Dental education practices during COVID-19: A scoping review

Teaching strategy adaptations in undergraduate dental education during the COVID-19 pandemic

BACKGROUND

During the COVID-19 pandemic, dental institutions were challenged to rapidly adapt to the inability of teaching in-person lectures and pre-clinical simulations. Strategies had to be quickly developed to guarantee the safety of faculty and students, while also adhering to national guidelines to ensure that educational standards were met and students' graduations and entrance into residency programs were not delayed. This literature review assesses the novel strategies that dental schools created and implemented to teach in a distance-learning platform and evaluates the advantages and disadvantages of these strategies. In addition, this review talks about the lessons learned during the pandemic and the incorporation of successful strategies after the pandemic ended.

METHODS

This review evaluated the literature using PubMed and ScienceDirect with the following keywords: "teaching strategies," "dental education," and "COVID-19." The search strategy yielded 15 articles that assessed relevant teaching strategies that were implemented during the COVID-19 pandemic.

RESULTS

The literature described the swift response of dental institutions in implementing teaching strategies in response to the inability of continuing in-person teaching. An overwhelming majority of institutions moved their didactic lectures to online platforms. Several institutions implemented online simulations with virtual reality models, videos and discussion boards, standardized patient actors, and case-based discussions.

CONCLUSION

Many of the teaching strategies that were implemented as a result of the COVID-19 pandemic were highly effective. Dental schools were able to satisfy Commission on Dental Accreditation standards and meet students' requirements for graduation during the pandemic despite the rapid and unplanned shift away from in-person instruction and simulation secondary to the COVID-19 pandemic.

The impact of virtual reality simulation on dental education: A systematic review of learning outcomes and student engagement

PURPOSE

Virtual reality (VR) simulations have been increasingly employed to train dental students prior to clinical practice. According to the literature, blended learning designs in the form of VR simulations can be utilized by both dental students and instructors to provide quality education. They can also save time and improve motor skills before students enter clinical stages. Therefore, this study was designed to review the importance of available VR simulators and their impact on student learning and outcomes.

METHOD

The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed to review the literature systematically, and different databases such as PubMed, ScienceDirect, Cochrane Library, Scopus, and Google Scholar were searched (up to December 2023) for relevant articles using keywords: "virtual reality," "virtual reality simulators," "virtual reality simulation," and "dental education." The Mixed Methods Appraisal Tool was used to assess the study quality.

RESULTS

After a comprehensive literature search, 1477 research articles were identified, of which 16 were included in the present study. In terms of students' learning outcomes, engagement, and optimal approach, a significant improvement was observed compared to conventional training methods, specifically in their knowledge, performance, confidence, and psychomotor skills.

CONCLUSION

The findings suggest that VR simulators enhance the overall learning abilities of dental students and should be regarded as an integral component of the current curriculum. However, it is important to recognize that VR simulators cannot fully substitute traditional training methods; rather, they can effectively complement them.

Areas of Interest in Dental Education: A Bibliometric Analysis of the Last Decade

This study aimed to perform a comprehensive bibliometric analysis of journals focused on dental education (Journal of Dental Education and European Journal of Dental Education) from 2014 to 2023. An ISI Web of Science Search was performed in October 2023 with no filters for language or keywords. Published articles between 2014 and 2018, 2019 and 2023, and 2014-2023, along with the top 100 cited articles published within this period were exported as txt files. Keyword and title word network maps and occurrences were generated using VOS Viewer software. Author-affiliated countries with the most publications were tabulated from the Web of Science. Dental education and dental students and education were consistently in the top six keywords and title word occurrences in all periods and top 100 cited articles. Similar trends were observed for keyword and title word network maps with an emphasis on dental education and students. However, the 2019-2023 period saw the emergence of coronavirus disease 2019, three-dimensional printing, virtual reality, and education technology, with the earlier period (2014-2018) showing clusters around students, perceptions, dental hygiene education, and assessment. The United States ranked top of the list for most published author-affiliated countries, with England, Canada, Australia, and Saudi Arabia in the top six for all periods analyzed. In conclusion, within the limitations of this study, areas of interest in dental education journals in the last decade were identified along with the countries with most publications.

Clinical experiences of staff and students in transitioning from in-person to blended teaching

This paper describes some of the lessons learned during the COVID-19 pandemic from a study conducted with a group of clinical teachers and undergraduate dental students at the Faculty of Dentistry, Oral & Craniofacial Sciences (FoDOCS) at King's College London about the use of a combination of remote, online and in-person teaching methods that resumed from June 2020. In the narrative research, participants shared their experiences delivering online clinical workshops and their previous experiences delivering face-to-face sessions online, both during and before the pandemic. We conducted remote interviews with the participants via video conferencing, which were recorded, transcribed, and analysed using thematic analysis. Narrative accounts revealed commonalities organised into seven themes, highlighting some of the challenges encountered during the pandemic and providing insights into addressing different curricular constraints and concerns when utilising various delivery modes during emergency situations, such as pandemics. In our study, we concluded that students and teachers benefit from dissociating clinical learning from clinical treatment sessions to focus on the educational intent and content before applying them chairside with patients. Throughout the course, students and teachers were challenged by a lack of engagement. In addition, it is important to examine the online fatigue highlighted by both students and teachers and identify ways to improve time, literacy, and facilitation to create a more conducive learning environment.

The Impact of a Web-Based Restorative Dentistry Course on the Learning Outcomes of Dental Graduates: Pre-Experimental Study

BACKGROUND

Restorative dentistry plays a crucial role in dental practice, necessitating professionals to stay abreast with the latest advancements in the field. The advancement of technology has made web-based learning a widely used method of education delivery in dentistry, providing learners with extensive information and flexibility.

OBJECTIVE

This study aims to evaluate how effective an online educational course in restorative dentistry is for dental graduates in Syria.

METHODS

This study used a pre-experimental study design, with pretest and posttest assessments to measure changes in participants' knowledge and skills. A total of 21 dental graduates completed the online course in restorative dentistry, which was hosted on Moodle, using the learning management system of the Syrian Virtual University. Participants were provided with a suggested learning sequence and had the flexibility to navigate the course on their own and at their own pace. The course was developed based on the principles of web course design and web-based course development using the ADDIE (Analysis, Design, Development, Implementation, and Evaluation) general instructional design model. The pretest and posttest assessments consisted of 50 multiple-choice questions with a single correct answer, aligning with the course content. Furthermore, participants were asked to complete a course acceptance survey upon finishing the course.

RESULTS

The results showed a significant improvement in the participants' knowledge of restorative dentistry, supported by a statistically significant P value of less than .05. The effect size of the difference between the pre and posttest indicated that the effect size, as indicated by ω2, demonstrated a significant 62.1% difference between the pre and posttest, indicating a high and statistically significant effect. Furthermore, the value derived from the Haridy obtained work ratio formula indicated that the educational program was effective, with an effectiveness amount of 3.36%. Additionally, 93% (n=19) of respondents expressed confidence in having gained the expected benefits from the educational course upon its completion.

CONCLUSIONS

The findings indicated a notable enhancement in the participants' understanding of restorative dentistry. The participants' high satisfaction rate and positive feedback from the course acceptance survey further emphasize the favorable reception of the web-based learning approach. This study highlights the potential of web-based learning in dental education, opening the door for future research in this area. The findings of this study carry important implications for the design and implementation of web-based educational programs in dentistry, suggesting that such programs can serve as an effective tool for continuous professional development in the field.

Effects of Distance-Learning Strategies in Dental Fixed Prosthodontics Amidst the COVID-19 Pandemic: Cross-Sectional Questionnaire Study on Preclinical Dental Students' Perspective

BACKGROUND

COVID-19's high transmissibility led to gathering restrictions where dental schools experienced disruptions due to restrictions on attending in-person lectures and limitations placed on applied preclinical and clinical activities. Students not only had to rapidly switch to digital technology-based learning (TB-learning) modules but also experienced high levels of social isolation and anxiety around virus transmission.

OBJECTIVE

This study aims to evaluate the preclinical students' perception of switching TB-learning modules amidst the COVID-19 pandemic, identifying which module parameters were associated with strong student outcomes.

METHODS

A web-based survey of 39 Likert scale questions was delivered to preclinical dental students (Western University) to evaluate students' perceptions concerning TB-learning, fear amidst the COVID-19 pandemic, and the impact on their preclinical training. A Spearman rank correlation coefficient was determined to estimate the relationship between 2 variables in isolation (P=.01). An ordinal regression analysis was performed on variables of interest to determine how module variables (typically within the instructor's control) influenced the student outcomes (P=.05).

RESULTS

The response rate was 30% (n=39). TB-learning was considered vital (34/39, 87.2%) as the students' education improved (18/39, 46.2%). However, 53.8% (n=21) of students showed increased difficulties in retaining, visualizing, or understanding the materials using TB-learning, and 64.1% (n=25) found it more difficult to concentrate than in in-person classes. In total, 79.5% (n=31) of students showed different levels of agreement about feeling fatigued from TB-learning. Through Spearman ρ correlation analysis, the quality of questions in quizzes (ρ=0.514; P<.001), relevant handouts (ρ=0.729; P<.001), and high-quality audiovisuals (ρ=0.585; P<.001) were positively correlated with students responding that the modules were useful to preclinical training. Similarly, good organization (ρ=0.512; P<.001), high-quality questions in quizzes (ρ=0.431; P=.01), and relevant handouts (ρ=0.551; P<.001) were positively correlated with web-based classes as an effective way to learn. In total, 91.6% (n=36) of the students agreed that COVID-19 was a dangerous disease, whereas 53.8% (n=21) showed different levels of agreement that they were afraid to be infected personally, and 69.2% (n=27) feared passing COVID-19 along to family and friends. A total of 82.1% (n=32) of the students showed that COVID-19 impacted their overall learning process and had a negative impact on their practical preclinical training (31/39, 79.5%).

CONCLUSIONS

The students found a difference between TB-learning and face-to-face learning methods, where the students perceived fatigue toward the web-based method with difficulty concentrating and visualizing the subject. Moreover, there was a consensus that COVID-19 itself affected the students' overall learning process and preclinical training. As dental schools continue implementing TB-learning into their curriculum, this investigation identifies the students' struggles with the paradigm shift. In an effort to improve TB-learning, this work highlights 4 variables (organization, quizzes, quality handouts, and quality audiovisuals) within the control of instructors that can help improve content deliverance, improving the students' experience.

Creativity as a framework for innovation in dental education

Dental education is rich with examples of innovation as educators have responded to advances in knowledge, technology, the needs of the community, and most recently the challenges of the COVID-19 pandemic. Current challenges requiring innovative pedagogies include developing graduates who are interprofessional collaborative practice-ready, adapting to technological advances, embedding sustainability in the curriculum, and addressing equity and diversity in dental education. Creativity is the production of something that is novel and useful and is intimately linked to innovation which is the implementation of new and improved ways of doing things. To develop innovative pedagogies and address the current challenges facing dental education, educators and dental schools must reflect on the factors necessary for supporting creativity and innovation and seek to remove barriers to or biases against creativity. Here, we discuss the importance of creativity in supporting innovation in dental education, and call for leadership to actively support all elements of creativity for continued innovation to address the challenges we face in educating the future oral health workforce.

Effectiveness of distance learning for preclinical periodontal education

INTRODUCTION

This study aimed to investigate the effectiveness of distance learning (DL) for the second-year periodontics course compared to classroom learning (CL). MATERIALS AND METHODS: DL for Class A (n1 = 126) and CL for Class B (n2 = 133) were implemented. The same instructors recorded or delivered the same lectures in the two learning modules during the second-year periodontics course. Classes A and B took the same final examinations (a total % score of 200). General linear model (GLM) and ordinal logistic regression (OLR) analyses were conducted after considering individual first-year final % scores as a covariate to test if the second-year final % scores and the distributions of letter grades were significantly different between Class A and B.

RESULTS

The mean second-year final % score of the DL group (166.4) was significantly higher than that of the CL group (160.8) (independent t-test, p = .019). However, in GLM, the first-year final % scores significantly affected the second-year scores (p = .016); the second-year final % scores between the two groups were not significantly different (p = .268) after considering the individual first-year scores. In OLR, there was no difference in the likelihood of getting lower grades in the second-year course between the two groups (odds ratio = 1.6; 95% confidence interval = [0.95, 2.72], p = .078) after considering the first-year final % scores.

CONCLUSION

Within the limitations of the study, the DL for preclinical periodontics resulted in comparable student learning outcomes when compared to the traditional CL.

Special care dentistry education during the COVID-19 pandemic: The impact of online peer-assisted learning

OBJECTIVES

This study aims to analyze the impact and students' perceptions of online peer-assisted learning (OPL), developed as an alternative and innovative approach to Special Care Dentistry (SCD) training during the COVID-19 pandemic. Online peer-assisted learning (OPL) is an alternative pedagogical approach that combines online education and peer-assisted teaching.

METHODS

The OPL session was conducted by two postgraduate students in SCD (as teachers), to final year undergraduate dental students (as learners) (n = 90), supervised by two specialists in SCD-related areas (as supervisors). Vetted online pre- and post-intervention quizzes were conducted before and after the session, respectively, followed by an online validated feedback survey of the students' learning experiences. Meanwhile, a reflective session was conducted between the postgraduate students and supervisors to explore their perceptions of OPL. Quantitative data was analyzed via paired t-test (significance level, P < .05). Qualitative data was analyzed via thematic analysis.

RESULTS

Overall, 68 (response rate = 75.6%) and 81 (response rate = 90.0%) undergraduate students completed the quiz and feedback survey, respectively. There was a significant difference in total mean scores, and mean scores of 7 (out of 10) individual items on the quizzes. Most students offered positive reviews of multiple aspects of OPL. They acknowledged the benefit of OPL for its content and preparation process, technology utilized, and experts' roles. Postgraduate students perceived that OPL encourages knowledge-recall and utilization of technology-based educational tools, while improving their teaching skills.

CONCLUSION

Students provided positive responses toward the implementation of OPL as an innovative approach to the teaching and learning of SCD during the COVID-19 pandemic.

Evaluation of national dental curriculum in Iran using senior dental students' feedback

BACKGROUND

Dental curriculums require regular revision to stay up to date in scientifical and societal fields. Senior dental students are among the main stakeholders of such curriculums. The present study investigated the opinions of Iranian senior dental students regarding the adequacy of their dentistry program and the national dental curriculum in training a competent dentist, the program's content, and its structure.

METHODS

A previously designed and validated questionnaire on the opinion of senior dental students regarding curriculum adequacy was sent to a representative in each of the country's dental schools. Before the COVID pandemic terminated data collection, a total of 16 schools (438 students) managed to respond (37%). The questionnaire asked the students to assess the adequacy of the training received in curriculum's theoretical and practical competencies with the help of a five-point Likert scale that ranged from "Completely inadequate" to "Completely adequate". It also questioned them on its teaching methods and intensity. SPSS software version 24 and Chi-square test served for statistical analysis.

RESULTS

In total, the study has 438 participants, 245 female and 193 male. Significant sex differences were spotted in the responses concerning both theoretical and practical training. Regarding general training adequacy, 50 (22.6%) female students and 50 male ones (30.7%), P = 0.08 agreed that the program was acceptable. The numbers for students of old (more than 15 years of activity) and new schools were 47 (21.7%) and 53 (31.7%), respectively (P = 0.03). Nearly one-third deemed the teaching methods appropriate. Regarding the duration of curriculum phases, 33 students (8.3%) believed that basic science required extension, while 108 (28.6%) and 266 (69.1%) reported such need for pre-clinical and clinical phases. The school's years of activity emerged as significant, as 38.1% of students from new schools versus 21.7% of those from old ones deemed the extension of pre-clinical phase necessary (P < 0.001).

CONCLUSION

A significant number of Iranian senior dental students found the undergraduate dental curriculum inadequate regarding competencies, content, and teaching. Further investigations will determine whether it's the curriculum or its implementation that warrants revision.

In‐person and virtual assessment of oral radiology skills and competences by the Objective Structured Clinical Examination

PURPOSE

Clinical education is an essential part of the Dental School curriculum and assessment is a fundamental component of the teaching-learning process.

OBJECTIVES

With the purpose of implementing a structured and objective assessment method in the teaching of Oral Radiology, undergraduate dentistry students were submitted to an assessment of clinical competences and skills in radiology by the Objective Structured Clinical Examination (OSCE), applied both in-person and virtually (VOSCE).

METHODS

The same group of students was evaluated by the OSCE and VOSCE in six-station circuits that involved the assessment of clinical skills in Oral Radiology. For each station, an individual evaluative checklist (per station) was prepared and the participants' general scores were obtained. The students' anxiety level was also assessed before and after the exams and a meta-evaluation was performed to indicate the participants' perception of the assessment methods.

RESULTS

The OSCE (0.61) and VOSCE (0.81) reliability values were considered substantial and almost perfect, respectively. The students evaluated showed a better performance in the OSCE (p ≤ 0.05). Anxiety levels were considered moderate in both assessments and showed no difference between the two exams. The meta-evaluation showed a positive evaluation for the items "time of execution", "clarity", "degree of difficulty" and "importance for clinical practice", both for the OSCE and the VOSCE.

CONCLUSIONS

The OSCE was effective for evaluating clinical competencies and skills in Oral Radiology, both in face-to-face and virtual examinations, but with a limitation in the online method for evaluating technical skills.

A homemade simulation model improves the impact of e-learning for the practical administration of dental anaesthesia

INTRODUCTION

A simulation model improves the learning of dental anaesthesia in dental students. This study explored first, the making at home of a dental anaesthesia simulation model by dental students, and second, the impact of that simulation model on the learning of dental students following an online course. We compared the level of knowledge, the level of perception of confidence to perform the basic injection technique (BIT) of dental anaesthesia, and the level of attitude towards e-learning of the BIT between a group of dental students who had an online course with a home-made dental anaesthesia simulation model (HMDASM) and a group of dental students who did not use that model.

MATERIALS AND METHODS

A group of participants (n = 28) used the HMDASM to learn the BIT with an e-learning course. Another group of participants (n = 28) followed the same e-learning course, but that group used a lemon to practise the BIT. The two groups answered questionnaires that explored the level of theoretical knowledge on the BIT, the level of perception of confidence to perform the BIT, and the level of attitude towards e-learning of the BIT. Questionnaire scores from each group were compared by a Student's t-test (p ≤ .05).

RESULTS

The group that used the HMDASM had a level of knowledge similar to that of the other group (p > .05). The group that used the HMDASM had a level of perception of confidence to perform the BIT and a level of attitude towards online learning of the BIT higher than those of the group that did not use the simulation model (p < .05).

CONCLUSION

The use of a HMDASM had a positive effect on dental students following an online course to learn the BIT.