Effectiveness of technology-enhanced learning in Endodontic education: a systematic review and meta-analysis

Blended learning compared to traditional learning for the acquisition of competencies in oral surgery by dental students: A randomized controlled trial

OBJECTIVE

To determine whether blended learning results in better educational outcomes compared to traditional learning in the acquisition of oral surgery technical skills for 4th-year undergraduate dental students.

MATERIALS AND METHODS

Seventy-three students participated in this two-arm parallel randomized controlled trial. Only students in the blended learning group had access to the online preparation platform for oral surgery practical work (PW) on a pig's jaw and to the debriefing. Kirkpatrick's four-level model was used to assess the educational outcomes directly after (levels 1 and 2) and 6 months later, after the start of the students' clinical activity (levels 3 and 4).

RESULTS

For level 1, higher global satisfaction scores were found for students in the blended learning compared to the traditional learning group (p = .002). For level 2, blended learning resulted in an increase in knowledge score (p < .01), comparable to that observed in the traditional learning group. For level 3, students in the blended group made more progress in 6 months than those in the traditional group in terms of feeling able to assess and perform anaesthesia (p = .040) and surgical tooth extraction (p = .043). No difference in level 4 was found for the 6-month clinical surgical activity between groups, but students in the blended group felt more able to assess and perform the surgical management of a failed extraction requiring bone removal (p = .044).

CONCLUSION

Blended learning for oral surgery PW had a positive impact on three of the four Kirkpatrick levels (level 1, 3 and 4). Efforts should focus on the procedures that are perceived as the most difficult.

Assessment of an online tooth morphology course and 3D examination tool during the COVID-19 pandemic

INTRODUCTION

The COVID-19 pandemic brought major disruptions to dental teaching and has impacted the delivery of tooth morphology courses where students are introduced to the three-dimensional features of the dentition. The aim of this study was to assess the implementation of newly developed online teaching modalities for tooth morphology, evaluate their usefulness and identify elements that are beneficial for learners.

MATERIALS AND METHODS

Following the delivery of an online course that included online 3D models, 2D cue cards, live discussion sessions and Socrative™ quizzes, the participants were asked to rate the usability and usefulness of each tool. The participants' knowledge of tooth morphology was assessed through an online examination using 3D-digitised tooth models.

RESULTS

The participants identified lecture handouts and online 3D models as their preferred learning tools, while lecture video recordings and 2D cue cards were viewed as less useful. Data analysis from Socrative™ quizzes demonstrated improvement in tooth identification skills throughout the course delivery. Finally, results from the final assessment are in line with previous in-person deliveries of this course.

CONCLUSIONS

The study provides valuable information on the usefulness of teaching modalities that were implemented in response to the COVID-19 pandemic and their merit to be retained in future deliveries of the course. The 3D models have been identified as particularly useful in this context, but the participants still value the opportunity to learn with extracted teeth. Furthermore, it remains to be confirmed whether tooth identification skills acquired using 3D models can be transferred to the clinical setting.

Parallel endodontic education via social media: An exploratory survey study

There is insufficient research to evaluate social media's influence on endodontic education. Therefore, this study assessed the percentage of students utilising Facebook in their education and the factors influencing their engagement. A survey was conducted on dental students, interns and dentists undertaking specialist programmes. Categorical data were analysed using Fisher's Exact test and multiple pairwise comparisons. The significance level was set at p < 0.05. Responses were received from 801 participants, with 98.4% using Facebook for endodontic knowledge. Although most students knew that scientific evidence is not always provided, they still deemed such information valuable as it was a practical demonstration of clinical cases. Most students turn to Facebook for endodontic education to compensate for the gap between their academic education and clinical practice. The utilisation of social media for education can be a concerning phenomenon and should not be ignored by academic institutes.

Effectiveness of endodontic complexity assessment tool (E-CAT) on the undergraduate students in an endodontic training program and its predictive capability on complications

INTRODUCTION

Dental students face a number of challenges when it comes to performing root canal treatments (RCTs). The Endodontic Complexity Assessment Tool (E-CAT) was developed to assist dental practitioners in assessing the complexity of RCTs before beginning treatment.

MATERIALS AND METHODS

The E-CAT was filled out independently by both the educator and the student. To allow educators to record scores and complexity classes, they transferred their and students' forms to the website https://www.e-cat.uk/. Students began endodontic treatment after learning about the complexity level of the case. The educators were responsible for recording any complications encountered in every case from the outset to 1 month after treatment.

RESULTS

A total of 70 students, 33 in fourth and 37 in fifth-grade, were included in the study. In the cases with higher E-CAT scores, complications such as misdiagnosed, faulty access cavity, furca or coronal third perforation, insufficient root canal instrumentation, working length loss, canal blockage, overpreparation, incomplete root canal filling and overfilling were experienced significantly more often compared to the cases with lower E-CAT scores (p < .05). The number of complications (r = .40, p < .001), treatment sessions (r = .44, p < .001), and teacher support (r = .24, p < .001) positively correlated with E-CAT score (p < .05).

CONCLUSION

The E-CAT is an effective tool for assisting dental students in understanding technical challenges, such as complex root canal anatomy and possible complications during treatment. Educators can also use e-CAT to pre-select clinical cases and standardise student training by offering cases of equal complexity.

A Critical Evaluation of the Undergraduate Endodontic Teaching in Dental Colleges of Saudi Arabia

BACKGROUND

The purpose of the research was to evaluate the content and delivery of the undergraduate endodontic curriculum.

METHODS

A needs assessment survey was distributed among the Deans of all the dental colleges in Saudi Arabia.

RESULTS

The response rate was 72%. All the colleges include foundational and advanced topics in their curriculum. Didactic lectures, clinical cases, self-directed learning assignments and projects, and videos are the most common teaching methods, whereas virtual learning and reading list are the least popular methods. The average staff-to-student ratio for preclinical and clinical training is 1:6 and 1:7, respectively. Eighty-six percent of colleges utilize dedicated endodontic clinics supervised by specialized endodontists. Eighty percent of colleges use simple cases for canal preparation and obturation. Most colleges do not use magnification and ultrasonic instruments. Saline and sodium hypochlorite are preferred irrigation solutions, whereas calcium hydroxide is the preferred inter-visit medicament. Many use MTA as an advanced material, calcium hydroxide as an inter-visit medicament, and provisional restoration after RCT.

CONCLUSION

The content and delivery of the endodontic undergraduate curriculum are primarily uniform. The use of specialist endodontists dedicated endodontic clinics, rotary instruments, and advanced materials have emerged as curricular strengths. However, diversification of teaching strategies, use of magnification instruments, and an increase in the minimum number of endodontically treated teeth are leading areas demanding curricular improvement.

Insight on the influence of technology-enhanced learning in orthodontics' education: A systematic review

OBJECTIVES

Technology-enhanced learning (TEL) provides a pliable and current way to present orthodontic curriculum material to students. This review aimed to assess the effectiveness of TEL compared with traditional learning methods in the field of orthodontics.

MATERIALS AND METHODS

The search comprised randomised controlled trials (RCTs) related to orthodontics' interactive learning from the following databases: PubMed, Scopus, CENTRAL, Psyclnfo, ERIC, Web of Science, Dissertations and Theses Global. Two authors performed the screening, data extraction and assessed risk of bias using the Cochrane tool (Rob 2) blindly and in duplicate. Kirkpatrick's 4-level evaluation model was used to evaluate educational outcomes.

RESULTS

A total of 3131 records were identified of which 11 RCT were included. On level 1 (Reaction), students had a positive attitude towards TEL. On level 2 (Learning), included studies did not report any significant knowledge improvement when TEL was compared with traditional learning strategies. One study assessed level 3 (Behaviour), where students felt that flipped classroom learning created feelings of greater confidence. On level 4 (Results), most studies suggested that TEL tools are as equally effective in imparting information as traditional tools and recommended that both methods should be considered in teaching students.

CONCLUSION

Technology-enhanced learning techniques might have the potential to enhance educational outcomes in orthodontic education and students seem to enjoy the implementation of technology in the learning process. These educational tools should be used as an adjunct to the traditional didactic classroom, and not as a replacement, due to the challenges encountered with their application.

Blended Learning in Health Care Education: An Overview and Overarching Meta-analysis of Systematic Reviews

INTRODUCTION

Blended learning is an educational approach that integrates face-to-face with online instruction. This overview of existing systematic reviews aims to evaluate the impact of blended learning on educational outcomes in health care professional education, identify gaps in the current evidence, and direction for future reviews.

METHODS

Five databases were searched (January 1, 2000 to January 14, 2021) for systematic reviews of blended versus nonblended learning approaches for health care education. "Flipped classroom", unpublished studies, abstracts, and study protocols were excluded. The extracted data included details of included reviews, description of populations, and outcomes according to Kirkpatrick levels. A narrative review is presented, along with an overarching meta-analysis, which evaluates a synthesized estimate of the effect of blended learning based on standardized mean differences.

RESULTS

Eleven systematic reviews were included, comprising of 160 primary studies (including 117 randomized controlled trials) from 56 countries with over 18,000 participants. The overall level of evidence was very low quality. An overarching meta-analysis of 93 studies addressing knowledge acquisition favored blended over nonblended learning methods (standardized mean difference 0.768 [95% confidence interval 0.594-0.941]; P < .001). None of the reviews identified an adverse effect on other educational outcomes.

DISCUSSION

Blended learning may be superior to traditional teaching approaches in improving knowledge acquisition. We recommend further research to describe the relative benefits of blended learning in each individual context and identify which elements of instructional design are beneficial for each outcome. Finally, we recommend the use of clear and consistent terminology in reported studies.

Organizational Aspects and Practices for Enhancing Organizational Project Management Maturity

An organization’s performance in a project is determined by its ability to implement project management knowledge and practices. This ability reflects the organization’s level of project management maturity (PMM). PMM is premised on the belief that the higher the PMM level, the higher the ability to successfully deliver a project. With this in mind, the current paper aims to determine the type of organizational aspects and practices that could influence the success of PMM implementation in organizations. For this purpose, a systematic literature review (SLR) was performed on 23 articles published between 2011 and 2021 that studied PMM. The findings showed that most articles stressed organizational culture and integration with strategic organizational initiatives. Among all the studied industries, the information technology industry stood out. Content analysis was used for analyzing data, which were thematized using ATLAS.ti. Ten sub-themes emerged, with six sub-themes under organizational aspects and four sub-themes under organizational practices. These sub-themes, which were intertwined with the implementation and growth of PMM in organizations, positively impact project delivery performance. Based on this, several future research opportunities were proposed.

Digital Education for Health Professionals: An Evidence Map, Conceptual Framework, and Research Agenda

BACKGROUND

Health professions education has undergone major changes with the advent and adoption of digital technologies worldwide.

OBJECTIVE

This study aims to map the existing evidence and identify gaps and research priorities to enable robust and relevant research in digital health professions education.

METHODS

We searched for systematic reviews on the digital education of practicing and student health care professionals. We searched MEDLINE, Embase, Cochrane Library, Educational Research Information Center, CINAHL, and gray literature sources from January 2014 to July 2020. A total of 2 authors independently screened the studies, extracted the data, and synthesized the findings. We outlined the key characteristics of the included reviews, the quality of the evidence they synthesized, and recommendations for future research. We mapped the empirical findings and research recommendations against the newly developed conceptual framework.

RESULTS

We identified 77 eligible systematic reviews. All of them included experimental studies and evaluated the effectiveness of digital education interventions in different health care disciplines or different digital education modalities. Most reviews included studies on various digital education modalities (22/77, 29%), virtual reality (19/77, 25%), and online education (10/77, 13%). Most reviews focused on health professions education in general (36/77, 47%), surgery (13/77, 17%), and nursing (11/77, 14%). The reviews mainly assessed participants' skills (51/77, 66%) and knowledge (49/77, 64%) and included data from high-income countries (53/77, 69%). Our novel conceptual framework of digital health professions education comprises 6 key domains (context, infrastructure, education, learners, research, and quality improvement) and 16 subdomains. Finally, we identified 61 unique questions for future research in these reviews; these mapped to framework domains of education (29/61, 47% recommendations), context (17/61, 28% recommendations), infrastructure (9/61, 15% recommendations), learners (3/61, 5% recommendations), and research (3/61, 5% recommendations).

CONCLUSIONS

We identified a large number of research questions regarding digital education, which collectively reflect a diverse and comprehensive research agenda. Our conceptual framework will help educators and researchers plan, develop, and study digital education. More evidence from low- and middle-income countries is needed.

An Evaluation of the Usefulness of YouTube® Videos on Crown Preparation

Background

You Tube is one of the most commonly used online sources for sharing information and knowledge. Academic topics or clinical data shared on this platform is not peer reviewed or evaluated by subject specialists for accuracy. No study was found in the literature examining the validity of crown preparation videos available at this platform.

Objective

To evaluate the authenticity of the content and quality of the crown preparation videos uploaded on the YouTube.

Methods

The systematic search for YouTube videos was carried out over a period of one year from January 2020 until February 2021. The keywords or phrases and tags used were crown preparation, PFM crown preparation, all ceramic crown preparation, and dental crown preparation. The videos were shortlisted on the basis of inclusion and exclusion criteria to select educationally useful videos in terms of content and quality.

Results

Three subject specialists evaluated the videos on crown preparation three times to shortlist only 12 (11%) educationally useful videos out of 109 relevant videos. These 12 videos met the preset inclusion criteria.

Conclusion

Although YouTube is the most popular social media platform used as the source of information by the students, the majority of uploaded content lacks authenticity. This study found that crown preparation videos uploaded by the faculty members or subject specialists can be considered as the reliable source.

Effect of Traditional and Virtual Oral Hygiene Instruction to School Health Instructors on Plaque Index of Elementary Schoolchildren

AIM: This study compared the effect of traditional and virtual oral hygiene instruction to school health instructors on plaque index (PI) of elementary schoolchildren. METHODS AND MATERIALS: In this descriptive, analytical study, 66 elementary schools in Kermanshah city were selected by cluster sampling. The school health instructors first participated in a pretest and filled out a questionnaire. The O’Leary’s index of 339 elementary schoolchildren was measured at baseline. Next, the school health instructors received oral hygiene instructions in two groups (n = 33) of virtual instruction through an online course and traditional classroom setting. After 3 weeks, a post-test was held and school health instructors filled out the same questionnaire for the 2nd time. After 3 months, the PI of students was measured again. Data were analyzed using the Chi-square test, t-test, Mann–Whitney U-test, and ANOVA. RESULTS: Both instruction methods significantly enhanced the oral hygiene knowledge of instructors (p < 0.001) but virtual instruction was significantly more effective (p = 0.02). No significant association was noted between age, work experience of instructors, or their level of education with their knowledge level in the virtual group (p > 0.05). An inverse correlation was noted between age and work experience of instructors with their knowledge level in the traditional instruction group (p < 0.05). Both instruction methods caused significant improvement of PI of students (p < 0.001) but virtual instruction was more effective (p < 0.001). CONCLUSION: Correct oral hygiene instruction to school health instructors (preferably by virtual instruction) can reduce PI elementary schoolchildren.

Effectiveness of technology-enhanced learning to improve periodontics educational outcomes: A systematic review

OBJECTIVES

Technology-enhanced learning (TEL) has been suggested as a suitable learner-centered pedagogical approach in dental education. However, the results of TEL effectiveness in periodontics education are controversial. Therefore, this systematic review aimed to evaluate the effectiveness of TEL to improve educational outcomes in the periodontics field compared to traditional learning methods.

METHODS

The search comprised randomized controlled trials (RCTs) and crossover studies that were related to periodontics education from the following databases: MedLine, PsycINFO, Eric, Scopus, EMBASE, and Web of Science. Two authors independently performed study selection, data extraction, and assessed risk of bias. Kirkpatrick's 4-level evaluation model was used to evaluate educational outcomes.

RESULTS

From 1642 studies, after applying inclusion criteria, 7 studies remained for analysis. On level 1 (Reaction), undergraduate dental students reported positive attitudes related to TEL. On level 2 (Learning), 3 studies found that TEL improved knowledge gain compared to traditional learning methods. Three other studies did not show any difference between TEL and conventional learning methods, and one found that traditional learning methods presented superior results. On level 3 (Behavior), 1 study found that TEL application improved students' performance. On level 4 (Results), 5 studies suggested that the implementation of TEL would improve educational outcomes in periodontics education if combined with traditional learning methods.

CONCLUSION

The findings showed that the exclusive use of TEL does not significantly improve periodontics educational outcomes when compared to traditional learning methods. However, the combination of TEL and traditional learning methods can be the key to enhancing periodontics education.

Application of a new system for classifying root canal morphology in undergraduate teaching and clinical practice: a national survey in Malaysia

AIM

To evaluate and compare the feedback of final year undergraduate dental students in eight Malaysian dental schools on the application of a new system for classifying root canal morphology in teaching and clinical practice.

METHODS

One PowerPoint presentation describing two classification systems for root canal morphology (Oral Surgery Oral Medicine Oral Pathology, 1974 38, 456 and its supplemental configurations, International Endodontic Journal 2017, 50, 761) was delivered to final year undergraduate dental students in eight dental schools in Malaysia by two presenters (each presented to four schools). To examine students' feedback on the utility of each system, printed questionnaires consisting of six questions (five multiple choice questions and one open-ended question) were distributed and collected after the lecture. The questionnaire was designed to compare the classification systems in terms of accuracy, practicability, understanding of root canal morphology and recommendation for use in pre-clinical and clinical courses. The exact test was used for statistical analysis, with the level of significance set at 0.05 (P = 0.05).

RESULTS

A total of 382 (out of 447) students participated giving a response rate of 86%. More than 90% of students reported that the new system was more accurate and more practical compared with the Vertucci system (P < 0.001). Overall, 97% of students reported the new system helped their understanding of root and canal morphology compared with the Vertucci classification (P < 0.001). Over 97% of students recommended the use of the new system in teaching, pre-clinical courses and clinical practice (P < 0.001). Except for two schools, no significant difference was detected between the responses of students for all questions at the different schools (P > 0.05). The students' responses for all questions were almost similar for both presenters (P > 0.05).

CONCLUSIONS

The new system of International Endodontic Journal 2017, 50, 761 for classifying root and canal morphology was favoured by final year undergraduate dental students in Malaysia. The new system has the potential to be included in the undergraduate endodontic curriculum for teaching courses related to root and canal morphology.

Difficulty levels of extracted human teeth used for pre-clinical training in endodontics in an Australian dental school

This study aimed to determine the difficulty level of extracted teeth treated by undergraduate students for pre-clinical endodontic training. Two independent observers assessed a consecutive sample of 1000 periapical radiographs of extracted teeth used in endodontic pre-clinical training. Chi-square test was used to evaluate the adjustment of the distribution, and inter- and intra-examiner agreement were calculated. Minimal, moderate and high difficulty teeth represented 23.1%, 52.1% and 24.8%, respectively. The presence of curvature was the most common grading factor, with 'moderate curvature' reported in 28.7%, and 'extreme curvature' reported in 15.6% of the sample. A difference in the distribution of frequencies was found, favouring the moderate category (P < 0.001). The inter- and intra-examiner strength of agreement were 0.78 and 0.86, respectively. More than 50% of the teeth were categorised as moderate complexity. Almost one-quarter of the total sample, in particular molars, was classified as high complexity, thus unsuitable for undergraduate pre-clinical training.

Pre-clinical endodontic education outcomes between artificial versus extracted natural teeth: a systematic review

AIM

To compare the educational outcomes using artificial teeth versus extracted teeth for pre-clinical endodontic training.

DATA SOURCES

Literature searches of PubMed, Scopus, Cochrane Library, Trip Database, Web of Science and Open Grey databases were conducted from their inception until November 2018 with no language restriction. Hand searching of most likely relevant journals was performed. The review followed the PRISMA guidelines.

STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND INTERVENTIONS

Studies that compared pre-clinical endodontic training using extracted teeth and artificial teeth were included.

STUDY APPRAISAL AND SYNTHESIS METHODS

The quality of included studies was appraised by Joanna Briggs Institute Critical Appraisal tools. The findings were tabulated and summarized according to their outcomes with distinct narrative syntheses.

RESULTS

Five studies were included. The component studies included 359 operators in total, mainly consisting of undergraduate students (97%, n = 349) and 10 endodontists (3%). Forty-seven per cent (n = 170) operated on artificial teeth only, whilst 19% (n = 67) worked primarily on extracted teeth, with the final treatment outcome being evaluated by independent observers using objective criteria. Operators in two studies (34%, n = 122) used both artificial teeth and ET and compared their experiences in surveys. Regarding technical outcomes, no significant differences between training with artificial teeth and extracted teeth were found, but the performance tended to be better in artificial teeth than extracted teeth. Operators trained solely on artificial teeth appeared to be adequately educated for subsequent root canal treatment (RCT) in the clinical setting.

LIMITATIONS

Due to the scarcity of research on the topic overall, and the methodological variation between the studies, it was not possible to perform a quantitative analysis (meta-analysis).

CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS

Based on the available evidence, the use of artificial teeth for pre-clinical endodontic training achieved similar educational outcomes compared to extracted teeth. However, the experiences reported by the operators diverged. Further studies assessing other artificial teeth available in the market testing other RCT procedures are necessary.

PRISMA for abstracts: best practice for reporting abstracts of systematic reviews in Endodontology

An abstract is a brief overview of a scientific, clinical or review manuscript as well as a stand-alone summary of a conference abstract. Scientists, clinician-scientists and clinicians rely on the summary information provided in the abstracts of systematic reviews to assist in subsequent clinical decision-making. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) for Abstracts checklist was developed to improve the quality, accuracy and completeness of abstracts associated with systematic reviews and meta-analyses. The PRISMA for Abstracts checklist provides a framework for authors to follow, which helps them provide in the abstract the key information from the systematic review that is required by stakeholders. The PRISMA for Abstracts checklist contains 12 items (title, objectives, eligibility criteria, information sources, risk of bias, included studies, synthesis of results, description of the effect, strength and limitations, interpretation, funding and systematic review registration) under six sections (title, background, methods, results, discussion, other). The current article highlights the relevance and importance of the items in the PRISMA for Abstracts checklist to the specialty of Endodontology, while offering explanations and specific examples to assist authors when writing abstracts for systematic reviews when reported in manuscripts or submitted to conferences. Strict adherence to the PRISMA for Abstracts checklist by authors, reviewers, and journal editors will result in the consistent publication of high-quality abstracts within Endodontology. This article is protected by copyright. All rights reserved.