The benefits of incorporating active learning into online, asynchronous coursework in dental physiology.

The COVID-19 pandemic required a shift to online learning that posed particular challenges for the education of dental students. Basic science courses were presented in an online, asynchronous format to facilitate small group rotations through preclinical work. The success of active learning was previously examined in a Dental Physiology course, and it was desired to reassess those methods in an online environment. Students were provided with prerecorded lectures containing learning activities, and the effectiveness was compared with traditional lecture recordings. On surveys, dental students had more positive perceptions of online recordings that incorporated active learning strategies, with higher perceived effectiveness of the lecturer, ability to pay attention, motivation to study, and confidence with the material. This was similar to the previous study, in which face-2-face (F2F) active learning was more positively reviewed than traditional lectures. Compared with these past sections, the online cohort expressed similarly positive perceptions of the active learning sections, but the online traditional lectures were perceived to be less effective than F2F lectures. Despite the differences in student perceptions, unit exam scores were similar for didactic lectures in both online and F2F settings. Unit exam scores were significantly higher when active learning strategies were employed, with the highest performance levels in the F2F cohort. While active learning strategies continue to be effective, further research is needed to optimize these methods and engage students in online coursework. The results suggest the importance of active and collaborative learning opportunities in the education of students in physiology coursework.

Effects of active engagement and spaced retrieval practice on knowledge and application of a self-assessment rubric.

PURPOSE/OBJECTIVES: This study examined effects of active engagement (ENG) and spaced retrieval practice (SRP) on D1 dental students' self-assessment knowledge acquisition. METHODS: D1 dental students (N = 120) were randomly assigned to one of four conditions in a 2 (ENG or no ENG) X 2 (SRP or no SRP) design. Students were tested on their knowledge of a self-assessment grading rubric (on a 30-item multiple-choice exam) and their ability to apply the rubric (on a simulated dentoform assessment). RESULTS: There were significant main effects of both ENG and SRP on both outcome measures. Both ENG and SRP increased students' knowledge of, and ability to apply, the self-assessment rubric. Effects of ENG were larger than those of SRP. There was also a significant ENG X SRP interaction on the knowledge measure. The effect of SRP was larger in the no-ENG conditions than the ENG conditions, which may reflect a ceiling effect in the ENG conditions. CONCLUSIONS: ENG and SRP have the potential to substantially enhance D1 dental students' learning outcomes. These results should motivate dental educators to reject outdated instructional techniques and thereby unleash students' full learning potential. Additional research is needed with a wider range of dental students and learner topics.

The stress of success: An online module to help first-year dental students cope with the Impostor Phenomenon.

CONTEXT: Professors often spend a great deal of time counseling poorly performing students, which limits the time dedicated to high achievers. This may be problematic, as psychiatrists have determined that gifted students may be susceptible to feelings of inadequacy despite positive external evidence. Dr. Pauline Clance coined the term "Impostor Phenomenon" (IP) to describe these traits. OBJECTIVE: Dental students, while academically successful, may be prone to IP and lack appropriate coping strategies. The goal of this project was to create and publish an online module to educate dental students about IP and provide 6 coping mechanisms. DESIGN: After viewing the video at the beginning of the semester, students completed the Clance IP Scale to determine the prevalence of IP thoughts. This was repeated at the end of the semester to determine the impact of the online training module. RESULTS: There was a decrease in postsemester scores from 63.44 (±14.92) to 59.12 (±14.56), n = 103, 86% response rate, dependent samples within subjects t-test, P < 0.001). The percentage of students reporting intense impostor experiences decreased from 13.6% to 4.9%. Females exhibited significantly higher scores than males, but there was no statistically significant impact of age or race on results. The most common reported coping strategies were a reduction in time spent on nonessential tasks and the use of scheduling to prevent procrastination. CONCLUSION: These results suggest that an online training module can improve awareness of the Impostor Phenomenon and help high-achieving students to cope with their stress and feelings of inadequacy.

The in's and out's of science outreach: assessment of an engaging new program.

Many professors are interested in providing science outreach to local K-12 students, but may not have the time or resources needed to create an engaging presentation. The American Physiological Society supports outreach initiatives through programs such as the Physiology Understanding (PhUn) Week. Building on these activities, it was desired to create and assess an immersive and engaging Outreach Program in a disadvantaged K-12 student population. Three distinct modules were created on cardiovascular physiology, respiratory physiology, and oral health. All resources for these modules underwent peer review and publication, allowing other professors to easily execute their own outreach programming. The outreach modules were presented to 288 students in 3rd, 5th, 6th, and 7th grade classes. Implementation of the modules resulted in significant increases in student content knowledge, ranging from 32 to 57% improvement ( P < 0.001, dependent t-test), with an average increase of 46%. K-12 science teachers reported that the program was at an appropriate educational level, increased students' enthusiasm for science, and increased students' exposure to science careers. Additionally, the presenters of the Outreach Program were perceived to be enthusiastic, knowledgeable, and proficient at interacting with the students. On open-response survey items, the science teachers indicated a high level of satisfaction with the program and an enthusiasm for continued collaborations. These results indicate the importance of organized and interactive science activities for the success of a new Outreach Program.

An Online Module to Understand Body Fluid Status in Clinical Cases.

Introduction: A thorough understanding of body fluid alterations is essential for the success of both practicing dentists and physicians. However, the time constraints of professional school curricula often limit the time available in physiology courses to address this material. Methods: The primary goal of this resource was to improve student comprehension of body fluid status by using three online videos that explain volume-osmolality diagrams. An additional goal was to improve students' ability to apply their physiological knowledge by showcasing real-life clinical situations in medicine and dentistry. The videos were created using custom-designed PowerPoint animations, video recordings, and Camtasia video-editing software. Results: On assessment of exam performance, students performed similarly in sections of the course that were taught using the online modules versus face-to-face lectures. Student performance was extremely high on the body fluid assessment-questions, with an average of 95%. This high level of student performance was notable, particularly given the complexity of the questions. Discussion: These results indicate that this online volume-osmolality module enabled students to improve their comprehension of body fluid concepts in physiology. Furthermore, the data indicates the feasibility of replacing lectures with online modules, freeing valuable class time for active learning or more advanced physiological concepts.

Satisfaction of Dental Students, Faculty, and Patients with Tooth Shade-Matching Using a Spectrophotometer.

The aims of this study were to evaluate dental students' clinical shade-matching outcomes (from subjective use of shade guide) with an objective electronic shade-matching tool (spectrophotometer); to assess patients', students', and supervising faculty members' satisfaction with the clinical shade-matching outcomes; and to assess clinicians' support for use of the spectrophotometer to improve esthetic outcomes. A total of 103 volunteer groups, each consisting of patient, dental student, and supervising faculty member at the University of Louisville, were recruited to participate in the study in 2015. Using the spectrophotometer, clinical shade-matching outcome (ΔEclinical) and laboratory shade-matching outcome (ΔElaboratory) were calculated. Two five-point survey items were used to assess the groups' satisfaction with the clinical shade-matching outcome and support for an objective electronic shade-matching tool in the student clinic. The results showed that both ΔEclinical (6.5±2.4) and ΔElaboratory (4.3±2.0) were outside the clinical acceptability threshold ΔE values of 2.7, when visual shade-matching method (subjective usage of shade guide) was used to fabricate definitive restorations. Characteristics of the patients, dental students, supervising faculty members, and restorations had minimal to no effect on the ΔEclinical The patients, dental students, and supervising faculty members generally had positive opinions about the clinical shade-matching outcome, despite the increased ΔEclinical observed. Overall, clinical shade-matching outcomes in this school need further improvement, but the patients' positive opinions may indicate the need to revisit the acceptability threshold ΔE value of 2.7 in the academic setting.

Student Self-Assessment of Operative Dentistry Experiences: A Time-Dependent Exercise in Self-Directed Learning.

The aim of this study was to evaluate the process of student self-assessment on operative dentistry skills across four years at the University of Louisville School of Dentistry. First, a retrospective analysis of the Class of 2016 students' self-assessment and faculty assessment grade sheets was conducted to determine mean differences and correlations across time. Both preclinical (D2: n=120) and clinical (D3: n=120; D4: n=120) grade sheets were evaluated. Second, 25 students from each of the D1, D2, D3, and D4 classes in 2016 were asked to evaluate dentoform work, and 25 operative calibrated faculty members graded the same two dentoforms. The results of the retrospective analysis were that the D2 students' self-assessment scores were significantly higher than the faculty scores (t-test; p<0.05), and there was a negative correlation of scores (r=-0.503). The D3 students' self-assessment scores were also significantly higher than the faculty scores (t-test; p<0.05), and there was a negative correlation (r=-0.235). The D4 students' self-assessment scores were not significantly different from the faculty scores (t-test; p>0.05), and there was a positive correlation (r=0.408). In the prospective analysis, the D1, D2, and D3 students graded the dentoforms significantly higher (ANOVA; p<0.05) than did the D4 students and faculty members. There was an increasing correlation of scores directly related to experience (D1: r=-0.120; D2: r=0.255; D3: r=0.352; D4: r=0.689). These results support the concept that students' self-assessment is a learned process through experiential and continual encounters across time. The summative goal for all dental schools is to provide students with the skills and knowledge to critically evaluate their work for self-directed learning.

A Training Program Using an Audience Response System to Calibrate Dental Faculty Members Assessing Student Clinical Competence.

The aim of this study was to assess the effectiveness of calibration training of departmental faculty and competency graders using an audience response system on operative dentistry concepts across 12 months. The training sessions were designed to further solidify the process and equilibration of clinical opinions among faculty members and provide a more calibrated grading assessment during patient care for student performance feedback. Four (quarterly) calibration sessions occurred over 12 months in 2015. The first session was considered the baseline (control value) for this study. Pre- and post-calibration interrater agreement was assessed. Additionally, a pre and post assessment with ten Likert-scale questions was used to measure students' perceptions of instructional consistency. The results showed that a statistically significant increase in conceptual knowledge scores occurred for both departmental faculty members and competency graders across each of the four sessions (one-factor ANOVA; p<0.05). Interrater reliability agreement also significantly improved for both department faculty members and competency graders' clinical assessments over 12 months of implementation (Cohen's Kappa; p<0.05). There was a statistically significant increase in positive student perceptions on all ten questions (dependent t-test; p<0.05). Implementation of an audience response system for departmental and competency graders was found to be effective in facilitating a discussion forum, calibrating clinical assessments, and improving student perceptions. The positive results from this study support the value of dental schools' introducing faculty development programs to ensure consistent instruction for assessing dental student competence.

A cost-effective treatment for severe generalized erosion and loss of vertical dimension of occlusion: laboratory-fabricated composite resin restorations.

This case report describes preventive and restorative treatment planning for a 56-year-old female patient with severe, chronic, poorly controlled gastroesophageal reflux disease and resulting loss of vertical dimension of occlusion. First, the demineralization process was controlled through collaboration with the patient's physician, and measures were taken to restore adequate stimulated salivary flow. Then, for financial reasons, indirect laboratory-fabricated composite resin restorations were adhesively bonded to replace lost tooth structure and reestablish the patient's collapsed vertical dimension. Indirect-laboratory fabricated restorations can be a cost-effective alternative to direct composite resin or all-ceramic restorations for the treatment of chronic severe erosion, but there are no long-term clinical reports in the current literature to support or contraindicate the use of indirect composites for this type of clinical application. Therefore, careful, long-term follow-up evaluations are planned for this patient.

Use of intraoral digital scanning for a CAD/CAM-fabricated milled bar and superstructure framework for an implant-supported, removable complete dental prosthesis.

This report describes a clinical technique for fabricating a maxillary implant-supported, removable complete dental prosthesis by using an intraoral digital scanner to register implant positions and soft tissue morphology. The presented technique uses computer-aided design/computer-aided manufacturing (CAD/CAM) technology with a subtractive manufacturing process to fabricate a milled bar (infrastructure framework) and an additive process to fabricate a friction fit, superstructure framework. This digital restorative pathway may decrease patient discomfort and reduce the labor associated with fabricating implant-supported, removable complete dental prostheses.

Digital data acquisition for a CAD/CAM-fabricated titanium framework and zirconium oxide restorations for an implant-supported fixed complete dental prosthesis.

This dental technique report describes a digital workflow with digital data acquisition at the implant level, computer-aided design and computer-aided manufacturing fabricated, tissue-colored, anodized titanium framework, individually luted zirconium oxide restorations, and autopolymerizing injection-molded acrylic resin to fabricate an implant-supported, metal-ceramic-resin fixed complete dental prosthesis in an edentulous mandible. The 1-step computer-aided design and computer-aided manufacturing fabrication of titanium framework and zirconium oxide restorations can provide a cost-effective alternative to the conventional metal-resin fixed complete dental prosthesis.

A comparison of professional-level faculty and student perceptions of active learning: its current use, effectiveness, and barriers.

Active learning is an instructional method in which students become engaged participants in the classroom through the use of in-class written exercises, games, problem sets, audience-response systems, debates, class discussions, etc. Despite evidence supporting the effectiveness of active learning strategies, minimal adoption of the technique has occurred in many professional programs. The goal of this study was to compare the perceptions of active learning between students who were exposed to active learning in the classroom (n = 116) and professional-level physiology faculty members (n = 9). Faculty members reported a heavy reliance on lectures and minimal use of educational games and activities, whereas students indicated that they learned best via the activities. A majority of faculty members (89%) had observed active learning in the classroom and predicted favorable effects of the method on student performance and motivation. The main reported barriers by faculty members to the adoption of active learning were a lack of necessary class time, a high comfort level with traditional lectures, and insufficient time to develop materials. Students hypothesized similar obstacles for faculty members but also associated many negative qualities with the traditional lecturers. Despite these barriers, a majority of faculty members (78%) were interested in learning more about the alternative teaching strategy. Both faculty members and students indicated that active learning should occupy portions (29% vs. 40%) of face-to-face class time.

A technique for verifying and correcting a milled polyurethane definitive cast for nonsegmental implant restoration in an edentulous jaw.

This report describes a technique that uses an acrylic resin verification device and polyvinyl siloxane impression to verify and correct the analog position in a milled polyurethane definitive cast with removable periimplant soft tissue replica for a nonsegmental implant restoration in an edentulous jaw.

Implementation of a laboratory quality assurance program: the Louisville experience.

Remakes, or the refabrication of dental prostheses, can occur as a result of inherent inaccuracies in both clinical and laboratory procedures. Because dental schools manage large numbers of predoctoral dental students with limited familiarity and expertise as related to clinical prosthodontic techniques, it is likely these schools will experience an elevated incidence of laboratory remakes and their ramifications. The University of Louisville School of Dentistry, not unlike other dental schools, has experienced remakes associated with both fixed and removable prosthodontic procedures. Limitations in faculty standardization and variable enforcement of established preclinical protocols have been identified as variables associated with the high percentage of remakes documented. The purpose of this study was to introduce the implementation of a new multidepartmental quality assurance program designed to increase consistency and quality in both information provided to commercial dental laboratories and the prostheses returned. The program has shown to be advantageous in terms of cost-effectiveness and treatment outcomes. A statistically significant decrease in remake percentages has been recorded from inception of this program in December 2010 until December 2012. Furthermore, this program has resulted in more consistent communication between the dental school and commercial dental laboratories, among faculty members, and between faculty and students.

A comparison of traditional and engaging lecture methods in a large, professional-level course.

In engaging lectures, also referred to as broken or interactive lectures, students are given short periods of lecture followed by "breaks" that can consist of 1-min papers, problem sets, brainstorming sessions, or open discussion. While many studies have shown positive effects when engaging lectures are used in undergraduate settings, the literature surrounding use of the learning technique for professional students is inconclusive. The novelty of this study design allowed a direct comparison of engaging physiology lectures versus didactic lecture formats in the same cohort of 120 first-year School of Dentistry DMD students. All students were taught five physiological systems using traditional lecture methods and six physiological systems using engaging lecture methods. The use of engaging lectures led to a statistically significant higher average on unit exams compared with traditional didactic lectures (8.6% higher, P < 0.05). Furthermore, students demonstrated an improved long-term retention of information via higher scores on the comprehensive final exam (22.9% higher in engaging lecture sections, P < 0.05). Many qualitative improvements were also indicated via student surveys and evaluations, including an increased perceived effectiveness of lectures, decrease in distractions during lecture, and increased confidence with the material. The development of engaging lecture activities requires a significant amount of instructor preparation and limits the time available to provide traditional lectures. However, the positive results of this study suggest the need for a restructuring of the physiology curriculum to incorporate more engaging lectures to improve both the qualitative experiences and performance levels of professional students.

Clinical evaluation of 15% carbamide peroxide on the surface microhardness and shear bond strength of human enamel.

PURPOSE: This clinical evaluation compared a neutral sodium fluoridated whitening product to a neutral non-fluoridated whitening product in terms their effects on human enamel surface microhardness (SMH) and human enamel/resin composite shear bond strength (SBS) following various treatment times. MATERIALS AND METHODS: Subjects were evaluated for enamel SMH and enamel/resin SBS following 15% carbamide peroxide (CP) with and without potassium nitrate and fluoride (PF). Twenty subjects (80 first or second premolars), who were treatment-planned for premolar extraction due to orthodontic therapy, were allocated into two groups, A and B. Group A received 15% CP, while Group B received 15% CP with PF. Each patient had a control tooth, a 14-day treatment + 14-day recovery tooth, a 14-day treatment + no recovery tooth and a 4-day + no recovery tooth. Each tooth was further divided into two testing surfaces; the facial surface was used for SMH, while the lingual surface was used for SBS. RESULTS: The results of this study determined that there was no statistically significant difference between the effects of the two products on SMH and enamel/resin SBS. Additionally, there was no statistically significant difference between the treatment specimens compared to the controls in terms of SMH. However, there was a significant difference between the treatment groups compared to the controls in terms of enamel/resin SBS. CONCLUSION: Within the limitations of this clinical study, 15% CP with and without PF does not seem to alter the SMH of human enamel. However, 15% CP with and without PF significantly reduced enamel/resin SBS immediately following tooth whitening therapy, up to 14 days post-treatment.