemented, and its electronic version was uploaded to an e‐learning educational platform. The course was attended by two groups of final‐year students, who were taught by either the conventional face‐to‐face methodology or the blended learning methodology. Students answered a series of questionnaires, before and after following the course, regarding their perceptions, attitudes and evaluation of the course. Additionally, they completed knowledge assessment tests and their grades (before and after the course) were compared. Educational effectiveness of the course was determined by analysing the results of the questionnaires and the tests. Results: Students in the blended group performed significantly better than their colleagues of the conventional group in the post‐course knowledge test, and female students of the blended group performed better than male students. Students evaluated high the course content, organisation, educational material, and the blended group students additionally appreciated the course design and clarity of instructions. Students’ attitudes towards elements of blended learning (effectiveness, motivation and active engagement) were very positive. Most of the blended group students, who attended the face‐to‐face meeting (approx. 91%), evaluated it as helpful for summarising the subject and clarifying difficult issues. Conclusions: Blended learning is effective and well evaluated by dental students and can be implemented in undergraduate curriculum for teaching oral radiology.     

The importance of student research projects in dental education

In this article, our aim was to summarise students’ research over 15 years at Istanbul University Faculty of Dentistry and to evaluate both the research activities from the students’ perspectives and the effect of this activity on their undergraduate and postgraduate success. In 1992, dental students formed ‘a Student Research Club’ (SRC), which new students attend voluntarily and carry out a scientific project outwith the normal curriculum every year. In total, 409 different students have presented 193 research projects at these meetings over 15 years. Seventy‐four of these students were from other universities and presented 37 projects. In this research, a questionnaire containing 20 items was administered to 93 students who were the members of SRC to learn their own perception of the development of their academic and research skills and the broader impact of the club on their career. It was evaluated using Likert scale (ranged from strongly disagree to strongly agree). Student feedback was very positive and over three quarters (81%) of answers ranged between ‘agree’ and ‘strongly agree’. When the cumulative grade point average (CGPA) of the 88 SRC members in the last 6 years (2003/2004 to 2008/2009) was evaluated as the school success rate, significant difference was found between the grades obtained by members and non‐members (P < 0.001). There was also significant difference between the CGPA of 25 members of SRC who were randomly chosen, before and after membership to the club (P < 0.001). While the 141 members of SRC applied to postgraduate education to Istanbul University Faculty of Dentistry over the last 5 years, 74 of them accepted for PhD (52.6%). There is a statistically significant difference between the member and non‐member groups (P < 0.001). In addition, of the 58 teaching assistants who stayed in academic life after postgraduate studies at Istanbul University Faculty of Dentistry, 16 of them had been a member of the SRC (31%). However, no statistical difference was found between members of SRC and non‐members. These data showed that although the students had an intensive programme in the school, they were able to carry out this voluntary activity successfully and this activity contributed to their educational process. Students also believe that participation of them to this activity effects positively on both personal development and academic success.     

A systematic approach to improve oral and maxillofacial surgery education

To improve teaching quality and student satisfaction, a new curriculum in Oral Surgery was implemented at Karolinska Institutet in 2007. This paper describes the curriculum change as well as the results regarding quality, satisfaction, cost‐effectiveness and workload for teachers and staff. To design the new curriculum, all members of the teaching staff participated in a series of group discussions where problems with the previous curriculum were identified and ideas on how to improve the curriculum were discussed. Cost‐effectiveness was evaluated by comparing the number of teaching sessions between the new and the old curriculum. A questionnaire was used to investigate the staffs’ perceived change in workload and teaching quality. The students’ satisfaction and attitudes to learning was screened for by on‐line questionnaires. The large amount of passive observational teaching was considered as the main problem with the old curriculum. Half of these sessions were replaced by either clinical seminars or demonstrations performed in an interactive form. Students rated the new curriculum as a clear improvement. Analyses of time and cost‐effectiveness showed a decrease in teaching sessions by almost 50%. Generally, the teachers were more positive towards the changes compared to the non‐teaching staff. The students rated the new type of learning activities relatively high, whilst the traditional observational teaching was seen as less satisfactory. They preferred to learn in a practical way and few indicated analytic or emotional preferences. The majority of the students reported a good alignment between the new course curriculum and the final exam.     

Oral health students’ perceptions of clinical reflective learning – relevance to their development as evolving professionals

Context: A clinical professional should be a reflective practitioner, however reflective learning and deliberate clinical reflections have not traditionally featured in dentistry or dental hygiene programs. To the authors’ knowledge, there are no studies exploring the perceptions of oral health students to reflective learning and clinical reflective practices. Aim: This study determined student perceptions of clinical reflective learning and its relevance to their clinical and professional development. Methods: Reflective learning was embedded as a topic in the curriculum of the University of Queensland Bachelor of Oral Health program, within the discipline of dental hygiene practice. Reflective practices were integrated with clinical practice, and were linked with assessment requirements. Students’ perceptions of clinical reflective learning were obtained via quantitative and qualitative analyses of sequenced questionnaires. Computer‐assisted thematic analyses of the students’ reflective journals, reflective essays and summary notes from in‐class group discussions validated students’ perceptions. Results: Students (n = 17) perceived clinical reflective learning as relevant, and useful for consolidating their clinical learning and accelerating their professional development. In particular, students gained insights about their strengths and weaknesses, thought more deeply about what they were doing in the clinic, and unpacked difficult concepts. Conclusion:  Students views of clinical reflective learning in this program were positive. They believed that the deliberate reflective process assisted their clinical learning and professional development.     

A comprehensive clinical competency‐based assessment in periodontics

Traditional periodontics clinical examinations in dental education frequently assess a narrow set of clinical skills and do not adequately assess the ability of students to independently manage a periodontal patient. As an alternative, the authors developed a comprehensive periodontics competency case experience (CCCE) for senior dental students and surveyed students regarding their experience with the CCCE. Students challenging the CCCE must treat a patient with moderate periodontitis and must independently decide when a state of periodontal and oral health has been achieved. Students are also required to conduct an oral presentation to periodontology faculty. Dental students who completed the CCCE had a favourable impression of the experience, compared with the traditional clinical examinations taken in the junior year. The majority of students rated all the components of the CCCE as ‘somewhat’ or ‘very helpful’. About 72.4% of students felt that being able to work independently on the examination was very helpful for learning about the clinical management of patients with periodontal disease, followed by ‘simulation of care in private practice’ (65.5%), and oral photography experience (55.2%). The greatest difficulty reported by students was finding an acceptable patient. About 62.1% of students rated ‘finding the right patient’ as very difficult. Students reported having to screen a mean of 5.9 patients (SD: 4.5) to find a qualified patient. The results of the survey will be useful in improving the examination as an assessment tool in periodontal therapy.     

Multidisciplinary case-based learning for undergraduate students

This report describes the introduction of case-based learning into the final-year dental programme at the Dublin Dental School. Students attended a series of one-hour sessions in groups of 8. Each group appointed a chairman for each session and a tutor facilitated the discussion. Case details were provided during the session with relevant diagnostic records. At weekly discussion sessions, the group findings and treatment options were considered. The diagnosis and treatment plans were then discussed by clinicians involved in the treatment of the case. Following the last session, the case-based learning programme was evaluated by means of a questionnaire distributed to both tutors and students. Both students and tutors rated the sessions positively. Case-based learning was found to be a worthwhile progression from problem-based learning.     

“Flipped OR”: a modified didactical concept for a surgical clerkship in Oral and Maxillofacial Surgery

The concept of the clerkship at the Department of Oral and Maxillofacial Surgery was modified into a modern and sustainable teaching model with a flipped classroom approach. The aim was to prove whether these changes increased the students’ learning success. For the preparation of the clerkship, an e-learning module with 10 chapters was established. Students were supposed to access one chapter ahead of each day’s seminar. A test to assess the gain in knowledge was undertaken before and after participation in the clerkship. An evaluation took place after the test. The results of the test after the clerkship were significantly higher than before (p < 0.0001). The evaluation showed that the students were highly satisfied with the course in general, and the e-learning module specifically. In particular, the surgical videos helped them to better understand the operative steps. The clerkship at the Department of Oral and Maxillofacial Surgery was modified into a sustainable blended learning concept with a flipped classroom approach. With these developments, the “flipped operating room” was shown to be effective in improving knowledge and competence among undergraduate dental students.     

A community of learners in the evidence‐based dental clinic

An increasing emphasis has been placed on the need for an evidence‐based approach in dentistry. This calls for effort in dental education to develop and implement tools for the application of evidence in clinical decision‐making (evidence‐based decision‐making, EBDM). Aim: To evaluate whether the implementation of a community of learners (COL) within a clinical EBDM course enables students, clinical teachers and scientists to discuss the application of evidence in clinical decision‐making and whether it stimulates a scientific approach in students. Material and Methods: A clinical course in EBDM was created. Students presented and discussed patient cases in a COL of student‐peers, clinical teachers and scientists. From the discussion, clinical questions arose and were translated into PICO format (Problem, Intervention, Comparison and Outcome). Students searched for evidence in the literature. Four weeks later, they presented and discussed the evidence found. Before and after the implementation of the course, students, clinical teachers and scientists completed a questionnaire anonymously on the procedure adopted, its content, the learning outcomes and their appreciation of this course. Assessment of the competence EBDM was performed at the end of the course. Grading scores of students in the COL were compared with scores of a student group that did not participate in the COL and were not advised by scientists. Results: Evaluation showed that scientists, clinical teachers and students gradually became more positive on the adopted procedure, content, learning outcomes and the appreciation of this course (ANOVA Bonferoni P < 0.05). The student’s evaluation showed the development of a more scientific approach. Assessment scores of EBDM were sufficient and promising. Conclusion: A stimulating arena was created: a COL, in which the evidence used in clinical decision‐making, was discussed. The COL involved dental students, clinical teachers and scientists. In this setting, an EBDM course appeared to result in a more scientific approach from dental students. The COL provided a good working concept for EBDM in dental education.     

Student attitudes towards computer‐aided testing

Introduction: Computer‐aided learning (CAL) is a viable alternative to traditional teaching methods. While CAL is used for teaching only, computer‐aided testing (CAT) can be applied as a computer‐based examination method. The aim of the present study was to evaluate students’ attitude towards CAT as compared to written multiple choice tests. Materials and methods: Forty‐one undergraduate dental students underwent a mock examination consisting of 15 written multiple choice questions and 15 questions delivered using the interactive MobiTed^® system. A questionnaire based on an eight‐item seven‐point Likert scale was used to evaluate the students’ attitude towards CAT. The students’ performance in both tests was analysed using paired t‐tests. Correlations between test performance and questionnaire were expressed by Pearson correlation coefficients. Results: Despite study‐design‐related differences, students’ test performance between written multiple choice and MobiTed^® was comparable. No correlations between test results and questionnaire could be set up. Students rated MobiTed^® to be equivalent to written multiple choice and had no difficulties with the CAT set up. The pre‐defined sequence of questions with each question being shown only once was considered to be a major disadvantage of the CAT system. Complex questions should be displayed longer compared to short questions. Discussion: Computer‐aided testing appeared to be equivalent to written multiple choice tests not only in terms of student performance but also to their perception. This is consistent with previous studies. Conclusions: Interactive multiple choice tests may provide an alternative to written tests, but should allow examinees to have control over the sequence, as well as the length of time the questions are displayed.     

Students’ perceptions of the educational environment in a Greek Dental School,as measured by DREEM

Aim: The aim of this study was to estimate the dental students’ perceptions of their educational environment and to identify any differences related both to their gender and semester of studies. Materials and methods: The translated and validated in Greek Dundee Ready Education Environment Measure (DREEM) questionnaire was distributed to all 2nd‐ to 5th‐year students of the Athens Dental School. The questionnaire consisted of 50 statements organised in five subscales (perceptions of learning, teachers, atmosphere, academic self‐perceptions and social self‐perceptions). Internal validity was checked with Cronbach alpha. Confirmatory factor analysis (CFA) was performed under the same conditions as the original inventory. Mean statement, subscale and overall scores were calculated and given as percentages. Results: The response rate was 64%. Overall Cronbach alpha was 0.93 (excellent). CFA produced five meaningful subscales, not matching the original ones. The overall DREEM mean score was 56%. Gender did not influence the findings. The students’ perceptions of the educational environment with the exception of the academic self‐perceptions were more positive in the pre‐clinical years. Statistically significant differences were revealed only for the ‘learning’ subscale between the 3rd‐ and the 4th‐year students. Seventy‐eight percent of the statements were in the positive side. The lowest scores were related to students’ stress, tiredness and lack of appropriate feedback from the teachers, and the highest were related to accommodation, school friends and perceptions that they feel socially comfortable in class. Conclusions: Students’ perceptions of the educational environment were reasonably positive, with no gender difference. However, some weaknesses were identified, particularly in the clinical years. Further research is needed to clarify appropriate interventions.     

Improvement in patients with a TMD‐pain report. A 6‐month follow‐up study

Even though chronic TMD pain tends to persist in most patients, some chronic patients show improvement. It is largely unknown which factors contribute to the improvement of chronic pain. The aim of this study is to investigate which factors, from a biopsychosocial perspective, help to predict improvement in patients with a report of TMD pain. Methods: Subjects with a report of TMD pain were recruited in seven TMD clinics. They received a baseline questionnaire which included a wide range of possible predictors for improvement. After 6 months they received a follow‐up questionnaire which included a measure to determine which participants were ‘improved’ or ‘not improved’. To study which predictive variables were associated with improvement, multiple regression models were built. Results: From the 129 patients who responded to the baseline questionnaire, 100 patients also filled in the follow‐up questionnaire (85% women, mean age (years) ± s.d. = 46·0 ± 13·8). Fifty percentage of these subjects had improved at the 6‐month follow‐up. Pain duration was the strongest (negative) predictor for 6‐month improvement (P = 0·009). Also the number of care providers (P = 0·017) and the degree of hindrance on function (P = 0·045) helped to predict improvement. Conclusions: The duration of the TMD‐pain complaint, the number of care practitioners attended and the degree of hindrance on function (negatively) helped to predict 6‐month improvement. No evidence is found to support the role of psychological or social factors on the improvement in patients with a report of TMD pain.     

Comparative study on interactive computer-aided-learning and computer-aided-testing in patient-based dental training in maxillofacial surgery

Aim: The objective of this comparative study was to validate, through empirical data, the use of interactive, problem‐oriented computer‐aided‐learning (CAL) and computer‐aided‐testing (CAT) in dental studies by directly comparing these methods with conventional teaching. Method: A total of 95 students from the third and fourth clinical semesters participated in an interdisciplinary seminar on oral maxillofacial implantology; 47 of these were taught using conventional teaching methods, while the remaining 48 students were taught using mobiTED, a CAL/CAT‐based interactive communication system that can be used patient‐ and problem‐oriented. An examination was given at the end of the course to evaluate student learning. A student’s interest/attentiveness, involvement, knowledge gain, and the course attractiveness and quality were evaluated with visual analogue scales (VAS) in a subjective experience protocol. Results: The study group taught using the CAL/CAT‐based interactive communication system showed statistically significant better results in the examination, with a median score of 89.2%, while the conventional teaching study group achieved a median score of 76.0%. A VAS‐based analysis of subjective experiences also revealed statistically significant differences between the two study groups. Conclusion: Use of the CAL/CAT system for interactive, problem‐oriented learning in patient‐based dental training led to increased levels of attentiveness, of student acceptance and of the perceived attractiveness of the seminar. CAL/CAT‐mediated instruction also led to increased communication, with a subsequent improvement in the qualitative and quantitative parameters of knowledge transfer and cognitive knowledge assimilation. Use of CAL/CAT also facilitated the acquisition, appraisal, and understanding of complex medical data.     

Perceived relevance of oral biology by dental students

Objectives: This study investigated the perception that dental students have regarding the relevance of oral biology (OB) to dental education and dentistry in general. Moreover, this study analysed students’ attitude towards OB learning approaches and resources. Methods: A questionnaire based on a Likert scale was used to survey pre‐clinical/second (BDS2)‐ and final/fifth (BDS5)‐year dental students at the School of Dentistry of the University of Birmingham (United Kingdom). In comparison, a small group of postgraduate specialist registrars were surveyed to evaluate the attitudes of practising dentists. Results: The results show that all study groups expressed a high level of perceived relevance of OB to dentistry. Students’ perception of OB for dental education, clinical training and practice also scored high. More than 40% of undergraduate students and about 55% of the postgraduates indicated a perceived change in their attitude towards OB with time characterised by increased appreciation of the subject. Lectures were considered as the most important teaching approach, whereas ‘group poster projects’ ranked lowest. Of the different study resources, lecture handouts received the overall highest importance score. Conclusions: The results indicate that dental students considered OB relevant for dental education and dentistry and suggest a positive attitude towards the subject. This study also suggested that dental students prefer teacher‐centred/led teaching rather than student‐directed learning of OB. The article addresses the role of OB and science‐related research projects within the dental curriculum and discusses that close integration of basic sciences with dental education may enrich dental education and overall learning experience.     

The use of video‐clips as a teaching aide

Introduction: Video‐clips of tooth preparations recorded with a digital head‐mounted camera replaced live demonstrations midway in a preclinical operative dentistry course. DVDs of the video‐clips were made available to the students for home use. Aims: The aim of this study was to determine whether the use of these video‐clips had any impact on students’ practical examination results and to analyse students’ opinions of this new technology and the perceived impact on their learning. Methods: A questionnaire was administered to all students (n = 26) who completed the course, asking their opinions on the video‐clips. The results of student practical examinations before the introduction of the camera were compared with those after the video‐clips were available and also to the examination outcomes of the previous year’s students (ANOVA, P < 0.05). Results: Twenty‐one students completed the questionnaire. Sixteen students (76%) preferred the video‐clips to the live demonstrations, and 12 students (57%) made and reviewed the DVDs at home. They expressed a preference for the videos to be made available online or as podcasts. Twelve students (57%) felt that one‐to‐one supervision was more effective developing their competence in tooth preparations when compared to their viewing of the video‐clips. There were no statistically significant differences between the practical examination results. Conclusion: In this group of students, video‐clips were the preferred method of demonstration of tooth preparations in the preclinical environment. However, students perceived their learning to be facilitated more by one‐to‐one supervision. The students preferred to have the video‐clips made available to them online instead of in the form of a DVD. The introduction of this educational aide did not make a difference in practical examination results.     

Stress levels and related variables among dental students in Jerusalem,Israel

The aim of the study was to assess levels of stress and associated socio-demographic variables among dental students in their clinical years in the School of Dental Medicine at the Hebrew University and Hadassah in Jerusalem, and compare the findings with those of a similar study undertaken 10 years previously. The study was carried out among the 4th, 5th and 6th year students because these years involve maximum clinical activity. 112 students out of a population of 120 participated. Students were asked to complete a 17-item anonymous questionnaire composed of items describing potential stressors in the learning environment. The quantitative requirement system per completion of dental procedures received the highest stress scores among all students (3.15±0.82), followed by ‘fear from staying behind peers without being able to catch up’. The lowest scores were given to ‘learning new vocabulary as well as new concepts’. These findings were similar to those obtained 10 years ago, despite curriculum and social changes in the interim. Based on the median split of the population, it was found that among the high-stress group, significantly more students evaluated their achievements in school as below average, than did the low-stress group (χ², P=0.017). The % of students who were parents was significantly higher among the high-stress group, than the others (P=0.021). Female students repoted higher stress in the items comprising ‘Clinical work’. The results were similar to those of the previous study, despite curricular changes introduced in the interim.     

Self‐perceived preparedness for dental practice amongst graduates of The University of Hong Kong’s integrated PBL dental curriculum

Objectives: To determine how prepared for dental practice graduates from the integrated problem‐based learning (PBL) dental undergraduate curriculum at The University of Hong Kong (HKU) perceive themselves to be and to identify factors associated with self‐perceived preparedness. Materials and methods: A postal questionnaire was sent to five cohorts of dentists who had graduated from HKU’s integrated PBL curriculum between 2004 and 2008. Using a 4‐point Likert scale, the questionnaire assessed the self‐perceived level of preparedness in 59 competencies grouped in nine domains. Responses were dichotomised into ‘poorly prepared’ and ‘well prepared’. Results: The response rate was 66% (159/241). The mean proportion (± standard deviation) of respondents indicating well‐preparedness was 72.0 ± 15.1% overall, and for each domain was as follows: general patient management, 93.1 ± 12.1%; practice management, 81.0 ± 22.2%; periodontology and dental public health, 73.5 ± 19.3%; conservative dentistry, 92.5 ± 13.1%; oral rehabilitation, 62.8 ± 24.0%; orthodontics, 23.0 ± 32.9%; managing children and special‐needs patients, 64.8 ± 28.9%; oral and maxillofacial surgery, 52.2 ± 25.2%; and drug and emergency management, 84.7 ± 22.6%. The odds of self‐perceived well‐preparedness were increased for cohorts graduating in 2004 and 2005 and graduates working in a non‐solo dental practice. Conclusions: Dental graduates of HKU’s integrated PBL curriculum felt well prepared for the most fundamental aspects of dental practice. However, apparent deficiencies of training in orthodontics and oral and maxillofacial surgery will need to be addressed by continuing education, postgraduate training and planning for the new 6‐year undergraduate curriculum in 2012.     

Students’ perception of the prognosis for a single‐surface amalgam restoration

The aim of the study was to assess the self‐rated skill, clinical judgement and competency of final‐year pre‐doctoral dental students. The study was also designed to determine whether the students’ estimated durability of their single‐surface restorations was determined by their confidence. Students were given a questionnaire and completed it anonymously. One hundred and ninety‐six forms were returned from the 238 students (82% return rate). Complete analysis was possible on 169 questionnaires. The students’ self‐assessed skill and judgement were a significant factor in predicting how long they would tell a patient that their restoration would last. Those ranking themselves below average were more likely to state that their amalgam restorations would have a shorter life (odds increased by 2.82 for those ranking themselves lower than most others). There was a significant association between the students’ self‐assessed skill and judgement and their confidence in dealing with both the initial management of patients’ medical emergencies (ρ = 0.244, P = 0.001, n = 191) and their general confidence in dealing with medical emergencies (ρ = 0.187, P = 0.01, n = 188). Given a conversational scenario with a patient, the treatment prognosis given by final‐year pre‐doctoral students for a single‐surface amalgam restoration was dependent on their self‐assessed competence, skill and judgement.     

Comparison of attitudes towards dental education among dental students in Japan and China

The aim of this study was to identify and compare the attitudes of dental students towards dental education in Japan and China. Fifty‐four dental students from the Stomatology School of China Medical University and 51 dental students from the Dental Faculty of Kyushu University, Japan, participated in this study. Information was derived from a self‐answered questionnaire consisting of 11 items. Significant differences in the responses of the participants from the two countries were detected for 10 of the questionnaire items (P < 0.05). Nearly three‐quarters of the Japanese students were satisfied with the teaching faculties of their schools, while only a quarter of the Chinese students indicated satisfaction. A total of 69% of Chinese students thought that learning a foreign language wasted too much time compared with none of the Japanese students. A student‐oriented teaching mode was not well accepted by either of the groups, and 62% of Chinese students and 53% of Japanese students wanted to increase the duration of the clinical practice stage of education. The findings from this study enhance our understanding of differences and/or similarities among dental students in the two nations. This information may help to define strategies to improve the quality of dental education, and especially exchange programmes of international students.