Utilization of Blended Learning to Teach Preclinical Endodontics

Dental students in an orthodontic course flipped classroom: A semi-experimental study on knowledge, practice, attitude, and satisfaction

OBJECTIVE

The purpose of this study was to determine the students' attitudes before and after the flipped classroom, and the effectiveness of this method to promote the students' lateral cephalograms tracing abilities, students' satisfaction and their final exam scores.

MATERIALS AND METHODS

This is a single-group quasi-experimental research conducted on dental students of Shiraz University of Medical Sciences (SUMS), Iran in 2019. The intervention was carried out in a blended learning approach with the flipped classroom model. Thirty-five fourth-year dental students participated in a flipped classroom held during a semester for the lateral cephalograms tracing course. The students were provided with the educational materials before the class time through multimedia learning tools and the class time was devoted to discussions. The students were asked to fill out four questionnaires (pretest/posttest attitudes, pretest/posttest self-assessments of theoretical knowledge and practical skills in cephalograms, posttest of satisfaction from quality of the course, and posttest of students' views about effectiveness of blended learning tools) and final exam scores of students.

RESULTS

Students' attitudes toward e-Learning were improved after the flipped classroom and the quality of this method was acceptable to the students (p < .001). Their self-assessment of theoretical knowledge and practical skills were promoted (p < .001). While all blended learning tools averaged more than the cut-off-point, short lecture (5.11 ± 0.98) and live feedback (4.98 ± 1.07) were considered to be the most efficient interactive tools.

CONCLUSION

It seems that the flipped classroom has a positive effect on increasing students' knowledge, attitude, and satisfaction. In general, this method of learning seems to be favored by dental students.

CLINICAL SIGNIFICANCE

The findings showed that blended learning had a positive effect on increasing knowledge, performance, and satisfaction among dental students. Therefore, blended learning as a reliable method might be used in training dental students.

Is there any sustained effect of the coronavirus disease 2019 pandemic? - A controlled trial comparing pre- and post-pandemic oral radiology courses

PURPOSE/OBJECTIVES

Due to the coronavirus disease 2019 (COVID-19) pandemic, undergraduate education shifted towards online-only formats from April 2020 until July 2021. Previous research indicated a negative effect on students' competence development, and it remains unclear whether blended learning concepts could provide compensation. Therefore, the present study aimed to compare pre- to post-pandemic students' performance in standardized baseline (BL) and final exams (FE), as well as the associated knowledge gain (KG) in three consecutive undergraduate blended learning-based oral radiology courses (C1-3).

METHODS

Ninety-four students participated during two pre-pandemic semesters (October 17-July 18), and ninety-eight students during two post-pandemic semesters (October 21-July 22). Before the pandemic, conventional face-to-face lectures were combined with an oral radiology platform. Two years into the COVID-19 pandemic, additional video-based e-learning modules were adopted from the pandemic online-only curriculum. In each semester, skills and KG were assessed by conducting standardized BL and FE. Students' performance in BL, FE, and the associated KG during pre-pandemic semesters was compared to post-pandemic semesters.

RESULTS

In post-pandemic courses, students showed significantly lower BL scores, whereas KG was significantly higher in post- compared to pre-pandemic semesters (27.42% vs. 10.64%, p < 0.001, respectively). FE scores in C1 significantly improved from pre- to post-pandemic semesters.

CONCLUSIONS

Within the limitations of our study, the lower BL scores confirmed the negative effect of the pandemic on competence development. Blended learning concepts seem to compensate for this effect and enable students to return to pre-pandemic levels. Future studies are needed to assess the additional impact of video-based e-learning modules.

Effect of educational intervention on computer-aided-design and computer-aided-manufacturing technology to preclinical dental students

INTRODUCTION

This study evaluated the effectiveness of a video presentation instruction compared to the prevailing traditional lecture provided in the preclinical classroom when introducing computer-aided design/computer-aided manufacturing (CAD/CAM) technology.

MATERIALS AND METHODS

This study was conducted as a controlled educational trial (single-blind) on 120 first-year dental students. Students were assigned to two learning groups: the control (n = 60, traditional lecture) and the intervention (n = 60, video presentation). Both groups completed a self-efficacy scale (SES) survey before instruction. Then, the intervention group actively participated in a one-session video presentation while the control group was given a traditional lecture. After the presentations, student knowledge was assessed with a hands-on simulated exercise that was scored out of 60 points. At last, students completed a post-instruction student perception and attitude (SPA) survey. Inferential hypothesis testing was conducted with two-sample t-tests, and significance was defined as p ≤ .05.

RESULTS

There were no significant differences in the student pre-instruction SES scores between the control and intervention groups. After the video learning, CAD/CAM knowledge application during the hands-on simulated exercise showed significantly higher results in the intervention group as the assessment scores from the intervention group averaged 13.6 ± 2.0 points higher than the control group (p < .001). The results from the post-instruction SPA survey showed no statistically significant difference between groups.

CONCLUSION

With the video presentation technique, our first-year dental students were able to greatly enhance their CAD/CAM application skills. The results from this study could be applied at other dental educational institutions with potential similar outcomes.

A bibliometric comparison of undergraduate and postgraduate endodontic education publications: The topics, trends, and challenges

OBJECTIVES

This study employs bibliometric analysis to compare knowledge units and main topics in undergraduate and postgraduate endodontic education, aiming to identify similarities, differences, and connections. The insights gained are expected to inform the future of two-stage education to enhance continuity, highlighting evolving trends, challenges, and development directions.

METHODS

Citation data were retrieved from the Web of Science Core Collections (WOSCC) database and non-WOSCC databases with two separate search formulas. VOSviewer and CiteSpace were used to analyze the distribution of research by publication years, citation-sources, co-authorship network of authors and countries, and clusters of keywords.

RESULTS

The focus on undergraduate education preceded postgraduate education by nearly a decade. The United Kingdom has emerged as the most prominent contributor to endodontic literature at both levels, with the International Endodontic Journal representing the most voluminous and cited resource in this domain. Dummer is recognized as the most prolific author in undergraduate endodontic education, while Gulabivala spearheads the most extensive cluster of postgraduate education. Keywords clustering analysis reveals that undergraduate education places greater emphasis on fundamental knowledge, while postgraduate education concentrates more on clinical practice. Descriptive analyses from non-WOSCC databases align with the topics and findings from WOSCC-based bibliometric analysis.

CONCLUSION

This bibliometric analysis revealed the emphasis on fundamental knowledge and teaching techniques at the undergraduate level versus advanced clinical knowledge and techniques at the postgraduate level, which originated from different learning aims and contexts. Updating the curriculum to meet the latest practices and innovations is crucial for aligning learning objectives with current and future needs, and the connection between the two levels remains a central challenge in endodontic education.

The effect of instructional methods on dental students' performance in a preclinical endodontic course: A comparative ambispective cohort study

OBJECTIVE

The aim of this ambispective cohort study was to examine the effect of instructional methods on dental students' performance in a preclinical endodontic course. Two cohorts of undergraduate students were included. The pre-pandemic (retrospective) cohort, which had been taught via traditional instruction (live lecture and live demonstration), and the pandemic (prospective) cohort group, which had been taught via a blended learning approach (online/video recorded lecture and video demonstration, combined with practical training in the simulation laboratory).

METHODS

A total of 263 dental students' competencies and written exam results were reviewed, with 137 students from the traditional and 126 from the blended learning groups. Students' performances in the competency practical and written exams for both groups were compared. Additionally, a post-course survey was designed to explore the students' perceptions of blended learning and was sent to the blended learning cohort.

RESULTS

There was a statistically significant difference between both groups in students' weekly practical project scores. The average score for females was significantly higher than that of males. However, their practical competency exam scores were comparable. On the other hand, the written exam scores were significantly higher in the blended than in the traditional group, with females demonstrating significantly higher written exam scores compared to males (p < 0.001).

CONCLUSION

Blended learning is an effective teaching method for preclinical endodontic courses. It could be more useful than traditional learning methods for the course's theoretical content. Additionally, the students preferred to continue learning using this model.

Undergraduate dental students' perception of paediatric dental teaching in an urban and rural Australian dental school

BACKGROUND

Confidence in performing paediatric dental treatment is important as it ensures better oral health outcomes in the patient's adulthood.

AIM

To investigate the confidence and attitudes of final year dentistry students, attending an urban and rural dental programme, towards their paediatric dentistry training.

DESIGN

A questionnaire was distributed to final year dentistry students at the urban-based university, The University of Queensland, and at the rural-based university, La Trobe University. The questionnaire collected information using 5-point Likert scale and short-answer questions, which explored the theoretical, observational, preclinical and clinical aspects of students' paediatric dentistry training. Jamovi and GraphPad Prism were used for data analysis and the creation of graphs.

RESULTS

The questionnaire was completed by 32 rural students and 47 urban students, with a response rate of 79%. Rural students were found to be less confident with the theory on restorative procedures than urban students. Observations of a dentist performing treatment on child were completed by a significantly larger proportion of urban students (70.2%) than rural students (46.9%). Students from both universities reported to have developed the least confidence in the preclinical training of pulp therapies and expressed the need for additional preclinical sessions for more training. At both universities, students indicated they were the least confident in the clinical practice of pulp therapies and management of traumatic dental injuries. Urban students were found to be more confident than their rural counterparts in the clinical practice of examination, treatment planning and preventative procedures, as well as in restorative procedures.

CONCLUSIONS

Both urban and rural students were found to have the least confidence in preclinical and clinical skills related to pulp therapies. Restorative dentistry was an area in which urban students were significantly more confident than rural students in both the theoretical and the clinical aspects.

Assessment of the educational value of endodontic access cavity preparation YouTube video as a learning resource for students

Objective

To evaluate the educational value of YouTube as a learning tool for dental students regarding endodontic access cavity preparation.

Methods and findings

YouTube search was made for videos related to endodontic access cavity preparation using specific terms. After exclusions, 41 videos were chosen and assessed for tooth type, video length, days since upload, country of origin, number of views and likes, source of authorship, and viewing rate. To grade the content of videos, a usefulness score with seven elements was developed. Each element was given a score of 0 or 1. Statistical tests were run by using Kruskal-Wallis and Mann-Whitney tests (SPSS Inc, Chicago, IL, USA) at a 5% significance level. The videos received a mean of 181198.5 views with a mean duration of 686.1 seconds. The mean number of “likes” was 1047.8. Almost half of the videos covered content related to molar teeth. Most videos were provided by health care professionals with almost 50% uploaded from India. The mean usefulness score was 4.29 (range: 1–7) and the most discussed elements were description, instruments used, access cavity demonstration, and evaluation criteria. About a quarter of the videos were classified as good, while 46.3% as moderate and 29.3% as poor. Among the content usefulness categories, no difference was found in the video demographics (p>0.05) except “days since upload” (p = 0.018) in which good quality videos were found to have the highest median. Moreover, although insignificant, good videos were found to have the longest duration and lowest number of views, likes, and viewing rate. The mean usefulness score of videos released during the COVID-19 pandemic was lower than that for pre-pandemic videos (p = 0.042), and videos uploaded by academic institutions had a higher mean usefulness score than videos uploaded by health care professionals (p<0.001).

Conclusions

Information on endodontic access cavity preparation is not comprehensive in most of the reviewed YouTube videos and could be of low educational value.

Dental Students' Perception of Integrating E-learning During COVID-19: A Cross-Sectional Study in a Saudi University

PURPOSE

The aim of this study was to assess dental students' perceptions and overall experiences regarding e-learning at King Abdulaziz University, Jeddah, Saudi Arabia, during the COVID-19 pandemic.

METHODS

This cross-sectional study was carried out from November 2020 through March 2021. A pre-structured, self-administered questionnaire was emailed to undergraduate dental students (second year through sixth year and dental interns). The final sample included 296 undergraduate dental students and interns. Univariate analysis was done to report the sample characteristics. Chi-square and Fisher exact with Monte Carlo were conducted to evaluate the preference of students regarding e-learning across characteristics of the study sample.

RESULTS

The majority of students preferred to integrate e-learning into traditional classroom lectures, although 51.7% did not favor it for clinical subjects. More than half of the sample believed that e-learning allowed excellent interactivity with the instructors. A higher percentage of second-year students preferred traditional learning (71%) than students in other years who preferred a combination of both traditional and online learning (P-value < 0.001). The mode of learning is not associated with marital status, though 36.4% of married students prefer e-learning (P-value = 0.4). Most dental students considered e-learning a positive experience.

CONCLUSION

There were significant differences in the mode of learning preference between the preclinical and clinical years. Continuous monitoring of learners' needs, challenges, and outcomes is crucial to effectively evaluate e-learning in dental education.

Using quizzes to provide an effective and more enjoyable dental education: A pilot study

INTRODUCTION

Increasingly, dental education is using digital strategies to deliver teaching; however, not all of these learning materials are engaging and effective.

AIM

To evaluate the perception and knowledge retention of undergraduate dental students after using two different digital learning tools: quizzes and PDF.

METHODS

Thirty-three students from a Dental School in the United Kingdom took part in the research. They received learning material derived from the Prosthodontic (Kennedy classification) or Paediatric dentistry content (Tooth classification). The same content was delivered in two different formats: quiz game (n = 17) and PDF file (n = 16). The PDF file had ten images and their classifications, whilst the quiz had the same images with a question about the classification, along with alternatives (single best answer).

RESULTS

All students gave similar performances on the knowledge assessment; however, their perception about the learning material differed. Students using quizzes (88%) agreed that they were fun and an interesting way of learning, while only 37.5% had this opinion about PDF material (p = .002). When using quizzes, learners were more motivated and confident. They would frequently recommend quizzes to other colleagues; however, the use of PDF was not suggested as frequently (p = .039). As a learning strategy, 100% of the students using quizzes wanted more of the same to study other dental subjects. This was not the case with the PDF format (p = .005).

CONCLUSION

Despite quizzes and PDF files resulting in a similar understanding of dental subjects, learners prefer quizzes to supplement their studies. Educators should consider using this interactive digital tool to engage students, instead of PDF files.

Integration of a new classification scheme for periodontal and peri-implant diseases through blended learning

PURPOSE

In recent years, dental education has experienced a general shift toward an increased technology presence in education delivery and learning. This research examines the student-perceived efficacy of a blended learning approach (mixture of online content and face-to-face instruction) in a predoctoral periodontics curriculum to teach a new periodontal classification scheme to dental students in clinical training.

METHODS

Participants were recruited from third- and fourth-year predoctoral periodontal classes at the University of Washington School of Dentistry. Students were administered a live lecture introducing the new classification system and given access to an online module with built in case quizzes and interactive activities. Upon completing the module, students were given a post-module survey to assess learning preferences, utilization of various learning methods, and student-perceived efficacy of blended learning.

RESULTS

In a study group of 69 predoctoral dental students, the online module was the most preferred (52.2% ranked first) and utilized learning method for students (p < 0.001). Over 80% of students agreed or strongly agreed that they enjoyed using it and found it more effective than traditional lecture alone. Traditional lecture was preferred by 31.9% of students, and no students ranked the assigned reading as their first choice of learning method (p < 0.001).

CONCLUSIONS

Our findings demonstrate higher student preference, utilization, and self-perceived efficacy of blended learning as compared to traditional assigned readings and lectures - supporting blended learning as a promising educational approach for predoctoral dental education.

The Effectiveness of the Blended Learning in Conservative Dentistry with Endodontics on the Basis of the Survey among 4th-Year Students during the COVID-19 Pandemic

The COVID-19 pandemic has undoubtedly affected education at all levels, including medical and dental education. Our study aimed to assess the effectiveness of the blended learning in conservative dentistry with endodontics. The students had theoretical classes in a remote form (using the e-learning portal and Teams communicator) and practical classes with the participation of patients in the appropriate sanitary regime. The author's survey was conducted among fourth-year dental students. The online questionnaire consisted of 5 parts: self-evaluation, evaluation of theoretical e-learning classes, evaluation of practical clinical classes, evaluation of safety, and evaluation of performed blended learning. The majority of respondents declared that their learning effectiveness increased during the pandemic. Most surveyed students preferred remote learning in asynchronous form (e-learning portals) to synchronous form (virtual meetings in real-time). All respondents described the provided personal protective equipment as sufficient or even as excessive. Our students were very satisfied with the proposed blended-learning model and would like to continue it even after the pandemic has ended. Among the advantages, they particularly mentioned the increase in efficiency and the individualised pace of learning, while the disadvantage was the limitation of social contacts. The appropriate use of modern technology can effectively revolutionise dental education.

The Effects of the COVID-19 Pandemic on Postgraduate Endodontic Programs in the United States

In December 2019, the coronavirus disease 2019 (COVID-19) was first identified as an acute infectious disease in Wuhan, China, and subsequently led to an ongoing pandemic. At the onset of the pandemic, dental professionals were understood to face the greatest exposure risk to SARS-CoV-2 due to aerosolization of fluids from the oral cavity and respiratory airways. As a result, dental professionals, including academic institutions and their students and residents, halted much of their operations to minimize exposure risks and potentially slow the spread of infection to peers and patients alike. Currently, there is little in the literature that describes the changes that academic institutions have implemented in the face of pandemics. This study will discuss the chronology, modifications, and possible resultant outcomes of COVID-19 related events in respect to graduate endodontic programs in the United States.

Assessment of blended learning for teaching dental anatomy to dentistry students

OBJECTIVES

Blended learning (BL) combines conventional face to face (F2F) sessions with online educational resources. This method includes the advantages of online course delivery without the omission of conventional F2F interaction. The purpose of the present study was to evaluate students' satisfaction and educational outcomes in a BL course compared to traditionally administered dental anatomy course.

METHODS

A prospective non-randomized study was conducted to compare the outcomes and perception of BL for teaching dental anatomy to dental students. First year dental anatomy students (n = 98) were included (48 in the conventional F2F learning and 50 in the BL group). Multiple choice questions were used to assess the achievement of learning outcomes and the Dundee Ready Education Environment Measure (DREEM) to determine the educational environment during the course.

RESULTS

There was no significant difference in the pre-test scores of both groups; however the mean post-test score for the BL group (31.5 ± 4.5) was significantly higher than the F2F group (27.2 ± 4.9). The post-test scores were comparable across both genders in the BL group while females secured significantly higher scores than males in the F2F group. The DREEM scores were also significantly higher in the BL group (147.3 ± 15.5) than the F2F group (134.5 ± 15.1) (p < 0.002). A similar pattern was observed in DREEM subscales.

CONCLUSIONS

The BL course is associated with improved students' satisfaction and learner achievement compared to a conventionally administered dental anatomy course. In addition, BL enhanced students' accessibility, self-assessment, and higher level of engagement compared to F2F delivery of the course.

Evaluation of a Distance Education Course Using the 4C-ID Model for Continuing Endodontics Education

Continuing professional development (CPD) is needed in endodontics, and distance learning environments and courses may be preferable for CPD. Instructional designs (IDs) have been reported to strongly influence the educational effectiveness of these courses. Four Component Instructional Design (4C-ID) is an ID found to be effective for distance learning. The aim of this study was to evaluate the effectiveness of a distance learning CPD course on regenerative endodontic procedures (REPs) designed with a 4C-ID model. The study was conducted between April 2017 and March 2018 with volunteers from the 2015-16 graduates of Selçuk University's Faculty of Dentistry in Turkey. Pre- and posttests and skill assessment guide were used for assessment. To determine the participants' satisfaction levels, the Satisfaction Scale for e-Learning Process and an open-ended question were used. Of the 86 graduates invited to participate, 79.1% (n=68) responded they would; but the investigators limited the participants to 30, and the first 30 volunteers who had identified a need for REPs CPD were accepted to the course. Four (0.13%) had to drop out during the course, so data from the 26 who completed it were evaluated. The findings showed the difference between pre- and posttest results was significant (p<0.001). The mean score for psychomotor skills at the end of the course was 99.62±1.96 out of 100. On the satisfaction scale, the mean score for all participants was 138.5 on a scale from 29=lower satisfaction to 145=greater satisfaction with the e-learning process. At the end of the REPs course, the participants' knowledge levels had increased, and they were able to apply REP steps on a model. These results suggest the 4C-ID was effective in this distance education course in REPs.

Self-Paced Versus Instructor-Paced Preclinical Training in Operative Dentistry: A Case Study

Preclinical operative dentistry courses have traditionally involved a lockstep series of live lectures and laboratory exercises. The aims of this study were to assess the effects of an experimental self-paced operative dentistry course on students' perceptions and performance and to compare performance outcomes for this class with the classes two years prior and two years after, which were instructed with the traditional curriculum. In 2013, all lectures in one of three operative dentistry courses at the University of Minnesota School of Dentistry were placed online as narrated slide sequences. For the study, conducted in 2017, students' performance in the course in all five years was assessed, based on exams taken after the laboratory and lecture segments of the course and the practical exam. The experimental class was also invited to complete an end-of-course survey on perceptions of the learning experience. The number of students in classes using the traditional format (in 2011, 2012, 2014, and 2015) ranged from 103 to 108. In the experimental year (2013), 106 students were in the class; course assessments were done for all 106, and 104 responded to the survey (response rate 98%). The results showed no significant differences in assessments between the experimental class and the traditional classes. However, bench instructors reported feeling students in the experimental class were not as well prepared in laboratory sessions as were the traditionally trained students. On the survey, only 22% of students in the experimental class said they always viewed assigned material before the lab periods, with 78% viewing it often, sometimes, seldom, or never. In this class, 48% preferred the online lectures, 37% preferred live lectures, and 16% had no preference. These mixed results suggest caution when developing self-paced courses.

Students' perceptions of a blended learning experience in dental education

INTRODUCTION

"Flipped" instructional sequencing is a new instructional method where online instruction precedes the group meeting, allowing for more sophisticated learning through discussion and critical thinking during the in-person class session; a novel approach studied in this research.

PURPOSE

The purpose of this study was to document dental students' perceptions of flipped-based blended learning and to apply a new method of displaying their perceptions based on Likert-scale data analysis using a network diagramming method known as an item correlation network diagram (ICND). In addition, this article aimed to encourage institutions or course directors to consider self-regulated learning and social constructivism as a theoretical framework when blended learning is incorporated in dental curricula.

MATERIALS AND METHODS

Twenty (second year) dental students at a Northeastern Regional Dental School in the United States participated in this study. A Likert scale was administered before and after the learning experience to obtain evidence of their perceptions of its quality and educational merits. Item correlation network diagrams, based on the intercorrelations amongst the responses to the Likert-scale items, were constructed to display students' changes in perceptions before and after the learning experience.

RESULTS

Students reported positive perceptions of the blended learning, and the ICND analysis of their responses before and after the learning experience provided insights into their social (group-based) cognition about the learning experience. The ICNDs are considered evidence of social or group-based cognition, because they are constructed from evidence obtained using intercorrelations of the total group responses to the Likert-scale items.

CONCLUSIONS

The students positively received blended learning in dental education, and the ICND analyses demonstrated marked changes in their social cognition of the learning experience based on the pre- and post-Likert survey data. Self-regulated learning and social constructivism are encouraged as useful theoretical frameworks for a blended learning approach.

Pattern of online communication in teaching a blended oral surgery course

AIM

To explore the factors that might affect the patterns of interaction amongst dental students that can be found in asynchronous online discussion fora.

SUBJECTS AND METHODS

It is a qualitative study that involved the participation of 71 dental students (42 male and 29 female) who belong to one academic year. Students were participated in asynchronous online discussion fora as a part of a blended oral surgery course that involved both face-to-face lecture and an online learning environment using the Blackboard learning management system. Qualitative analysis of students' pattern of discussion was performed using Transcript Analysis Tool.

RESULTS

The total number of postings was 410. Sixty-seven of 71 students participated in the discussion by writing posts, whereas all of the students had accessed all of the postings. A positive correlation between imposing vertical questions and the number of non-referential and referential statements was observed. Regarding horizontal questions, a positive correlation was observed with the number of referential statements, whilst there was a negative correlation with the number of non-referential statements.

CONCLUSION

Asynchronous online discussion fora that are integrated as a part of a whole pedagogical practice may provide an opportunity for promoting learning, especially when consideration is given to the structure of problems, timely feedback by tutors and supportive strategies within the discussion threads.

Time Spent, Workload, and Student and Faculty Perceptions in a Blended Learning Environment

Objective. To evaluate student perception and time spent on asynchronous online lectures in a blended learning environment (BLE) and to assess faculty workload and perception. Methods. Students (n=427) time spent viewing online lectures was measured in three courses. Students and faculty members completed a survey to assess perceptions of a BLE. Faculty members recorded time spent creating BLEs. Results. Total time spent in the BLE was less than the allocated time for two of the three courses by 3-15%. Students preferred online lectures for their flexibility, students' ability to apply information learned, and congruence with their learning styles. Faculty members reported the BLE facilitated higher levels of learning during class sessions but noted an increase in workload. Conclusion. A BLE increased faculty workload but was well received by students. Time spent viewing online lectures was less than what was allocated in two of the three courses.