Reorganizing assessment questions to provide additional information on student understanding of specific course content.

OBJECTIVES: Performance on exams and course letter grades are broad standards used to determine understanding of course content. To gain a different perspective on students' knowledge, we examined whether grouping exam questions based on the topic they assessed would provide additional information on students' comprehension. METHODS: Assessment questions from our physiology course were organized into groups based on major physiology content categories. We created 10 content categories and calculated students' performance in each category. The average of the 10 scores was compared with the course grade. RESULTS: The scores in individual categories reflected student knowledge of specific physiology content. The average scores of the 10 categories correlated with course letter grades. Analysis of performance demonstrated that 65% of students with course grades between 70 and 73% answered less than 70% of assessment questions correctly in four or more content categories. CONCLUSION: Evaluation of performance in grouped assessment questions provided additional information on student understanding and identified specific course content in which students underperformed.

Impact of test-enhanced learning as a study strategy: An exploratory study with first-year dental students.

PURPOSE: Research has demonstrated that learners who practice self-testing have superior long-term retention compared to those rereading the material alone, a phenomenon called test-enhanced learning. This testing effect can be leveraged by spacing out the testing practice over time, a technique called spaced repetition. In 2017, we provided dental students at the school with access to Osmosis, a web-based platform that supports test-enhanced learning and spaced repetition through flashcards. This exploratory study examined students' adoption of self-testing with flashcards and its impact on learning performance in basic sciences. METHODS: Participants were 143 first-year predoctoral students at a dental school in the US. The platform analytics revealed the number of flashcards students answered throughout the first academic year (2019-2020). Regression analyses examined how self-testing with flashcards impacted students' exam scores in basic sciences. Analysis of variance (ANOVA) tests examined the difference in students' exam performance among the non, minimal, occasional, and regular flashcard users who answered 0, 1-99, 100-499, and over 500 flashcards, respectively. RESULTS: Students answered 82,766 flashcards during the year. Additionally, they created 17,973 flashcards using the platform's flashcard authoring tool. Regression analyses showed that self-testing with flashcards correlated positively with students' exam performance in anatomy, biochemistry, nutrition, and physiology. ANOVA results revealed a statistically significant difference in students' exam performance in anatomy, biochemistry, and nutrition among the four groups. CONCLUSIONS: This study is the first in dental education to examine students' self-testing on the Osmosis platform. Results revealed that there was widespread adoption of self-testing with flashcards. The study provided additional evidence to support the value of self-testing for dental students. It has practical implications of how test-enhanced learning can be incorporated into dental education to support student learning. The study contributed to the test-enhanced learning literature in dental education, an area that has been underexplored.

Online learning during COVID-19 produced equivalent or better student course performance as compared with pre-pandemic: empirical evidence from a school-wide comparative study.

BACKGROUND: The COVID-19 pandemic forced dental schools to close their campuses and move didactic instruction online. The abrupt transition to online learning, however, has raised several issues that have not been resolved. While several studies have investigated dental students' attitude towards online learning during the pandemic, mixed results have been reported. Additionally, little research has been conducted to identify and understand factors, especially pedagogical factors, that impacted students' acceptance of online learning during campus closure. Furthermore, how online learning during the pandemic impacted students' learning performance has not been empirically investigated. In March 2020, the dental school studied here moved didactic instruction online in response to government issued stay-at-home orders. This first-of-its-kind comparative study examined students' perceived effectiveness of online courses during summer quarter 2020, explored pedagogical factors impacting their acceptance of online courses, and empirically evaluated the impact of online learning on students' course performance, during the pandemic. METHOD: The study employed a quasi-experimental design. Participants were 482 pre-doctoral students in a U.S dental school. Students' perceived effectiveness of online courses during the pandemic was assessed with a survey. Students' course grades for online courses during summer quarter 2020 were compared with that of a control group who received face-to-face instruction for the same courses before the pandemic in summer quarter 2019. RESULTS: Survey results revealed that most online courses were well accepted by the students, and 80 % of them wanted to continue with some online instruction post pandemic. Regression analyses revealed that students' perceived engagement with faculty and classmates predicted their perceived effectiveness of the online course. More notably, Chi Square tests demonstrated that in 16 out of the 17 courses compared, the online cohort during summer quarter 2020 was equally or more likely to get an A course grade than the analogous face-to-face cohort during summer quarter 2019. CONCLUSIONS: This is the first empirical study in dental education to demonstrate that online courses during the pandemic could achieve equivalent or better student course performance than the same pre-pandemic in-person courses. The findings fill in gaps in literature and may inform online learning design moving forward.

Evaluating outcomes of computer-based classroom testing: Student acceptance and impact on learning and exam performance.

Computer-based testing (CBT) has made progress in health sciences education. In 2015, the authors led implementation of a CBT system (ExamSoft) at a dental school in the U.S. Guided by the Technology Acceptance Model (TAM), the purposes of this study were to (a) examine dental students' acceptance of ExamSoft; (b) understand factors impacting acceptance; and (c) evaluate the impact of ExamSoft on students' learning and exam performance. Survey and focus group data revealed that ExamSoft was well accepted by students as a testing tool and acknowledged by most for its potential to support learning. Regression analyses showed that perceived ease of use and perceived usefulness of ExamSoft significantly predicted student acceptance. Prior CBT experience and computer skills did not significantly predict acceptance of ExamSoft. Students reported that ExamSoft promoted learning in the first program year, primarily through timely and rich feedback on examination performance. t-Tests yielded mixed results on whether students performed better on computerized or paper examinations. The study contributes to the literature on CBT and the application of the TAM model in health sciences education. Findings also suggest ways in which health sciences institutions can implement CBT to maximize its potential as an assessment and learning tool.

Flipped classroom narrows the performance gap between low- and high-performing dental students in physiology.

The flipped classroom has been shown to have positive outcomes in learning. However, relatively little has been reported on the implementation of it in dental education. The purpose of this study was to evaluate the impact of the flipped classroom on predoctoral dental students' learning. Two consecutive classes of dental students learned the physiology of the autonomic nervous system through the nonflipped (traditional lecture) or the flipped approach. Students' learning was assessed with an identical quiz at the end of the module. The mean score in the flipped approach was higher than that in the nonflipped approach ( P < 0.01). Mean score on the content-based quiz questions in the flipped approach was higher than that in the nonflipped approach ( P < 0.05). Performance on case-based questions did not show a significant difference ( P = 0.12). Mean quiz performance of the lower 27% scorers in the flipped approach was higher than that in the nonflipped approach ( P < 0.05). Mean quiz performance of the upper 27% scorers showed an increase in the flipped approach as well ( P < 0.05), but to a less extent than that of the lower 27% scorers ( P < 0.01). The flipped approach also increased peer collaboration ( P < 0.01). In summary, the flipped classroom improved dental students' performance on content-based questions in physiology. The flipped classroom narrowed the performance gap between the low- and high-performing dental students.

An interactive online approach to small-group student presentations and discussions.

Student presentations had been widely implemented across content areas, including health sciences education. However, due to various limitations, small-group student presentations in the classroom may not reach their full potential for student learning. To address challenges with presentations in the classroom, we redesigned the assignment by having students present and discuss online using VoiceThread, a cloud-based presentation and discussion tool. First-year students pursuing a Doctor of Dental Surgery degree were assigned into small groups to present physiology content and to discuss that content online. This assignment was similar to traditional student classroom presentations, with the exception that the entire assignment was conducted online. The primary purpose of this exploratory study was to investigate the impact of the online format on the discussion quality. Another purpose of the study was to examine students' perceptions of using VoiceThread for presenting and learning, as well as the online interactions between the presenter and audience. Students posted a higher number of questions and comments than required by the assignment. The questions from students were also higher level questions, and the answers to these questions were more thorough compared with what we had previously observed in classroom presentations. The survey results showed that students preferred using VoiceThread for presenting, learning from other presentations, and discussing presentation content over performing this process in the classroom. Preliminary findings suggested that having dental students make presentations and hold discussions online might help address the challenges of student presentations in the classroom.

An Interactive Online Approach to Teaching Evidence-Based Dentistry with Web 2.0 Technology.

At many dental schools, evidence-based dentistry (EBD) is taught in a traditional lecture format. To avoid the constraints of lectures, in 2012 the EBD unit was redesigned for online delivery at the Arthur A. Dugoni School of Dentistry at the University of the Pacific with a Web 2.0 tool called Voicethread. The aim of this study was to assess the impact of Voicethread-based online learning on students' perceptions of learning EBD, their participation and engagement, and their acceptance of this new online delivery approach. Students' perceptions were collected from two sources: a self-assessment quiz and a question on their self-reported preparedness in EBD from the 2014 American Dental Education Association (ADEA) Survey of Dental School Seniors. The Voicethread analytics tool provided data on students' participation and engagement. Students' responses to the survey questions on the self-assessment quiz provided data on their acceptance of Voicethread-based learning. The average score of the 124 students (91% of total) taking the quiz was 7.3 out of 8. The percentage of students who reported in the 2014 ADEA survey that they were "well prepared" in EBD was 45.2%, compared with the national average of 31.2%. Responses to this question for the Classes of 2013 and 2015, who received instruction in the traditional lecture format, were 35.2% and 34.6%, respectively. With Voicethread, students actively participated and interacted with their peers through questions and answers. They perceived Voicethread to be more effective than other delivery approaches and reported that it made learning more active and engaging. These findings suggest that Voicethread may be an effective tool for students to learn EBD since it adds interactivity to online learning.