Step-by-step teaching method improves the learner achievement in dental skill training

Impact of the modified curricula on periodontal instrumentation skills development during the COVID-19 pandemic from 2020 to 2023

OBJECTIVES

This study aimed to evaluate the impact of curriculum modifications on periodontal instrumentation skills development among classes of 2021, 2022, and 2023 during the COVID-19 pandemic.

METHODS

The pandemic began and affected the three classes at different stages of their studies. Onsite simulation-based learning (SBL) was employed for the classes of 2021 and 2022; remote SBL was adopted for the class of 2023. Modified clinical education, due to social distancing guidelines, impacted the class of 2021 significantly and the class of 2022 to a lesser extent. A multiple linear regression model was built to examine the association between the fourth-year patient-based scaling competency examination scores and selected predictors.

RESULTS

The classes of 2021 and 2023 showed consistent performances over time, while the class of 2022 exhibited significant variation exhibiting the lowest performance at the second-year practical examination. While the clinical experience of the class of 2021 was significantly less than that of the classes of 2022 and 2023, the fourth-year competency examination scores did not differ across the three classes. The clinic points (p = 0.014) significantly affected the fourth-year competency examination score while student gender (p = 0.18), the first-year (p = 0.736), and second-year (p = 0.198) practical examination scores showed no correlations.

CONCLUSION

Based on student performance in the fourth-year scaling competency examination, the curriculum modifications due to the COVID pandemic did not affect student learning outcomes. Clinical experience was the most influential determinant of skill development in periodontal instrumentation.

Effect of a digital assessment system for the preclinical tooth preparation of metal-ceramic crowns: A pilot study

STATEMENT OF PROBLEM

Tooth preparation is a fundamental aspect of prosthodontics and serves as a focal point in preclinical courses. Conventional pedagogy relies heavily on the expertise of instructors, whereas digital technology has the potential to offer instantaneous feedback. The efficacy of a digital assessment system in comparison with traditional teaching methods remains uncertain.

PURPOSE

The purpose of this study was to compare the training effects of traditional assessment and digital evaluation on tooth preparations for the metal-ceramic crowns performed by preclinical students on the convergence angle and tooth reduction.

MATERIAL AND METHODS

A total of 40 predoctoral students were randomly divided into the digital group and the traditional group to complete tooth preparation for a metal-ceramic crown on a left mandibular first molar. Students in the traditional group were taught by an experienced instructor, while the digital group students were trained by an objective digital assessment system without instructor guidance. Each student completed the tooth preparation in 20 min, received feedback according to the respective training methods, and later prepared another tooth. In this way, all students completed 4 tooth preparations in 2 weeks. All preparations were evaluated by an optical scanner. Parameters for comparing the digital group with the traditional group were the convergence angle and reduction at different stages. Questionnaires on the digital training system were answered by the students of the digital group. The t tests or Wilcoxon signed rank tests and chi-squared tests were used to analyze the differences between the 2 groups (α=.01).

RESULTS

A decreasing trend in convergence angle was seen in both groups, but the 2 groups were statistically similar (P>.01). After training, a decreasing trend was seen in under-reduction and overreduction on 5 surfaces in the digital group. Conversely, in the traditional group, a noteworthy increase was seen in under-reduction on the distal surface (P=.002). Nevertheless, no significant difference was found between the 2 groups (P>.01). According to the results of the questionnaire, over 80% of the students had a positive attitude toward the digital assessment system, and more than 80% of the students expressed their interest in the digital assessment system for tooth preparation training.

CONCLUSIONS

Traditional teaching and digital feedback provided similar training effects to improve the quality of tooth preparations for preclinical dental students.

Clinical Evaluation of Reasons for Immediate Composite Restoration Failure Placed by Dental Students: A Cross-sectional Study in Jordan

Objective:

The present study aims to investigate the reasons for the immediate failure of direct anterior and posterior resin composite restorations placed by dental students.

Methods:

A cross-sectional study on resin composite restorations placed by fourth- and fifth-year dental students (n=436). Variables included in the study were; the operative field isolation method, the time needed to complete the restoration after cavity preparation to polishing and finishing, and the plaque index of the patient. Restoration class distribution according to the type of tooth and cavity classification was examined and recorded. Restorations were clinically evaluated immediately after placement. It involved the assessment of the restoration’s mobility, marginal discoloration, and lack of anatomy.

Results:

A total of 233 direct anterior and posterior resin composite restorations which were placed by 127 students were diagnosed as failed restorations. The mode of failure was distributed as mobility/debonding (61.80%), marginal discoloration (29.18%), and lack of anatomy (9.02%). Cl III restorations demonstrated the highest failure on tooth type and cavity classification (30%), followed by Cl II restorations in molars (18.45%). Failure-associated factors were proper restoration manipulation, field isolation, and patients’ plaque index.

Conclusion:

In the current study, the most frequent reason for the immediate failure of resin composite restorations was the quick application of the restoration either as the only associated factor or coupled with other failure-associated factors. Failure to maintain proper field isolation and the poor oral hygiene of the patient were the other two failure-associated factors.

Mobile educational tool based on augmented reality technology for tooth carving: results of a prospective cohort study

BACKGROUND

Augmented reality (AR) technology has been shown to be effective in displaying information and presenting three-dimensional objects. Although AR applications are commonly used by learners via mobile devices, plastic models or two-dimensional images are still commonly used in tooth carving practice. Learners practicing tooth carving face a challenge due to the three-dimensional features of teeth as there is a lack of tools available that provide sequential guidance. In this study, we developed an AR-based tooth carving practice tool (AR-TCPT) and compared it to a plastic model to evaluate its potential as a practice tool as well as its user experience.

METHODS

To model tooth carving, we created a three-dimensional object from sequential steps that included the maxillary canines and maxillary first premolars (16 steps), mandibular first premolars (13 steps), and mandibular first molars (14 steps). Image markers, created using Photoshop software, were assigned to each tooth. An AR-based mobile application was developed using the Unity engine. For tooth carving, 52 participants were randomly assigned to a control group (n = 26; using a plastic tooth model) or an experimental group (n = 26; using the AR-TCPT). User experience was evaluated using a 22-item questionnaire. Data were comparatively analyzed using the nonparametric Mann-Whitney U test via the SPSS program.

RESULTS

The AR-TCPT detects image markers with the mobile device camera and displays three-dimensional objects for tooth fragmentation. Users can manipulate the device to view each step or examine the shape of a tooth. The results of the user experience survey revealed that the AR-TCPT experimental group scored significantly higher in tooth carving experience compared with the control group that used the plastic model.

CONCLUSION

Compared with the conventional plastic model, the AR-TCPT provided a better user experience for tooth carving. The tool is highly accessible as it is designed to be used on mobile devices by users. Further studies are required to determine the educational impact of the AR-TCTP on quantitative scoring of carved teeth as well as individual user's carving abilities.

Step-by-Step Method Combined with Simulation-Enhanced Learner Outcomes in Minimally Invasive Breast Surgery Education

PURPOSE

Traditional standardized training in ultrasound-guided minimally invasive breast surgery (UMIBS) focused on lecture-based learning (LBL) resulted in students' insufficient analysis, limited spatial visual conversion ability, and poor practical application. This study examined the effects of the step-by-step (SBS) method combined with a simulation model in UMIBS education.

SUBJECTS AND METHODS

A total of 84 residents participated in this study. The residents were divided into the SBS group (experience group, n=42) and the LBL group (control group, n=42), and the same teacher taught the two groups to ensure a comparable result. Based on the pork simulation model, two experts evaluated student performance scores, and the total time taken by each student was also counted. The participants were surveyed with 7 questions after the training, and each answer was assigned a score of 1, 2 or 3 to compare the participants' satisfaction.

RESULTS

The average value of the surgical skills for SBS group were significantly higher than LBS group, which was 82.8±4.4 and 72.7±4.0 (t=4.27, P<0.001), the time spend of neoplasm localization by the experience group was significantly less than the control group, which was 17.9±1.6 and 20.9±1.2 secs, (t=1.58, P<0.001), and there were significant differences in puncture accuracy and excision integrity between the two groups (P<0.05). In addition, the results of the questionnaire survey showed that learning interest, surgical ability and satisfaction were better in the SBS group than in the LBS group (P<0.05), and there were no significant differences in clinical thinking and learning pressure between the two groups.

CONCLUSION

The SBS teaching method may help to improve the surgical skills and learning interest, as well as reduce adverse reactions and cultivate clinical thinking of the students in UMIBS training. Future studies could consider multicenter clinical research to further confirm the practicality of this teaching method and reduce the risk of deviation.

Preclinical 3D-printed laboratory simulation of deep caries and the exposed pulp reduced student anxiety and stress, while increasing confidence and knowledge in vital pulp treatment

Aim

To evaluate the impact of a preclinical laboratory session using 3D printed teeth on dental student stress, anxiety, confidence and knowledge when treating deep caries and pulp exposure.

Methodology

This was a two‐centre controlled study, with randomized distribution of students into two groups: a vital pulp treatment (VPT) lecture‐only (control) group and a VPT‐lecture combined with a VPT‐laboratory (experimental) group. In both universities, preclinical students with endodontic or operative dentistry laboratory sessions could participate. All students were invited to the lecture. Two weeks later (timepoint‐T1), both groups completed validated and bespoke questionnaires and scales to evaluate their stress (Stress‐VAS), anxiety (STAI Trait [T] and State [S]), self‐confidence and knowledge. Thereafter, only the experimental group attended the hands‐on laboratory session demonstrating the techniques of selective caries removal and partial pulpotomy on a commercial 3D‐printed tooth. Two weeks later (timepoint‐T2), the participants from both groups repopulated the same questionnaires and VAS. The control group had the laboratory session after the completion of the study. The statistical analysis was performed with Statistica® (significance p = .05). The homogeneity between the two samples was checked by Khi² and Student tests. Stress‐VAS, STAI‐S, confidence and knowledge scores were compared within each group, and between the two groups, at T1 and T2, with a repeated measures anova test (+/−Tukey post‐hoc test).

Results

The groups comprised 54 students each, with no statistical difference between the groups regarding demographic, academic data and STAI‐T score. The two groups had no significant difference of Stress‐VAS, STAI‐S, confidence and knowledge scores at T1 while they presented a significant difference in stress, anxiety and confidence scores at T2, but with no significant difference in knowledge score. However, knowledge score, as other parameters, improved significantly between T1 and T2 in the experimental group.

Conclusions

The addition of a laboratory session using 3D‐printed teeth that simulated deep caries and pulp exposure management, significantly reduced the stress and anxiety of students and increased their confidence. Within the limitations of this study, the benefit of introducing new technology in increasing student confidence and reducing stress offers opportunity for educational improvement in the VPT and cariology areas.

Mixed Reality and Haptic-Based Dental Simulator for Tooth Preparation: Research, Development, and Preliminary Evaluation

Background

Virtual reality (VR) dental simulators are currently used in preclinical skills training. However, with the development of extended reality technologies, the use of mixed reality (MR) has shown significant advantages over VR.

Objective

This study aimed to describe the research and development of a newly developed MR and haptic–based dental simulator for tooth preparation and to conduct a preliminary evaluation of its face validity.

Methods

A prototype of the MR dental simulator for tooth preparation was developed by integrating a head-mounted display (HMD), special force feedback handles, a foot pedal, computer hardware, and software program. We recruited 34 participants and divided them into the Novice group (n=17) and Skilled group (n=17) based on their clinical experience. All participants prepared a maxillary right central incisor for an all-ceramic crown in the dental simulator, completed a questionnaire afterward about their simulation experience, and evaluated hardware and software aspects of the dental simulator.

Results

Of the participants, 74% (25/34) were satisfied with the overall experience of using the Unidental MR Simulator. Approximately 90% (31/34, 91%) agreed that it could stimulate their interest in learning, and 82% (28/34) were willing to use it for skills training in the future. Differences between the 2 study groups in their experience with the HMD (resolution: P=.95; wearing comfort: P=.10), dental instruments (P=.95), force feedback of the tooth (P=.08), simulation of the tooth preparation process (P=.79), overall experience with the simulation (P=.47), and attitude toward the simulator (improves skills: P=.47; suitable for learning: P=.36; willing to use: P=.89; inspiring for learning: P=.63) were not significant. The Novice group was more satisfied with the simulator’s ease of use (P=.04). There were significant positive correlations between the overall experience with the simulation and the HMD’s resolution (P=.03) and simulation of the preparation process (P=.001).

Conclusions

The newly developed Unidental MR Simulator for tooth preparation has good face validity. It can achieve a higher degree of resemblance to the real clinical treatment environment by improving the positional adjustment of the simulated patients, for a better training experience in dental skills.

Eleven-year experience implementing a dental undergraduate research programme in a prestigious dental school in China: Lessons learned and future prospects

OBJECTIVE

To summarise the lessons learned from implementing a dental undergraduate research programme over the past eleven years and identify key elements to guarantee the success of dental undergraduate research in the future.

MATERIAL AND METHODS

An overview of 80 research projects from 2007 to 2017 was provided, consisting of 239 participating undergraduates and 47 faculty advisors. Students' academic performance was compared between participating and non-participating undergraduates. An anonymous questionnaire was designed and distributed to participants, with VAS satisfaction assessment, Likert-scale items and open-ended questions. Questions focused on overall satisfaction, motivation, benefits to student career development and essential elements for the dental undergraduate research programme in the future.

RESULTS

The undergraduate participants had significantly better scores of GPAs (3.41 vs 3.21; P < 0.0001), obtained more awards on the honour rolls (0.53 vs 0.30; P = 0.0171) and published more peer-reviewed articles (1.62 vs 1.31; P = 0.0253) than non-participants. Seventy-two undergraduates (75.79%) and thirty-eight advisors (80.85%) responded to the questionnaire. The overall satisfaction was scored as 78.18/100 and 72.36/100 amongst advisors and students, respectively. Interest was considered the best motivation for participation by students (3.81/5.00) and advisors (4.00/5.00). The research programme was beneficial to students' overall career development. Essential roles played by the dental school, faculty and undergraduates were suggested to improve the research environment.

CONCLUSION

The dental undergraduate research programme has positive effects on students' academic performance. The support of the dental school, the engagement of qualified faculty, the interest and autonomy of students and camaraderie amongst these three key elements are essential for the research programme in the future.

Application and practice of a step-by-step method combined with case-based learning in Chinese otoendoscopy education

BACKGROUND

Standardized training allows more physicians to master otoendoscopic surgery. However, the lecture-based learning (LBL) applied in otoendoscopy teaching may not be conducive to training students in clinical thinking and surgical ability. It is necessary to explore innovative methods for otoendoscopy teaching. This study aimed to determine the effect of a step-by-step (SBS) method combined with case-based learning (CBL) in otoendoscopy teaching.

METHODS

Fifty-nine physicians who participated in otoendoscopy training were selected as the study subjects and randomly divided into two groups (A and B). Group A underwent training with the SBS & CBL method, while Group B underwent training with the LBL & CBL method. The effects of these two methods for otoendoscopy training were compared by evaluation of professional skills and questionnaires before and after the training.

RESULTS

Proficiency in otoendoscopic anatomy and grades for both professional knowledge and otoendoscopic skills were significantly higher in Group A than in Group B(P < 0.05). In terms of learning interest, surgical ability, acting capacity during surgery, reducing surgical complications, and satisfaction with learning experience, all responses from Group A were better than those from Group B(P < 0.05).

CONCLUSIONS

The SBS & CBL method may help to improve ability in otoendoscopic surgery and clinical thinking and appears suitable for endoscopy teaching.

Improving the quality of preclinical simulation training for dental students using a new digital real-time evaluation system

BACKGROUND

With the rapid development of technology, traditional dental education has undergone a transition with the active incorporation of digital technology into curricula. DCARER is a recently developed digital real-time evaluation system for the digital assessment of student preclinical simulation practice performance. The system provides supplementary feedback on process analysis in addition to an objective final result. This study evaluated the grading validity of the DCARER system and its effect on dental preclinical practice skills training.

METHODS

Seventy-three residents of Grade 2018, all of whom had completed their 3-year term residencies in standardised and systematic training, were recruited into this study to examine the system's grading validity. All performed crown preparations with the adoption of the DCARER system, which generated both process and final scores. Three experts gave their own grade anonymously according to the final work. The differences between the digital system and the expert scores were analysed. In addition, 60 dental students in Grade 4 and 10 dental faculty members were randomly divided into traditional and digital groups. The students in the traditional group prepared the tooth with the guidance of supervisors, whilst the digital group used the DCARER system. After the class, the students' tooth preparations were scored by the same three experts in a blinded manner. The students and faculty members completed two different sets of questionnaires to evaluate the effects of teaching, acceptance, satisfaction, and evaluation accuracy of the digital system and the traditional method.

RESULTS

The grading validity assessment showed no significant difference between the tooth preparation scores given by the DCARER system and the experts (P> .05). The unique process scores given by the DCARER system were weakly correlated with the final scores given by both the digital system and the experts. The main characteristics of the 60 students and 10 faculty members were homogeneous at baseline (P> .05). The tooth preparations of the traditional group scored significantly lower than those of the digital group (P < .01). More students in the digital group (93.3%) believed the judgement to be objective than in the traditional group (73.3%). All students guided by the DCARER system (100%) and 80% of students taught in a traditional manner felt that the assessment reinforced the learning process. Faculty members reported that use of the digital system did not significantly increase their workload and reinforced the learning process for the internship.

CONCLUSION

The results presented here indicate the validity of grading using the digital real-time evaluation system. Students and faculty could benefit from application of the system in tooth preparation practice, which may provide effective clinical interaction training for dental education.

Improving effectiveness of dental students' feedback and course evaluation

Dental students providing feedback about a course they take, in a timely manner, benefits not only teachers, but also indirectly the students themselves, especially if given with confidence in a constructive manner. Therefore, the aim of this study was to train students on how to give feedback, to ask them to provide feedback before and after the instructions were given, and analyze the change in their responses. Participants were students who attended the second-year preclinical course in prosthodontics. They were asked to provide feedback anonymously with online surveys after completing modules of the course during the academic year. There was no intervention prior to the first feedback; however, before providing the second feedback, students were asked to read a 1-page handout related to feedback modalities. Following this, an interactive workshop in feedback was provided prior to the third survey. The received responses were ranked as either: neutral, positive, negative, or constructive and were analyzed using a mixed repeated measures test with Bonferroni correction at a 0.05 significance level. The results showed a higher number of constructive and positive responses than both neutral and negative feedback (P ≤ 0.05) within the same surveys, but no interaction effect was found between the surveys (P = 0.076). Our data showed an increase in constructive feedback provided by students after the 2 different training methods, but the modality of delivery did not seem to significantly influence the results. In summary, training students on how to provide constructive feedback may be beneficial for teachers to improve their courses.

Learner behaviors in synchronous online prosthodontic education during the 2020 COVID-19 pandemic

Statement of problem

Synchronous online prosthodontic courses became a popular learning mode during the 2020 COVID-19 pandemic crisis. Nonetheless, the extent of learner participation and completion of these courses remains unknown.

Purpose

The purpose of this study was to assess learner behaviors in synchronous online prosthodontic continuing education lectures in China during the 2020 COVID-19 pandemic.

Material and methods

All live online prosthodontic courses held by an online dental school in China from February to May 2020 were retrieved. The no-cost lectures could be accessed anonymously and viewed repeatedly on the day of broadcast. Learning behavior data (teacher speaking time, audience total, timing of first visit to the online classroom, viewing time, and completion rate) were obtained. Learning progress was calculated by dividing viewing time by teacher speaking time. When a learner progressed through 95% of a lecture, the lecture was considered completed.

Results

A total of 41 781 learners participated in 18 online prosthodontic courses, which had a mean duration of 77.2 ±15.8 minutes. For each lecture, 2321 ±1454 participants attended, with 510 ±404 participants completing each session. There were 13 098 participants (31.35%) who viewed the lectures for less than 1 minute. Approximately half of the participants viewed the lectures for less than 10 minutes, with their learning progress failing to pass 10%. The average completion rate was 21.97%, with variation in completion rate dependent on when a learner first visited the online classroom. Significant differences were found among the lecture completion rates and the timing of the first visit to the online classroom (P<.001).

Conclusions

Synchronous online prosthodontic education courses in China had a high number of participants but low learning progress and completion rates during the 2020 COVID-19 pandemic.

Step-by-step teaching method: improving learning outcomes of undergraduate dental students in layering techniques for direct composite resin restorations

BACKGROUND

Layering techniques for direct composite resin restorations might be complicated for inexperienced learners, as a number of materials and instruments are required at each step. The present study aimed to compare and assess the teaching effect of step-by-step and all-in-one teaching methods in layering techniques for direct composite resin restorations among undergraduate dental students.

METHODS

A total of 68 junior dental students participated in this study, which was a prospective and single-blind trial. The students were randomly divided into a step-by-step group (experimental group, n = 34) and all-in-one group (control group, n = 34). The same teacher taught the two groups, ensuring a comparable teaching effect. The final score of each student was an average of scores by two experts who were blinded to the grouping. The scoring system was consisted by five parts. Each part was assigned scores of 3.0, 1.5, or 0. The total maximum score was 15 and minimum was 0. The total time taken by each group was also calculated.

RESULTS

The values of the quality of tooth restorations evaluated by experts for step-by-step and all-in-one groups were 11.29 ± 2.13 from 15 and 9.00 ± 2.71 from 15 (t = 3.88, P < 0.001), respectively. In addition, the time spent by the experimental group was significantly lesser than that spent by the control group, which was 122.47 ± 2.82 and 137.18 ± 6.75 min, respectively (t = 11.72, p < 0.001).

CONCLUSION

With regard to the layering techniques for direct composite resin restorations, the outcomes were better in the step-by-step group than in the all-in-one group.