An systematic review of e-learning outcomes in undergraduate dental radiology curricula-levels of learning and implications for researchers and curriculum planners

Effectiveness of using concept mapping by dental students in the radiographic interpretation of jaw diseases

OBJECTIVES

Interpretation of dental radiographs is a difficult process, particularly for inexperienced students. This study introduced concept mapping for dental students to help in the radiographic interpretation of common jaw lesions. We aimed to analyze the efficacy of the concept map (CM) in radiographic interpretation, with a discussion of the diagnostic reasoning dilemma.

METHODS

This study included 39 dental students. After a 1-h class for CM guidance and based on three group discussions and one-on-one feedback, the students completed and submitted CMs for three jaw diseases (ameloblastoma, odontogenic keratocyst, and simple bone cyst). All participants underwent a pretest and posttest of knowledge and diagnosis; all students but one completed an open-ended questionnaire regarding the use of CMs.

RESULTS

Concept mapping effectively improved diagnostic accuracy. The participants' posttest scores were better than their pretest scores in both knowledge and diagnostic tests. Most of the students attempted radiographic interpretation through analytic reasoning. The time required for the students to draw a CM varied from student to student from 3-5 h to 1-3 days.

CONCLUSION

This study shows that CMs can improve the radiographic diagnostic ability of dental students by providing a framework for analytic reasoning. Continuous research is warranted to improve the effectiveness of CM in oral radiographic interpretation in the dental student's class.

Is online-only learning as effective as blended learning? A longitudinal study comparing undergraduate students' performance in oral radiology

INTRODUCTION

Blended learning seems to be an effective teaching concept in oral radiology. During the COVID-19 pandemic, blended learning shifted towards online-only learning. The aim of the present study was to compare the effectiveness of pandemic online-only and pre-pandemic blended learning in three consecutive oral radiology courses (C1, C2 and C3) and to examine whether additional video-based e-learning modules (VBLMs) had a positive impact on undergraduate students' performance during pandemic semesters.

MATERIALS AND METHODS

Data from 205 undergraduate dental students participating either in a blended learning or an online-only learning concept were analysed. Pre-pandemic blended learning comprised face-to-face seminars and access to an oral radiology platform (ORP). Pandemic online-only learning comprised online seminars, access to the ORP and additional VBLMs (two VBLMs for C1, four VBLMs for C2 and six VBLMs for C3). Through standardised e-exams at the beginning and end of each semester, performance in final exams and knowledge gain were compared between the two groups.

RESULTS

No significant differences in scores in final exams (p = .11) and knowledge gain (p = .18) were found when comparing the pre-pandemic and pandemic groups. On course level, however, students receiving a lower number of VBLMs performed significantly worse in final exams (C1: p < .01, C2: p = .02) and showed inferior knowledge gain (C2: p < .01) during the pandemic.

CONCLUSIONS

Within the limitations of the study, the present investigation confirmed that pandemic online-only learning involving VBLMs might be as effective as pre-pandemic blended learning.

Factors That Enhance and Hinder the Retention and Transfer of Online Pre-Clinical Skills Training to Facilitate Blended Learning

Purpose

During the SARS-CoV-2 pandemic, various online instructional strategies in clinical skills training were piloted. The sudden transition to the remote platform circumvented the rigorous planning associated with curriculum reform. This study aimed to explore students' and tutors' perceptions of factors that promoted or hindered successful learning transfer and to propose a blended conceptual model to guide affective, cognitive, and psychomotor clinical skills training in the pre-clinical phase of medical education.

Methods

A mixed-method quasi-experimental study assessed third-year students' transfer of clinical skills and knowledge following online learning in 2021. Students and their tutors completed online surveys that included open and closed-ended questions regarding factors influencing their experience of the adapted teaching methods. Descriptive statistical analysis was used for the quantitative data. Qualitative responses were thematically analyzed.

Results

One hundred fourteen students (48%) and seven tutors (100%) responded to the surveys. The questionnaires' internal consistency and construct validity were determined using Cronbach's α-Coefficient. There was an overall positive response (86%) to the acceptability of the online platform in clinical skills training. Using online simulations with targeted onsite practice was reported as effective in clinical skills training. Tutors perceived students as well-prepared for the skills laboratory. Five emergent themes, qualified by a linear model of asynchronous and synchronous online and onsite teaching with the evaluation of the instructional design and institutional support, informed the proposed blended learning guide for clinical skills training in the pre-clinical phase.

Conclusion

Blended clinical skills learning that included the flipped classroom concept was well-accepted. Virtual patients proved a convenient cognitive preparation tool for skills training and potentially optimized teaching delivery. The study found that the adapted teaching frameworks incorporating an online clinical skills component into a modified onsite curriculum augmented learners' ability to transfer knowledge to the clinical skills laboratory. An integrated five-step blended model is proposed for future interventions.

Identification of Critical Parameters Affecting an E-Learning Recommendation Model Using Delphi Method Based on Expert Validation

E-learning is an innovative strategy for enhancing teaching and learning in digital environments with the goal of enhancing education. In the same context, recommendation models have been developed for predicting the user’s learning preferences. A task that has become urgently necessary is enhancing the learning process by designing recommendation models for e-learning software that then helps users choose the most pertinent learning materials (contents) from a wide number of sources. The general consensus is that designing a recommendation model for e-learning is influenced by parameters that are related to e-learning, and much effort has been exerted to determine those parameters. However, no agreement has been reached as to what constitutes such parameters. Keeping this issue in mind, this study aims to identify the parameters that should be considered when generating e-learning recommendations in developing countries. On the basis of the relevant literature, with the use of the Delphi method and with aid from e-learning experts, this paper identifies ten critical parameters related to e-learning. The results show that perceived ease of use is the most critical parameter out of the ten e-learning-related parameters, while user preference is the parameter that contributes least to e-learning.

A comparative analysis of the impact of online, blended, and face-to-face learning on medical students' clinical competency in the affective, cognitive, and psychomotor domains

BACKGROUND

The Coronavirus Disease-2019 (COVID-19) pandemic in South Africa compelled medical schools to switch to a purely online curriculum. The innovative changes transformed the standard clinical skills curriculum to increase learning transfer to bridge the theory-practice gap. The efficacy of this intervention remains unknown. This study aims to measure medical students' clinical competency in the affective, cognitive, and psychomotor domains by assessing clinical skills knowledge retention and transfer from the online platform compared to face-to-face and blended learning.

METHODS

A non-random cross-sectional quasi-experimental study assessed third-year medical students' knowledge retention and learning transfer in three domains of clinical skills competence. Data were obtained using a score sheet during a directly observed formative and a trial online summative assessment. One hundred and one third-year medical students volunteered for the formative onsite assessment that tested the psychomotor domain. Two hundred and thirty-nine students were evaluated on the affective and cognitive domains in the summative online trial mini-objective structured clinical examination (tm-OSCE). The OSCE scores were analysed using descriptive statistics. The significance of the findings was evaluated by comparing OSCE scores with the pre-pandemic 2019 third-year medical students.

RESULTS

Statistically significant differences were found between the two cohorts of medical students from both years (p < 0.05). The 2021 blended group's (n = 101) medians were 90%, 95%CI [86, 92], 82%, 95%CI [80, 85], and 87%, 95% CI [84, 90] for the psychomotor, affective, and cognitive skills, respectively. The e-learning group's affective and cognitive skills medians were 78%, 95%CI [73, 79] and 76%, 95%CI [71, 78], respectively. The 2019 face-to-face cohort (n = 249) achieved medians of 70%, 95% CI [69, 72] and 84%, 95%CI [82, 86] for the affective and psychomotor skills, respectively.

CONCLUSION

Medical students demonstrated near and far transfer bridging the theory-practice gap in three clinical skills domains. The blended group performed significantly better than the e-learning and face-to-face groups. Medical schools and educators play a vital role in overcoming learning challenges and achieving higher transfer levels by adopting multiple student-centered teaching delivery approaches and arranging immediate application opportunities. This study offers medical educators suggestions that encourage the transfer of online learning to face-to-face practice, decentralising medical education with a revised blended learning strategy.

Opportunities and threats of e-learning in dental education in viewpoints of faculty members: A Mixed method study

BACKGROUND

The aim of the study was to assess the opportunities and threats of e-learning in dental schools and explore the experiences of dental faculty members in the coronavirus disease-19 (COVID-19) epidemic conditions.

MATERIALS AND METHODS

The present study was a sequential exploratory mixed method study (quantitative-qualitative). In the quantitative phase, a survey study was conducted to investigate the perspectives of faculty members regarding the opportunities and threats of e-learning during the COVID-19 epidemic. The data were analyzed by descriptive indicators (frequency, percentage, mean, and standard deviation) and analytical tests (t-test and analysis of variance). In the qualitative phase, data were collected through semi-structured interviews. In the qualitative phase, the inductive content analysis approach of Graneheim and Lundman was used to analyze the interviews.

RESULTS

In this study, 213 faculty members of dental schools of Iran participated; among whom 100 were men (46.9%) and 133 were women (53.1%). The results indicated the mean scores of the perspectives of faculty members regarding the opportunities and threats of e-learning in dentistry (4.05 ± 0.49 out of 5). Experiences of the participants in the qualitative phase were explored in the theme of "ups and downs of e-learning in dentistry" with three categories "unaccountability of e-learning in dental education," "challenges of human resource empowerment in the e-learning process," and "planned education."

CONCLUSION

The majority of the faculty members agreed with the use of e-learning in dental education and considered it as an opportunity. However, educational design for blended learning, creation of appropriate infrastructures, and empowerment of human resources as e-teacher and e-student were emphasized as key requirements for e-learning development in dental schools.

Students' perspective of the teaching-learning process of oral radiology before and during the COVID-19 pandemic

The SARS-Cov-2 (COVID-19) pandemic changed the educational structure of dentistry courses and highlighted the importance of online tools. Understanding students' perception regarding these changes is essential to establishing future teaching-learning strategies to accommodate students' needs in higher education. The aim of this study was to assess students' perceptions of the Oral Radiology teachinglearning process before and during the COVID-19 pandemic. The sample consisted of students (n = 111) of the 2nd, 4th and 6th semesters of the dentistry course, who answered a questionnaire with 21 items: A) Students' demographic data (5 questions); B) Students' teaching-learning experiences during the pre-pandemic period (8 questions); and C) Students' teaching-learning experiences during the post-pandemic period (8 questions). Stuart-Maxwell tests revealed statistically significant differences between students' opinions before and during the pandemic when they were asked about the structure of the Oral Radiology module (p = 0.008); their previous experience with e-learning and teaching (p < 0.001); their thoughts about the importance of e-learning in Oral Radiology (p < 0.05); and the time they spent online for academic purposes (p < 0.05). Students seem to prefer on-campus activities (before COVID-19), but the pandemic increased their awareness of the importance of e-learning, the time they spent on online studies, and their knowledge of online educational tools.

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.

Practice-Based Learning Using Smart Class: A Competency-Based Model in Undergraduate Radiology Education

RATIONALE AND OBJECTIVES

A need for adequate and early exposure to radiology practice is rising in undergraduate students, taking competency development as the orientation. We aimed to develop a competency-based model of practice-based learning for undergraduate radiology education.

MATERIALS AND METHODS

The model of practice-based learning was constructed upon an e-learning smart class environment, with case-based learning and simulators for competency development. To assess the model effectiveness, a randomized controlled experiment was performed, where 57 third-year medical students received the model (Smart-Class group) and another 57 received traditional teaching (Traditional group). Seven quizzes, a final exam, and a survey were performed in both groups.

RESULTS

Smart-Class group achieved higher mean score in the quizzes (r = -0.4, p < 0.001) and application subscore in the final exam (r = -0.3, p = 0.005) compared to Traditional group. Smart-Class group also gave higher ratings in students' perceptions concerning promotion of learning interests, radiology skills, and diagnostic reasoning (r = -0.2 to -0.3, p = 0.001-0.034).

CONCLUSION

Practice-based learning using smart class improved students' application ability and satisfactions in undergraduate radiology education, suggesting it a practical model for early exposure to radiology practice and competency development for undergraduate medical students.

Impact of COVID-19 pandemic on radiology education, training, and practice: A narrative review

Radiology education and training is of paramount clinical importance given the prominence of medical imaging utilization in effective clinical practice. The incorporation of basic radiology in the medical curriculum has continued to evolve, focusing on teaching image interpretation skills, the appropriate ordering of radiological investigations, judicious use of ionizing radiation, and providing exposure to interventional radiology. Advancements in radiology have been driven by the digital revolution, which has, in turn, had a positive impact on radiology education and training. Upon the advent of the corona virus disease 2019 (COVID-19) pandemic, many training institutions and hospitals adhered to directives which advised rescheduling of non-urgent outpatient appointments. This inevitably impacted the workflow of the radiology department, which resulted in the reduction of clinical in-person case reviews and consultations, as well as in-person teaching sessions. Several medical schools and research centers completely suspended face-to-face academic activity. This led to challenges for medical teachers to complete the radiology syllabus while ensuring that teaching activities continued safely and effectively. As a result, online teaching platforms have virtually replaced didactic face-to-face lectures. Radiology educators also sought other strategies to incorporate interactive teaching sessions while adopting the e-learning approach, as they were cognizant of the limitations that this may have on students’ clinical expertise. Migration to online methods to review live cases, journal clubs, simulation-based training, clinical interaction, and radiology examination protocolling are a few examples of successfully addressing the limitations in reduced clinical exposure. In this review paper, we discuss (1) The impact of the COVID-19 pandemic on radiology education, training, and practice; (2) Challenges and strategies involved in delivering online radiology education for undergraduates and postgraduates during the COVID-19 pandemic; and (3) Difference between the implementation of radiology education during the COVID-19 pandemic and pre-COVID-19 era.

An exploration of student access to a learning management system-challenges and recommendations for educators and researchers

INTRODUCTION

This study examined student access to online resources of a faculty's learning management system (LMS). Issues relating to current e-learning resources usage were identified and formed the basis for recommendations to help assist stakeholders in teaching, learning and research.

METHODS

Learning analytics from four cohorts of undergraduate dental students were extracted from the database of a LMS spanning between 2012 and 2016. Individual datasets were combined into one master file, re-categorised, filtered and analysed based on cohort, year of study, course and nature of online resource.

RESULTS

A total of 157,293 access events were documented. The proportion of administrative to learning data varied across cohorts, with oldest cohort having the highest ratio (82:18) in their final year and most recent cohort having a ratio of 33:67 in their 4th year demonstrating a higher proportion to learning. Seven Learning domains were identified in the access data: access to problem-based learning resources was the highest and next was fixed prosthodontics videos. The prosthodontics discipline had the highest access across the curriculum while some others had very limited or even no learning access events.

CONCLUSION

A number of limitations have been identified with the analytics and learning resources in this LMS and engagement with learning resource provision. More detailed data capture of access use and unique identifiers to resources as well as keyword tagging of the resources are required to allow accurate mapping and support of students learning. Moreover, motivation or nudging of students behaviour to more actively engage with learning content needs exploration.

Effectiveness of enhanced video-based learning on removable partial denture module

INTRODUCTION

The application of video-based learning in dentistry has been widely investigated; however, the nature of on-screen video enhancements of the video has been minimally explored in the literature. This study investigated the effectiveness of an in-class and on-demand enhanced video to support learning on removable partial dentures in terms of knowledge acquisition, perception and clinical skill performance.

METHODS

Fifty-four dental students enrolled in 2018 were recruited as participants and assigned to two groups. Both groups were given the same lecture and asked to watch the same video in either the enhanced or non-enhanced version. The enhanced video was modified with the contemporaneous subtitle of the presenters' dialogue, text bullet points and summary text pages. The knowledge acquisition from the two types of video was subjected to pre- and post-tests one month after the students watched the video. A questionnaire was used to evaluate the students' perceptions of the learning experience and a performance test on practical skills was performed after six weeks. All the students responded to the test (100%).

RESULTS

The enhanced video demonstration improved the students' short-term knowledge acquisition after they watched the video, with an average score of 1.59 points higher in the enhanced group than in the non-enhanced group (p < .05). The practical performance did not differ between the two groups. The students were more likely accepted the enhanced video as a replacement of the existing teaching method rather than a teaching supplement (70.3%).

CONCLUSION

The application of the enhanced video demonstration resulted in a better theoretical knowledge retention but not practical performance. Students also preferred watching video to using conventional learning methods.

The relation of online learning analytics, approaches to learning and academic achievement in a clinical skills course

INTRODUCTION

This study examined relationships of students' access of e-learning (learning analytics) for a healthcare psychomotor skills course, approaches to learning (R-SPQ-2F psychometric) and academic achievement (summative examination results). An understanding of the relationships may help in supporting students learning.

METHODS

Two consecutive cohorts of 5th year dental students were asked to complete the R-SPQ-2F questionnaire and permission to access data of online videos and associated quizzes and two summative written examination results were examined. The summative assessments were an OSCA and a written-paper question both in prosthodontics. Multiple linear regression and correlation analysis were performed.

RESULTS

Students (n=98) performed a total of 10470 video access events and 7714 attempts in online quizzes. Deep learning approach was the strongest predictor variable (β=0.270; P=.004) on written-paper question result. While video and quiz access were moderately correlated (r=0.600; P<.001) to each other, video access was not a significant predictor to either of the examination results. Quiz access was negatively associated with academic achievement for the written-paper question results (β=-0.349; P<.001).

CONCLUSIONS

Only deep approach to learning appeared to be relevant for the written-paper question examination grades. Conversely, the number of video and quiz access did not relate to either examination results. This suggests e-learning access and examinations do not appear to relate under the conditions explored. Other attributes of learning management access may need to be explored to determine if access to learning management systems may be useful in offering remedial support to students.

Education Technology in Orthodontics and Paediatric Dentistry during the COVID-19 Pandemic: A Systematic Review

Over the last decade, medical education changed from traditional teaching methods to telematic and networking scholar and e-learning approach. The objective of the present systematic review was to evaluate the effectiveness and teachers/student's acceptability of e-learning applied to the field of orthodontics and paediatric dentistry. A database search of the literature was conducted on PubMed and Embase databases from January 2005 to May 2021. A total of 172 articles were identified by the electronic search, while a total of 32 papers were selected for qualitative analysis. Overall, 19 articles investigated the effectiveness of e-learning, and no difference of acceptability was reported between e-learning and traditional methods for a wide part of the articles selected. A total of 25 papers provided a satisfaction questionnaire for learners and all were positive in their attitude towards e-learning. The results showed that e-learning is an effective method of instruction, complementing the traditional teaching methods, and learners had a positive attitude and perception. The evidence of the present study reported a high level of acceptability and knowledge level of e-learning techniques, compared to frontal lecture methods, in the fields of orthodontics and paediatric dentistry.

The effects of oral health education regarding periodontal health on non-dental undergraduates in southwestern China-exploring the feasibility of an e-learning course for oral health promotion

Background

The high prevalence of periodontal diseases is an important oral health problem worldwide. It is necessary to increase public knowledge on and influence attitudes towards periodontal diseases in order to prevent them. However, the effect of oral health education (OHE) as a primary preventive method in China is unsatisfactory. The aim of this study is to investigate the feasibility of extending an e-learning course regarding periodontal health by comparing the effects of oral health education regarding periodontal health (OHE-PH) on dental and non-dental students and the effects between a traditional course and an e-learning course among non-dental students at Sichuan University.

Methods

A quasi-experimental study with a pre-test and a post-test was performed. A total of 217 dental students and 134 non-dental students attended a traditional course; 69 non-dental students attended an e-learning course. Before- and after-course questionnaires about periodontal health knowledge, attitudes and behaviours were administered.

Results

After the traditional/e-learning course, the knowledge of both dental and non-dental students about periodontal diseases and self-reported behaviours for gingival bleeding and oral care improved. The non-dental students reached or surpassed the level of dental students before the course. The non-dental students taking the e-learning course performed better in some areas than those taking the traditional course.

Conclusions

OHE-PH was effective for dental and non-dental students. The e-learning course on OHE-PH was sufficient for improving knowledge and self-reported behaviours among non-dental undergraduates and was even better than the traditional course in some areas. The e-learning course may be an effective method for periodontal health education and oral health promotion among undergraduates.

Effect of computer-assisted-learning and simulation clinics on dental students' cognitive and performance skills: panoramic image errors related to patient's head position

OBJECTIVES

To assess dental students' ability to recognize head positioning errors in panoramic (PAN) images after individual learning via computer-assisted-learning (CAL) and in a simulation clinic (SIM). Both cognitive skills and performance in patient examination were assessed.

METHODS AND MATERIALS

60 students (mean age 23.25 years) participated in lectures on the relation between PAN-image errors and patient's head position. Immediately after they took a test, based on which they were randomized to three groups: control (CON) group, CAL group, and SIM group (both CAL and training in a simulation clinic with a phantom). 4-5 weeks after intervention/no intervention, all students individually examined a patient with PAN-exposure. A blinded rater, not knowing group allocation, supervised patient exposure and assessed student's performance (correct/incorrect head position in three planes). 1-2 weeks after, the students scored positioning errors in 40 PAN-images. Differences in cognitive test scores between groups were evaluated by ANOVA and in patient examination by χ² tests, and within-group differences by sign-tests.

RESULTS

No statistically significant difference in cognitive test scores was seen between the SIM and CAL group, while the CON group scored lower (p < 0.003). In all groups, several students positioned the patient incorrectly in the Frankfort horizontal plane. All students performed well in the sagittal plane. Students in SIM group positioned the patient more correctly in the coronal plane.

CONCLUSIONS

Training with CAL increased students' cognitive skills compared with a control group. Simulated patient exposure with a phantom increased to some extent their performance skills in examination of patients.