Did Clinical Reasoning and Knowledge Questions During Team-Based Learning Enhance Dental Students' Performance in Esthetic Dentistry?

Implementation of Chief Complaint-Based Clinical Reasoning Training in Periodontal Internships

BACKGROUND

The gap between theoretical knowledge and clinical skills highlights the need for clinical reasoning training curriculum in periodontal education, especially in periodontal internships. This study aims to develop a Chief Complaint-Based Clinical Reasoning Training (CCB-CRT) program and evaluate its impact on periodontal interns' clinical reasoning abilities and overall performance.

METHODS

The CCB-CRT program was developed based on eight common chief complaints (CCs) identified through surveys of periodontal specialists and an analysis of patient visit data from a university-affiliated hospital's periodontal clinic. The study involved a comparison between a control group of fifth-year dental students (2021) and a CCB-CRT group (2022). Both groups completed an 8-week training course. The CCB-CRT group received additional training focused on the 8 common CCs, using student-led discussions, flipped classroom, mind mapping, and presentations. Evaluation criteria included overall performance, disease diagnosis and treatment plan, misdiagnosis rates, and students' satisfaction.

RESULTS

After 1 year of CCB-CRT implementation, participants in the CCB-CRT group showed substantial improvements in overall performance, diagnostic accuracy, and satisfaction compared to traditional teaching methods. The program enhanced students' understanding of theoretical knowledge, improved their interpretation of clinical manifestations and examination results, and enhanced their clinical reasoning skills and diagnostic accuracy.

CONCLUSIONS

The successful application of the CCB-CRT program in periodontology education demonstrates its efficacy in improving clinical reasoning skills and diagnostic efficiency among students. The structured approach facilitates the transition from theoretical knowledge to practical application, contributing to better patient care in periodontal practice.

Learning by Clinical Reasoning Versus Interactive Lecture: An Analytical and Experimental Study of Teaching Urological Emergencies

OBJECTIVE

To scrutinize the progression of clinical reasoning and theoretical knowledge by comparing the impact of Clinical Reasoning-Based Learning (CRBL) sessions with interactive lectures (IL).

METHODS

In this experimental study conducted from November 15, 2021, to May 7, 2022, we focused on second-year students in the second cycle of medical studies. Four specific urologic emergency scenarios (nephritic colic, macroscopic hematuria, acute scrotal pain, and urinary incontinence in men) were selected for interactive teaching sessions. Four groups were studied. One urology item was taught via CRBL, the rest via IL. Each item was taught once with CRBL and thrice with IL. After instruction, learners took a 10-point evaluative test with multiple-choice questions and clinical scenarios.

RESULTS

Four groups of 14 learners attended our department, for a total number of 56 participants. Each student attended 4 learning sessions (1 CRBL session and 3 ILs) with a number of tests completed at 4 for each. The total number of tests taken was 224. The scoring of each test was out of 10 with theoretical scores between 0 and 10. The overall median score was 7/10. We noted better ratings after the CRBL sessions (n = 56) with a median of 8/10 [4-10] compared to the IL sessions (n = 168) whose median was 6 [3-10] with a significant difference between the 2 learning methods (P <.001).

CONCLUSION

The CRBL sessions were significantly better than the ILs at developing the clinical reasoning and theoretical knowledge in urology of our medical students.

Creation and evaluation of an educational escape room for preclinical training on 3D printing in dentistry

INTRODUCTION

The benefit of pedagogical escape rooms for dental students' stimulation, interest and knowledge strengthening has been suggested by several studies. However, in previous studies, only a few students were evaluated. This study aims to confirm the purpose of this innovative pedagogical tool in terms of learning consolidation and team building from students' perceptions. We directly incorporated an educational escape game into the fundamental academic formation as a practical-work course for fifth-year dental students.

MATERIALS AND METHODS

The present escape game focused on 3D printing, whose implementation fit the different steps of an escape game well. This study was conducted in March 2022. All fifth-year dental students (n = 212) were divided into 5-6 student groups to match the conditions of an escape game. Before entering the room, each student had to complete a cross-sectional knowledge true/false test of 8 questions to assess their general level. Additionally, an 18-question appreciation survey was completed when leaving the room.

RESULTS

The students perceived the 3D-printing escape game to be relevant and especially expressed the benefit of being part of a team to exchange and build knowledge. These results suggest knowledge strengthening. The instructional benefit of this process seemed to exceed its mere fun and appealing aspect.

CONCLUSION

Our results with a large number of students showed that, from the students' perception, the educational escape game significantly improved knowledge and team-building. It created a supportive learning environment and increased students' motivation. It can provide a fun and effective way to diversify instruction.

Development of a three-dimensional printed model from a digital impression of a real patient for aesthetic dentistry undergraduate teaching

INTRODUCTION

The acquisition of skills and manual dexterity in aesthetic dentistry in undergraduate teaching requires preclinical practices with simulation that should approximate real clinical situations.

OBJECTIVE

We will present a digital procedure for the creation of three-dimensional (3D) resin models adapted to the practices of the Aesthetic Dentistry course.

MATERIAL AND METHOD

Stereolithography or Standard Tesellation Language (STL) files of a real patient were previously obtained with a 3-shape intraoral scanner. Using the Exocad computer programme for dental prosthesis design, various modifications were made, such as incisor rotation, surface alterations imitating dysplasias or erosions, the creation of diastemas, or even changes in tooth size. The virtual model was printed in resin for use by students. Once the practices were finished, the students and the teachers evaluated the use of the 3D printed models.

RESULTS

The result is the typodont model, in which seven laboratory sessions took place: 1-Restoration of conoid tooth morphology, 2-Cervical abrasion/ erosion restoration, 3-Direct Composite Veneer, 4-Aesthetic correction in a tooth with rotation, 5-Diastem closure, 6-Occlusal abrasions/ erosion, and 7-Maryland bridge. 90.48% of the students evaluated the designed 3D model as the best method for laboratory practice compared to other methods, obtaining a general assessment of 8.3 out of 10.

CONCLUSION

The method used has provided a reproducible standard analog model for direct aesthetic dental restoration practice, with a good assessment by students and teachers.

Application of lecture-and-team-based learning in stomatology: in-class and online

BACKGROUND

This study aimed to evaluate stomatological students' learning efficacy and their attitude towards Lecture-Team-Based Learning (LTBL) on topics regarding the design of removable partial dentures via in-class, online, and both in combination.

METHODS

Students from seven distinct grades participated in the course in their fourth academic year (Years 2015, 2016, 2017, 2018, 2019, 2020, and 2021). Students of Years 2015-2019 attended in-class LTBL, students of Year 2020 attended online LTBL, and students of Year 2021 attended the combination mode. The scores of three examinations were compared, namely, individual readiness assessment test, team readiness assurance test, and individual application test. Visual Analog Scales (VAS) were used for students to self-assess their mastery of prosthodontics knowledge before and after the course. Anonymous questionnaires were delivered to evaluate their satisfaction with LTBL via a Likert scale.

RESULTS

In each academic year, the three exam scores were significantly improved as the course progressed and VAS-post scores were significantly higher than VAS-pre scores. The three examination and VAS scores of students in Year 2020 were significantly lower than those in Years 2019 and 2021. Students were highly satisfied with the LTBL course based on the three parameters of knowledge acquisition, teamwork, and classroom atmosphere.

CONCLUSION

Students were highly satisfied with the LTBL course and their learning performance was improved as the course progressed both in-class and online. Online LTBL could be adopted when students have to study online, while in-class LTBL could perform better when combined with video records of an online LTBL course.

Team-based learning versus interactive lecture in achieving learning outcomes and improving clinical reasoning skills: a randomized crossover study

BACKGROUND

This study aimed to investigate the impact of interactive lecture (IL) and team-based learning (TBL) on improving clinical reasoning skills (CRSs) and achieving learning outcomes (LO). Students' feedback was obtained about the strategies.

METHODS

This study was carried out at the Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia. Two modules, endocrinology, and emergency were selected. Students of each batch in both modules were divided into two arms. With a randomized crossover design, IL & TBL were used for two separate topics in each module. After each topic, a quiz in the form of well-structured MCQs was taken. A questionnaire was designed to obtain students' feedback. SPSS version 23 was used to analyse results. The difference between the mean values was calculated by Student's t-test. Feedback data is presented as frequency. P-value ≤ 0.05 was considered statistically significant.

RESULTS

Learning outcomes were achieved by all groups in two modules, with both instructional strategies, IL and TBL. Students attempted >70% correct answers. However, in the emergency module, the groups with TBL as the instructional strategy performed better in quiz1 and quiz 2 (p = 0.026 and p = 0.016, respectively). Similarly, in the endocrinology module (3^rd year), although the groups with TBL as the instructional strategy performed better in both quizzes, it was significant in quiz1 (p = 0.02). The difficulty indices of the clinical reasoning questions (CRQ) were used as the parameters for comparison. In the emergency module, group1, in quiz1, with TBL as an instructional strategy performed better in the CRQ (p = 0.017), while in quiz2, group2 with TBL as the instructional strategy performed better (p < 0.001). Group1 of the third-year students (endocrinology module) performed better in the CRQ in quiz 1 with TBL as an instructional strategy than group 2 with IL (p = 0.04). Mostly, students in both modules preferred TBL over IL, and especially they liked team application. Students perceived that TBL was a better strategy to learn CRS.

CONCLUSIONS

Students achieved LOs and CRS better with TBL as an instructional strategy. They preferred TBL over IL. It is suggested to include TBL, or increase its percentage, in the curriculum.

Effect of active learning and online discussions on the academic performances of dental students

BACKGROUND

COVID-19 caused significant confusion around the world, and dental education was no exception. Therefore, in line with the demands of the times, this study sought to determine the applicability of online active learning to dental education.

METHODS

This study was conducted in the second semester of 2020 at a school of dentistry in a selective university in Korea. A total of 114 dental students were recruited. Participants were assigned to four different groups (lecture and discussion [LD], lecture and discussion with instructor's worksheet [LW], self-study and discussion [SSD], and self-study and discussion with instructor's worksheet [SW]) using the random breakout room function in the Zoom video conference application. Their final test scores were then analyzed using analysis of variance and the online active learning results were compared with the offline learning results.

RESULTS

The scores were highest for the transfer type items in the SSD group, followed by the SW group and the two lecture groups, which had no significant differences. These scores and pattern differences between the groups were similar for all items. The results suggested that studying by oneself rather than simply listening to lectures enhanced the effects of the discussions and led to higher learning outcomes. In addition, the effect of the instructor's intervention in the middle of the discussion varied depending on the pre-learning activities of discussion. As with previous offline experiments, self-study followed by group discussion had higher learning outcomes for both the verbatim and transfer type items.

CONCLUSIONS

In agreement with the Interactive, Constructive, Active, and Passive (ICAP) framework and other active learning theories, the findings clearly indicated that online active learning was applicable to dental students, and when self-study precedes discussion, the learning is richer and the learning outcomes are better.

Team-Based Learning Among Health Care Professionals: A Systematic Review

Introduced in the 1970s to meet the academic needs of a growing number of students with relatively stagnant faculty, team-based learning (TBL) has revolutionized the modern classroom structure. Contrary to the traditional didactic model where the teacher assumes the central role and students are passive listeners, TBL participants are actively involved in the learning process. Teachers act as facilitators while the TBL participants work in groups to solve problems through engagement with their peers. The objective of the article is to conduct a systematic review on team-based learning using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline.

The studies were searched in databases like PubMed®, Scopus®, Embase®, and PubMed Central® using appropriate keywords. Two authors screened the papers, and a third author resolved the conflicts. This was followed by a bibliographic review based on the references of the selected study and bias assessment using the Joanna Briggs Institute (JBI) critical appraisal tool.

The team-based learning model is increasingly being used by different institutions globally. TBL and traditional lecture-based teaching outcomes revealed that TBL participants performed better in academic, clinical, and communication domains. In addition, TBL enhanced learners' engagement, collaborative spirit, and satisfaction. Our study results are similar to the prior meta-analysis and systematic review. Nevertheless, this systematic review remains more comprehensive, up-to-date, and inclusive thus far.

Team-based learning is a pragmatic and superior approach to learning among health care professionals. It has resulted in better academic, clinical, and communication outcomes. This finding spans all the medical and allied professions studied in this systematic review.

A comparison of team-based learning and lecture-based learning on clinical reasoning and classroom engagement: a cluster randomized controlled trial

BACKGROUND

The lecture-based learning (LBL) implemented in most Indonesian nursing/midwifery schools underlies the students' lack of ability in clinical reasoning. Team-based learning (TBL) was proposed to improve the students' ability in clinical reasoning as it is applying a course concept of real complex scenarios. In this study, we aimed to assess and compare the effects of TBL and LBL of postpartum hemorrhage topics on the clinical reasoning and classroom engagement of midwifery students in Indonesia.

METHODS

We conducted a cluster randomized controlled trial to compare the effects of TBL and LBL. The unit was schools and random allocation was conducted using a simple random sampling method (i.e., coin flipping). There was 1 cluster in the intervention group (n = 62 students) and 1 cluster in the control group (n = 53 students). The students in the intervention group participated in a TBL class (90 min) three times, whereas the students in the control group attended an LBL class on postpartum hemorrhage topics. The primary outcome was the clinical reasoning on postpartum hemorrhage score measured at pre-test, post-test, and 2 weeks post-test. The secondary outcome was Classroom Engagement Survey (CES) score measured after each class finished. We used an unpaired t-test to evaluate the differences between the two groups. The baseline characteristics of the participants were compared using standardized difference.

RESULTS

We evaluated a total of 115 participants. Regarding the baseline characteristics, there was a small difference in the age, Grade Point Average and knowledge at pre-test between the intervention and control groups. The mean clinical reasoning on postpartum hemorrhage scores were significantly higher in the TBL students than in the LBL students at post-test (p < .001; Cohen's d = 1.41) and 2 weeks post-test (p < .001; Cohen's d = 1.50). The CES showed a significantly higher in the intervention group than in the control group.

CONCLUSIONS

TBL is an effective learning method for enhancing the clinical reasoning ability of students. This learning method allows for more independent and active learning. Having a strong background knowledge, and discussing cases comprehensively with peers can sharpen the clinical reasoning ability of students.

Effects of team-based learning about postpartum haemorrhage on learning outcomes and experience of midwifery students in Indonesia: A pilot study

Aim

This pilot study aimed to evaluate the effects of team-based learning about postpartum haemorrhage on the learning outcomes and experience of midwifery students in Indonesia.

Design

One-group pre-test-post-test study.

Methods

This study enrolled 64 midwifery students as participants from an Indonesian health polytechnic school. This group attended two team-based learning class sessions (90 min weekly for 2 weeks) on postpartum haemorrhage. Student learning outcomes and experience were assessed quantitatively.

Results

The mean knowledge score (0-100) was significantly higher at post-test (mean = 85.9, SD 9.8) than at pre-test (mean = 61.4, SD 12.9) (p < .001). There was a significant difference in the mean clinical reasoning score (12-60) between post-test (mean = 35.4, SD 5.8) and pre-test (mean = 21.3, SD 7.9) (p < .001). Most students (98.4%) engaged in classroom activities.