Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 11  |  Issue : 2  |  Page : 100-104

Computer-Assisted Learning vs. Small Group Tutorials in Periodontal Charting: A Randomized Controlled Trial in a Malaysian Dental School


1 Department of Periodontology, Faculty of Dentistry, MAHSA University, Bandar Saujana Putra, Selangor, Malaysia
2 Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, MAHSA University, Bandar Saujana Putra, Selangor, Malaysia
3 Faculty of Dentistry, MAHSA University, Bandar Saujana Putra, Selangor, Malaysia
4 Department of Oral Biology and Biomedical Sciences, Faculty of Dentistry, MAHSA University, Bandar Saujana Putra, Selangor, Malaysia

Date of Submission17-Sep-2019
Date of Decision18-Nov-2019
Date of Acceptance04-Dec-2019
Date of Web Publication29-Jan-2020

Correspondence Address:
M. Alexander
Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, MAHSA University, Bandar Saujana Putra, Selangor
Malaysia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jofs.jofs_115_19

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  Abstract 


Introduction: Dental education, like most fields of healthcare education, embraces all three domains of learning − cognitive, psychomotor and affective. The aim of this study was to determine whether computer-assisted learning (CAL) can replace face-to-face teaching with reference to acquiring theoretical as well as practical skills in periodontal charting in dentistry. Material and Methods: A total of 70 year 4 dental students were randomly assigned to CAL and Small Group Tutorial (SGT) groups. Following the sessions, they underwent theoretical knowledge as well as practical skills evaluation tests. Pre- and post-tests Confidence Log Questionnaires (CLQ) were completed by the students. Results: CAL and SGT were equally effective from the theoretical knowledge aspect. SGT group did better in some aspects of practical skills acquisition. Conclusion: There was no statistical difference in the theoretical knowledge acquired by the different methods, whereas small group teaching was more effective in gaining certain psychomotor skills in periodontal charting, leading us to conclude that face-to-face teaching seems to be having an upper hand when it comes to teaching periodontal charting.

Keywords: Computer-assisted learning, small group tutorials, periodontal charting, randomized controlled trial


How to cite this article:
Thomas BS, Alexander M, NurSulwana MH, Yap HY. Computer-Assisted Learning vs. Small Group Tutorials in Periodontal Charting: A Randomized Controlled Trial in a Malaysian Dental School. J Orofac Sci 2019;11:100-4

How to cite this URL:
Thomas BS, Alexander M, NurSulwana MH, Yap HY. Computer-Assisted Learning vs. Small Group Tutorials in Periodontal Charting: A Randomized Controlled Trial in a Malaysian Dental School. J Orofac Sci [serial online] 2019 [cited 2020 Apr 6];11:100-4. Available from: http://www.jofs.in/text.asp?2019/11/2/100/276714




  Introduction Top


Dental education, like most fields of healthcare education, embraces all three domains of learning − viz. cognitive, psychomotor as well as affective. In the earlier days, there seems to have been more emphasis on the psychomotor field but with advances in biological science, dentistry has been giving equal importance to the cognitive aspects of various dental procedures also. At the same time, compared to most other related healthcare fields, psychomotor skills continue to occupy a place of great importance in dental education, since dental students begin treating patients from year 3 onwards. In dental educational institutions, this translates to more face-to-face teaching of students by lecturers − for achieving optimal motor skills as well as for lectures, small group tutorials (SGT), etc. This has resulted in increased workload for the lecturers. At the same time, there has been much said about the disadvantages of lectures like, students are passive during lectures, their attention wanes quickly after 20 to 25 minutes, etc. There seems to be an abundance of studies acclaiming the role of computers in education in general and higher education in particular.[1],[2] A perusal of literature suggests that these modern means of education, like computer assisted learning (CAL), can and should be taking up more and more of the workload of the lecturers.[3],[4] This prompted us to conduct this study to evaluate the role of computers in dental education in a developing country like Malaysia.

The aim of this study was to determine whether CAL can replace face-to-face teaching like SGT, with reference to acquiring theoretical as well as practical skills in periodontal charting, in dentistry. We hypothesized that the CAL group will fare better than the traditional SGT group.

Materials and Methods

We decided to follow the method used by V Bissell, R A McKerlie, D F Kinane, and S McHugh,[5] with a few variations, for this research. Ethical approval for this study (Ethical Committee No.: RMC/EC38/2018) was provided by the Research Management Center of MAHSA University (BSP campus), Selangor, Malaysia, in December 2018. The study was conducted among year 4 students during their first semester posting, midst of which they are taught periodontal charting (dental undergraduate program is of five years duration in Malaysia and periodontology is taught in years 3 and 4 in our university). After obtaining mandatory permissions, the aim as well as the procedure were explained to the students and they were assured that it would be an anonymous study. A total of 70 students volunteered for this study, all of whom were good at routine computer skills. After obtaining consent, 35 students each were randomly assigned to two groups − the CAL group and the SGT. The learning materials for the CAL and SGT sessions were prepared according to the Course Learning Outcome of the topic. The students were evaluated on the following parameters:
  1. technique of probing periodontal pockets;
  2. furcation detection and probing;
  3. identifying and measuring gingival recession;
  4. calculation of clinical attachment loss;
  5. plotting of gingival margin on the periodontal chart;
  6. eliciting tooth mobility.


The students of the CAL group utilized the computer lab to study periodontal charting using static pictures as well as animations which illustrated and explained various aspects of the topic. A lecturer was available during the session, in case they needed any clarifications. SGT sessions were carried out in batches of five to six students by a single lecturer who had prepared the CAL contents also. The duration of CAL and SGT sessions were of 45 minutes each. After these sessions, both the groups completed a pre-test confidence log questionnaire (CLQ) [Table 1], which was also adapted from V. Bissell et al.[5] (who had in turn adapted it from Draper et al.[6]). Then a written test to evaluate the theoretical knowledge followed by a practical skills evaluation test were carried out to gauge the level of understanding attained by the participants. To test the practical skills, models depicting periodontal disease (detailing periodontal pockets, furcation involvement, gingival recession, attachment loss, gingival margins at various levels, and teeth with various grades of mobility) were distributed to the students. All the models were prepared by a single lecturer and scoring for all the six practical skills mentioned above also was done by the same lecturer to minimize bias/variation. Post-test CLQs were then completed by the participants. To avoid contamination bias, the participants were advised to keep their mobile phones away till the conclusion of the study, so that there wouldn’t be any contact between the two groups.
Table 1 Confidence log questionnaire (CLQ)*

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Statistical Analysis

Data analysis was performed using SPSS software version 25.0. Initially, data were explored and divided into frequency (count) and percentage (%). Pearson Chi-square and Fisher’s exact test were used to analyze the difference between the groups in theoretical knowledge as well as practical skills. Further analysis was done using McNemar–Bowker test to analyze the difference/changes between pre- and post-CLQ. Any difference with P-value < 0.05 was considered as significant.


  Results Top


Of the 70 students who participated in this study, five did not complete all the evaluations in the time allotted and three left some of the practical skills untouched and so were excluded. The data from the remaining 62 students (30 from the CAL group and 32 from the SGT group) were analyzed.

Theoretical knowledge acquired by the students in both the groups was mostly above 85% with no statistically significant difference between them [Table 2].
Table 2 Scores of theoretical knowledge evaluation tests (n = 62)

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When it came to practical skills evaluation [Table 3], 83.3% of the students in the CAL group got the periodontal pocket probing correct, whereas 16.7% did not. In the SGT group, 96.9% were able to get it correct and 3.1% failed. Comparison of the groups did not show any significant difference (P = 0.131). For the furcation probing and detection test, 93.3% of the CAL group failed to detect the furcation involvement and only 6.7% got it correct. In the SGT group, 84.4% detected the furcation involvement whereas 15.6% did not. Statistical analysis showed a significant difference between the two groups in this skill (P < 0.001). Evaluation of the skills in identifying and measuring gingival recession showed that 93.3% of the CAL group and 100% of Group B got it right, displaying no statistical difference between the groups (P = 0.230). On evaluating the ability of the students to calculate the clinical attachment loss, CAL and SGT groups had success rates of 93.3% and 93.8%, respectively, again showing no statistically significant difference.
Table 3 Scores of practical skills evaluation tests (n = 62)

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Plotting of gingival margin on the periodontal chart for a given quadrant when evaluated in the CAL group showed that 30% were able to do it correctly and 70% were unable to record it correctly. In the SGT group, 78.1% correctly recorded the gingival margin and 21.9% did not. When the two groups were compared, a statistically significant difference was noticed (P < 0.001). The skill in eliciting tooth mobility was mastered by 83% in CAL group and 84.4% in SGT with no statistically significant difference between them (P = 0.911) [Table 3].

On evaluating the pre- and post-test confidence log questionnaires, the responses to Q1, Q4, and Q7 had significant changes in the CAL group after the practical skills session, with a statistically significant percent of students reporting less confidence or no confidence after the evaluation [Figure 1] in these aspects (P < 0.05). At the same time, the SGT group showed no significant changes between pre- and post-confidence log questionnaires (P > 0.05).
Figure 1 Figures of comparison of pre- and post-confidence log questionnaires (CAL).

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A post-evaluation discussion with the participants was informative. The CAL group said that they were “very happy” with digital learning but at the same time they said that it “should have been combined with tutorials also”. The SGT group was of the opinion that their learning process “should have been mixed with CAL also”.


  Discussion Top


Instructor-based teaching is the prevalent model in most educational institutions worldwide, even in higher education. It has certainly stood the test of time to a large extent. But with the advent of digital technologies, there has been increasing pressure on teachers to integrate the same into education as well. The present-day students are “digital natives” having grown up with digital technology, whereas some of the teachers could be seen as being reluctant to incorporate digital technologies into the curriculum due to diffidence or inflexibility. Technology certainly has a great role to play in the education of the “millennials”, the question being, to what extent?

In our study, we found that both CAL and SGT were equally effective when it comes to the theoretical knowledge aspect. But when it came to the “skills testing” part, there were statistically significant differences in two of the six parameters that were tested, with the SGT group doing better in both of these skills. In the furcation probing test, a large percent of participants in the CAL group (93.3%) did not know where the furcation entrance was and so got the procedure wrong. The second test where there was a statistically significant difference was the plotting of the gingival margin test. This was a difficult part for the participants in Bissell’s[5] study also and their explanation for it (“it is a fair reflection of this procedure clinically”) seems to hold good in our case also.

One of the main drawbacks of this study (as well as quite a few similar studies) is that “skills testing” was done soon after the CAL/SGT. According to Fleishman,[7] “skill is the level of proficiency on specific tasks. It is the learned capability of an individual to achieve desired performance outcomes”, meaning skills can be improved by guidance and repetition. According to the Ackerman[8] theory, “there are different abilities underlying performance at consecutive stages of skill acquisition”. As elaborated by Masumeh Taie,[9] “in phase 1, general ability measures (e.g., abstract reasoning) underlie performance. In phase 2, with the formation of the production systems for the consistent features of performance, the influence of these factors decreases, and perceptual speed abilities appear as important predictors of performance. And in Phase 3, the act is determined mainly by non-cognitive psychomotor abilities”. Most of the studies, including ours, have measured the outcome in phase 1 or 2, in our opinion. But we opted not to conduct an evaluation after some time because it would have been very difficult to rule out if the students had learned from other sources (textbooks, peer-to-peer learning, etc.), in the interlude.

One of the strengths of this study has been that the preparation of the computer lessons as well as the SGT materials were done by a single person. The scoring of all the students for the practical skills was also done by a single person, to minimize bias/variation. This certainly does not mean that everything could be literally standardized, which can be one of the advantages of digital technology. But then one wonders whether technological standardization is the panacea for divergence in teaching methods/techniques or for the ills that plague pedagogy.

There is no doubt that students may be more comfortable with CAL, some of the advantages being that it can be more interactive and engaging and can arouse the interest of even reluctant students. But a recent systematic review on the effectiveness of digital education of health professions on clinical practice guidelines found that it is only “at least as effective as traditional learning and more effective than no intervention in terms of knowledge”.[10]

The increasing workload of lecturers is a universal concern cutting across specialties with tasks ranging from teaching preparation and teaching, to writing reports and papers, student consultations, meetings and communications, internal quality assurance, etc.[11] Digital technology can help reduce part of this burden but as our study suggests, replacing the lecturer to any significant extent is not likely to happen in the near future. In our opinion, the ideal method might be to incorporate digital technology into pedagogy in a broader and comprehensive manner, without disturbing the teacher–student relationship which continues to be the foundation of education.

Our study showed that there was no difference in the theoretical knowledge acquired by the different methods of instruction, but small group teaching was more effective in gaining certain psychomotor skills in periodontal charting leading us to conclude that face-to-face teaching has an upper hand when it comes to teaching periodontal charting.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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Bissell V, McKerlie RA, Kinane DF, McHugh S. Teaching periodontal pocket charting to dental students: a comparison of computer assisted learning and traditional tutorials. Br Dent J 2003;195:333-6.  Back to cited text no. 5
    
6.
Draper SW, Brown MJ, Edgerton E, Henderson F, McAteer E, Smith ED et al. Observing and measuring the performance of educational technology TILT project. Glasgow: University of Glasgow Teaching and Learning Programme (Conference Proceedings) 1994;5:22.  Back to cited text no. 6
    
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Fleishman EA. On the relation between abilities, learning, and human performance. Am Psychol 1972;27:1017-32.  Back to cited text no. 7
    
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Ackerman PL. Determinants of individual differences during skill acquisition: cognitive abilities and information processing. J Exp Psychol Gen 1988;117:288-318.  Back to cited text no. 8
    
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Taie M. Skill acquisition theory and its important concepts in SLA. TPLS 2014;4:1971-6.  Back to cited text no. 9
    
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Tudor Car L, Soong A, Kyaw BM, Chua KL, Low-Beer N, Majeed A. Health professions digital education on clinical practice guidelines: a systematic review by Digital Health Education collaboration. BMC Med 2019;17:139.  Back to cited text no. 10
    
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University and Collee Union. Workload is an education issue. UCU Workload Survey Report 2016. Available at: https://www.ucu.org.uk/media/8195/Workload-is-an-education-issue-UCU-workload-survey-report-2016/pdf/ucu_workloadsurvey_fullreport_jun16.pdf.  Back to cited text no. 11
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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