A Blended Learning Course Taught to Different Groups of Learners in a Dental School: Follow-Up Evaluation Kimon Pahinis, D.D.S., M.Sc., Ph.D.; Christopher W. Stokes, M.Ed., Ph.D.; Trevor F. Walsh, B.D.S., F.D.S.R.C.S., M.Sc., D.D.S.; Effrosyni Tsitrou, D.D.S., M.Med.Sci., Ph.D.; Giuseppe Cannavina, Ph.D. Abstract: This article reports the results of a follow-up study conducted to investigate students’ perceptions about a blended learning health informatics course that combined online and traditional classroom instruction. The course is taught to five different groups of students at the School of Clinical Dentistry of the University of Sheffield each academic year: first-, third-, and fourthyear dental students, dental hygiene and therapy students, and postgraduate dental students. The goal of the study was to determine the impact of the modifications made to the course after the first year of implementation. To accomplish this goal, students’ perceptions of this blended learning course were compared after the first and second implementations. The methodology used for this study was action research. The data were collected using three processes: questionnaires were used to collect contextual data from the students taking the course; a student-led, nominal group technique was used to collect group data from the participants; and a non-participant observer technique was used to record the context in which certain group and individual behaviors occurred. Depending on group assignment, between 41.5 and 91.5 percent of students believed that the blended-learning course had added to their skills. The online learning environment was perceived as a useful resource by 75 percent of students in four of the five student groups, but only 45 percent of the fourth-year dental students indicated it was a useful resource. The perceived lack of sufficient online support material was one of the main concerns of the students at the nominal group evaluation sessions. The non-participant observer technique identified different engagement levels among the student groups. Discernible differences were identified, with improvement in some areas and a decline in others compared to a previous evaluation. The change in the delivery method influenced the students’ comprehension of the material negatively and the learning environment positively, but did not influence online collaboration among students. Dr. Pahinis is a dentist and was a Ph.D. student, Department of Adult Dental Care at the time of this study; Dr. Stokes is a University Teacher, Department of Adult Dental Care; Dr. Walsh is a Professor of Restorative Dentistry and Dean; Dr. Tsitrou is a University Clinical Teacher, Department of Adult Dental Care; and Dr. Cannavina is Director of the WILeN Project, Department of Adult Dental Care—all in the School of Clinical Dentistry, University of Sheffield. Direct correspondence and requests for reprints to Dr. Kimon Pahinis, Department of Adult Dental Care, School of Clinical Dentistry, University of Sheffield, Claremont Crescent, Sheffield S10 2TA, UK; 44-789-641-5368 phone; 44-114-���������������������������������������� 279������������������������������������� -������������������������������������ 7050�������������������������������� fax;
[email protected]. Key words: dental education, computers, web-based, blended learning, online, evidence-based Submitted for publication 5/29/07; accepted 4/17/08
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lectronic education (e-education or online learning) has the potential to shift the paradigm from passive teacher-centered learning to active learner-centered learning.1 Constructivism, one of the learning theories often associated with e-learning, views learning as an active process in which learners construct new ideas or concepts based upon their current and/or past knowledge.2 E-education can greatly promote activity and engagement by the use of interaction.3 Active learning can motivate learners to become more engaged with the content.3 A well-designed e-course can enhance learner-content interaction by the use of hyperlinks, as well as learner-learner and learner-tutor interactions with the use of synchronous and asynchronous communication tools such as forums.
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Blended learning is the latest approach in eeducation that combines (blends) the use of the online learning with traditional classroom-based learning.4 The main advantage of blended learning is that it integrates the strengths of synchronous (face-to-face) and asynchronous (web-based) learning activities. Various types of blended learning can exist, depending on how the two approaches are balanced. Some variations are that learners may be given access to the online material before, during, or after the traditional sessions. Also, attendance at the traditional sessions may or may not be compulsory. The Internet’s influence on dental education has been evident in the literature since the beginning of this decade.5-8 Using the advantages of e-education, dental schools are beginning to support face-to-face
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teaching using online educational tools,9-11 but only a few studies have been published evaluating this change in teaching and learning.6,12,13 Therefore, more research is required to evaluate the application of these new educational methods. Using the learners to evaluate e-education is critical because the educational environment is intended for them and should accommodate their needs if they are to become motivated and active learners. Students’ appraisal of the utility and value of e-education and assessment of their attitudes are essential before any learning outcomes achieved by e-education can be evaluated. Pilot-testing by students can also ensure that the system is not an ineffective application of the technology, but one that meets the users’ needs. This article reports the results of a follow-up study to further investigate students’ perceptions about a blended-learning course initially described in a previous article published in this journal.13 The purpose of this follow-up study was to evaluate the second implementation cycle of this blended-learning course titled “Health Informatics,” developed for undergraduate dental students (B.D.S.), postgraduate dental students, and Diploma in Dental Hygiene and Therapy students (D.H.T.) at the School of Clinical Dentistry of the University of Sheffield. To assess the impact of the modifications made to the course after year one, students’ perceptions after the first and second implementations were compared.
Evolution of the Blended Learning Health Informatics Course In 2003–04, the health informatics (HI) course formerly known as “Information and Communication Technology” (ICT) was redesigned to be the first electronically supported course at the dental school in Sheffield. The course, which has been a part of the curriculum since 1999, was developed using a blended-learning approach that accommodates both face-to-face sessions and an asynchronous online environment. The virtual learning environment (VLE) used to support this course was changed from the iCT portal (a bulletin board-based system) reported in the first article (which described the fundamental design of the course)13 to the Moodle-based LEGA (learning environment for group activity). Moodle is a popular VLE that is designed especially for educa-
September 2008 ■ Journal of Dental Education
tional purposes.14 Moodle offers several advantages over the previous bulletin board-based system. It is designed based on a social constructivist model of learning; it is open source; it is being used by a wide community, who offer modifications that can be integrated; and finally, it is very easy to edit and administer. A screenshot of the welcome page is shown in Figure 1. The course was taught to five groups of students each academic year. The groups and the teaching hours were as follows: first-year B.D.S. (twelve contact hours), third-year B.D.S. (twelve contact hours), fourth-year B.D.S. (eight contact hours), Diploma in Dental Hygiene and Therapy (D.H.T.; twenty contact hours), and postgraduate dental students (twenty contact hours). The core objectives of the HI course were for the students to learn information-sourcing techniques, data manipulation, and evidence appraisal, while building on their practical information technology skills (such as finding literature online, enhancing word-processing skills, preparing spreadsheets, etc.). As shown in Table 1, the formats of the educational activities of the five groups of students were essentially the same. The first and the last sessions of the course were in a traditional lecture setting, while the middle sessions were online, supported (blended) practical sessions. For the practical sessions, all the information required to complete the sessions was given through the Moodle (LEGA) system; the presence of the tutor was mainly to provide synchronous support to the students. Similar to the previous version of the course,13 attendance at the course sessions was compulsory for all groups. Course assessment was based on the session assignments. The sessions in the HI course were based on the student-centered, direct instruction, and minimalist approaches described previously13 (Table 1). For the sessions based on the direct instruction approach, a step-by-step instruction guide was given to the students. For the sessions based on the minimalist approach, only minimum instructions were given to the students to assist them in completing the tasks. For the sessions designed with the student-centered approach, students were required to work in groups based on experience gained from the previous sessions. The most important change from the previous course implementation strategy was that the course materials were available online a week before the session so that students could access these items and gain familiarity with them before attending the practi-
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Figure 1. LEGA front-end original version
cal session. Furthermore, apart from the substitution of the VLE used in the initial version of this course (and its inherently more visual format), the new VLE was integrated with the university’s account database to allow students to use their university account to access the system and to reduce password-related problems. Another change from the original version of the course was that computer-based animations were introduced into the course material in an attempt to explain and simplify session tasks.
Methods The sample of this study consisted of students from the first, third, and fourth B.D.S. years, D.H.T. students, and postgraduate dental students who participated in the health informatics course during the year 2005 at the dental school of the University of Sheffield.
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The overall methodology used to conduct the study was action research.15,16 The action research model is a spiral process: the actual cycle comprises diagnosis (data-gathering, analysis, and representation), action planning, action taking, and action evaluation.17 The data were collected using three processes: questionnaires were used to collect contextual data from the students taking the course; a student-led, nominal group technique was used to collect group data from the participants of the course; and nonparticipant observer technique was used to record the context in which certain group and individual behaviors occurred. Questionnaires 18 consisted of both closed and open-ended questions. The questions focused on eliciting learners’ attitudes towards the course content, the educational setting, and the e-learning applications in the course, as well as past, current, and possible future behaviors. Anonymous questionnaires were distributed at the start of the last session of each
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Table 1. Course outline and structure 1st-Year B.D.S.
3rd-Year B.D.S.
4th-Year B.D.S.
Postgraduate
D.H.T.
Learning Theory
Structure
Introduction lecture
Introduction lecture
Introduction lecture
Introduction lecture
Introduction lecture
Direct instruction
Didactic
Direct instruction
Blended
MS Word MS Word Finding literature Finding literature online online
Finding literature Finding literature Minimalism online online
Blended
Referencing
Referencing
Minimalism
Blended
MS Excel MS Excel Stats/MS Excel MS Excel MS Excel
Referencing
Direct instruction
Blended
Direct instruction
Blended
MS PowerPoint MS PowerPoint
Direct instruction
Blended
Presentation preparation
Presentation preparation
Presentation preparation
Presentation preparation
Presentation preparation
Student- centered
Blended
Student presentation
Student presentation
Student presentation
Student presentation
Student presentation
Student- centered
Didactic
Midterm assessment
class for each group of students and were collected at the conclusion. The students were informed that completion of the questionnaire was voluntary. The nominal group (NG) technique19 was used to identify strengths and weaknesses, using a group setting, and to allow solutions to be thought out and analyzed and plans for their implementation to be considered. The NG technique is split into four stages: idea, round-robin, clarification, and voting.20 One NG session was organized for each group of students, and five to ten students were invited with an email for each session. All of the nominal groups took place within two weeks of the completion of the course. The researcher introduced the NG technique to the students and answered any queries. The same instruction sheets were given to all student groups, and the venue for all sessions was the same. Only the students were present during the nominal group sessions, and the group participants were self-selected. Non-participant observation 21 is an ethnographic technique that provides information about the group dynamics. A structured approach was used, and the researcher was present at all sessions. Students were not informed of the intention of the observation in order to avoid any change in behavior. The quantitative analysis of the closed questions data was done with SPSS v13.22 The chi-square (χ2) test was used to compare categorical data, and ANOVA was used to compare means.23 The level of
September 2008 ■ Journal of Dental Education
Referencing
Midterm assessment
statistical significance was set at p
