Evaluating a Blended-Learning Course Taught to Different Groups of Learners in a Dental School Kimon Pahinis, D.D.S., M.Sc.; Christopher W. Stokes, M.Ed., Ph.D.; Trevor F. Walsh, B.D.S., F.D.S.R.C.S., M.Sc., D.D.Sc.; Giuseppe Cannavina, Ph.D. Abstract: The purpose of this study was to present and evaluate a blended-learning course developed for undergraduate (B.D.S.), postgraduate, and diploma (hygiene and therapy) students at the University of Sheffield School of Clinical Dentistry. Blended learning is the integration of classroom face-to-face learning with online learning. The overall methodology used for this study was action research. The data were collected using three processes: questionnaires to collect contextual data from the students taking the course; a student-led, nominal group technique to collect group data from the participants; and a non-participant observer technique to record the context in which certain group and individual behaviors occurred. The online component of the course was accepted as a valuable resource by 65 percent of those responding. While online information-sharing occurred (31 percent of the students posted in forums), there was no evidence of online collaboration, with only 8 percent replying to forum postings. Accessibility of the online environment was one of the main concerns of the students at the nominal group sessions. Differences regarding overall engagement with the course between the student groups (years) were observed during the sessions. The majority of the students were satisfied with the Information and Communication Technologies (ICT) course. No statistically significant differences between males and females were found, but there were differences between different student cohorts (year groups). Dr. Pahinis is a Dentist and a Ph.D. student, Department of Adult Dental Care; Dr. Stokes is a University Teacher, Department of Adult Dental Care; Dr. Walsh is a Professor of Restorative Dentistry and Dean; and Dr. Cannavina is Director of the WILeN Project, Department of Adult Dental Care—all at 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, Sheffield S10 2TA, United Kingdom; 00441142679741 phone; 00441142665326 fax;
[email protected]. Key words: dental education, computers, web-based, blended learning, online, evidence-based Submitted for publication 7/18/06; accepted 10/27/06
O
ne of the most important and valuable developments in recent years is the evolution of technology, especially in the form of information and communication technologies. Many aspects of our everyday life have changed as a result of technology: our means of communication, information retrieval, even the way we spend our free time (e.g., computer games). Dentistry could not be left unaffected. Nowadays, several aspects of dentistry are subserved or performed with the use of computers, and computers are increasingly prevalent in dental education, including continuing professional development. It has been reported that this technological shift could help dental education to overcome the challenge of meeting the growing need and expectations for higher-quality education with reduced funds.1-3 Computers in dentistry have been used as a learning tool since the early 1970s,4 and the first CAL (Computer-Aided Learning) tool was developed at the University of Kentucky.5 However, the real development did not actually start until the early February 2007 ■ Journal of Dental Education
1990s, when several CAL packages were developed.6-8 These were mainly distributed through floppy disks and CD-ROMs, as the Internet was not as widely available and easily accessible as it is today. Whilst those packages were mainly meant for continuing professional education, after the mid-1990s there were some attempts to create CAL packages for undergraduate education.9-11 From the beginning of this decade, as Internet accessibility and connectivity speeds have increased (and are likely to continue to do so),12 electronic education (e-education) is moving away from the hard mediums (floppy disks, CD-ROMs, etc.) and is now primarily offered in online environments,13-16 as they offer numerous advantages for the learner, including increasing the student’s independence and “anytime, anywhere” access to educational opportunities, as well as allowing teachers to more easily update e-education materials than they could with the previous hard mediums. The move towards e-education evolves through e-publishing (the use of static material) to e-learning (the use of interaction) as described by Allen.17 269
E-education has progressed in recent years to a new approach in the form of blended learning. Blended learning is the thoughtful integration of classroom face-to-face learning experiences with online learning experiences.2 The main advantage of blended learning is that it integrates the strengths of synchronous (face-to-face) and asynchronous (webbased) learning activities. Two key approaches for the development of online materials are described in the literature: direct instruction and student-centered approach.18 The direct instruction model is based on behaviorist learning theory,19,20 described as a direct provision of information. The student-centered approach is based on constructivist learning theory,21,22 which supports the notion that knowledge is constructed by learners through interaction. Another approach that lies between the two key approaches is minimalism, first described by Carroll.23 The key ideas behind this theory are that instructional material should be kept to a minimum to avoid obstruction of learning and the design should be focused on activities that support learner-directed activities. In recent years, more and more dental schools have moved to supporting face-to-face teaching using online platforms,24-26 but only a few studies have evaluated this transformation of the curriculum,27 especially in relation to a specific course.14 Furthermore, as the blended-learning approach is relatively new to education, only a few studies are available in the literature.28-30 To address this gap in the literature, our research study evaluated a blended-learning course titled “Information and Communication Technologies” (ICT), developed for the undergraduate dental students (B.D.S.), postgraduate students (PG), and Diploma of Hygiene and Therapy students (DHT) at the School of Clinical Dentistry of the University of Sheffield. Student behaviors, attitudes, and opinions towards the blended-learning ICT course were evaluated.
The ICT Course In the academic year 2003-04, the Information and Communication Technology course (ICT) was redesigned to be the first electronic course at the dental school in Sheffield. The course, which has been a part of the curriculum since 1999, was redeveloped using a blended-learning approach that accommodates face-to-face learning environments with the support of an asynchronous online environment.
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The environment used to host the course was the iCT Portal. The iCT Portal was developed in 2003 on an independent web server, connected to the University of Sheffield’s main data network. The front-end screen shot is shown in Figure 1. The iCT Portal was used as a VLE (Virtual Learning Environment). Information and instructions regarding each session were posted on the iCT Portal by the course tutor before each session. Furthermore, the iCT Portal allowed intra-student communication and student-tutor communication through forums. The course was taught to five different groups of students each academic year. Groups and teaching hours were as follows: first-year B.D.S., twelve academic hours; third-year B.D.S., twelve academic hours; fourth-year B.D.S., eight academic hours; DHT (Diploma in Dental Hygiene and Therapy) students, twenty academic hours; and postgraduate dental students, twenty academic hours. The core objectives of the ICT course were for the students to learn information-sourcing techniques, data manipulation, and evidence appraisal while building on their practical IT skills. As shown in Table 1, there were similarities between the structures of the different course years (modules). The first and last sessions of the course were in a traditional lecture setting, while the middle sessions were online-supported practical sessions. For the practical sessions, all the information required to complete the sessions was given through the iCT Portal, and the presence of the tutor was mainly to provide synchronous support to the students. Attendance at the course sessions was compulsory for all groups. Course assessment was based on the session assignments. The sessions were based on the three approaches described above (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 minimalism approach, only minimum instructions were given to the students to assist them in completing the task. For example, at the finding literature session, students were asked to retrieve the full reference of several articles using the hints provided by searching the suggested citation indices or another Internet search engine. Finally, for the session using the student-centered approach, students were required to work in groups based on their experience gained in previous sessions. For example, students had to create presentations in groups using the skills gained in prior sessions of the course.
Journal of Dental Education ■ Volume 71, Number 2
Figure 1. iCT Portal partial front-end screen-shot original version
Methods The sample of this study consisted of students from the first, third, and fourth B.D.S. years, DHT students, and postgraduate dental students. These students participated in the ICT course during the year 2004 at the dental school of the University of Sheffield. For the purpose of this study, the overall methodology used was action research.31,32 The ������� action research model is a spiral process:����������� ���������� the cycle comprises diagnosis (data gathering, analysis, and representation), action planning, action taking, and action evaluation.33 The data were collected using three processes: questionnaires to collect contextual data from students taking the course; a student-led, nominal group technique to collect group data from
February 2007 ■ Journal of Dental Education
participants of the course; and non-participant observer technique to record the context in which certain group and individual behaviors occurred. Questionnaires34 consisted of both closed and open-ended questions. The questions focused on eliciting attitudes towards the course content, the educational setting, and the e-learning innovations applied, as well as past, current, and possible future behaviors. Anonymous questionnaires were distributed at the start of the last session of each class (year group) and were collected at the end of it. The students were informed that participation was voluntary. The Nominal Group (NG) Technique35 was used to identify strengths and weaknesses, using a group setting, to allow solutions to be thought out and analyzed and plans for their implementation to be considered. �������������������������������������� This technique can be split into four main stages:����������������������������������������� ���������������������������������������� idea, “round Robin,” clarification, and
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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
DHT
Approach
Introduction lecture
Introduction lecture
Introduction lecture
Introduction lecture
Introduction lecture
Direct instruction Didactic
—————
—————
—————
MS Word
MS Word
Direct instruction Blended
Finding literature Finding literature online online
Finding literature Finding literature Minimalist online online
Blended
Referencing
Referencing
Referencing
Referencing
Minimalist
Blended
MS Excel
MS Excel
MS Excel
MS Excel
Direct instruction Blended
————— ————— —————
Midterm assessment
Midterm assessment
Direct instruction Blended
—————
—————
—————
MS PowerPoint
MS PowerPoint
Direct instruction Blended
Presentation preparation
Presentation preparation
Presentation preparation
Presentation preparation
Presentation preparation
Student-centered
Student presentation
Student presentation
Student presentation
Student presentation
Student presentation
Student-centered Didactic
Stats/MS Excel
voting.36 One NG session was organized for each student year, and five to ten students were invited for each session. The NG sessions took place on all occasions within two weeks of the completion of the course. The researcher introduced the NG technique to the students and responded to 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 group participants were selfselected. Non-participant observation 37 is an ethnographic technique that provides information about the group dynamics. The researcher was present at all sessions. Students were not informed of the intention of the observation in order to avoid change in behaviors. The quantitative analysis of the closed questions data was done with SPSS v13.38 Chi square (χ2) test was used to compare means between categorical data and ANOVA.39 The level of statistical significance was set at p< 0.05. Thematic analysis was performed for the nominal group, non-participant observation, and open questions data from the questionnaires.
Results An overall response rate of 95 percent of the distributed questionnaires was obtained (158 out of
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Structure
Blended
165). For each individual class, the response rate was as follows: first-year B.D.S., 100 percent (n=63); thirdyear B.D.S., 95 percent (n=36); fourth-year B.D.S., 79 percent (n=19); postgraduate students, 100 percent (n=10); and DHT students, 100 percent (n=30). Thirtyeight percent of the respondents were male (n=60) and 62 percent female (n=98). There was a statistically significant difference in gender distribution among participants from each year (p0.85). For the nominal group session, participation varied from five to eight students. For each individual class the participation was as follows: first-year B.D.S., six students (three female/three male); thirdyear B.D.S., five students (three female/two male); fourth-year B.D.S., six students (three female/three male); postgraduate dentists, seven students (four female/three male); and DHT, eight students (eight females). Thirty-six sessions of non-participant observations were observed. Six sessions were for the first-year B.D.S. course, six for the third-year B.D.S. course, four for the fourth-year B.D.S. course, ten for the postgraduate course, and ten for the DHT course. The following sections summarize the findings from the questionnaires, nominal group, and nonparticipant observations.
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Summary of Data from the Questionnaires According to 64 percent of the respondents, the aims and objectives of the course were clear. A significant difference was found between the years, as postgraduate and DHT students gave a more positive response than did the B.D.S. students (p
