Teaching with Technology: Learning Outcomes for a Combined Dental and Dental Hygiene Online Hybrid Oral Histology Course Cynthia C. Gadbury-Amyot, M.S.D.H., Ed.D.; Amul H. Singh, D.D.S.; Pamela R. Overman, B.S.D.H., Ed.D. Abstract: Among the challenges leaders in dental and allied dental education have faced in recent years is a shortage of wellqualified faculty members, especially in some specialty areas of dentistry. One proposed solution has been the use of technology. At the University of Missouri-Kansas City School of Dentistry, the departure of a faculty member who taught the highly specialized content in oral histology and embryology provided the opportunity to implement distance delivery of that course. The course is taught once a year to a combined group of dental and dental hygiene students. Previous to spring semester of 2009, the course was taught using traditional face-to-face, in-class lectures and multiple-choice examinations. During the spring semesters of 2009, 2010, and 2011, the course was taught using synchronous and asynchronous distance delivery technology. Outcomes for these courses (including course grades and performance on the National Board Dental Examination Part I) were compared to those from the 2006, 2007, and 2008 courses. Students participating in the online hybrid course were also given an authordesigned survey, and the perceptions of the faculty member who made the transition from teaching the course in a traditional face-to-face format to teaching in an online hybrid format were solicited. Overall, student and faculty perceptions and student outcomes and course reviews have been positive. The results of this study can provide guidance to those seeking to use technology as one method of curricular delivery. Dr. Gadbury-Amyot is Associate Dean and Professor, Instructional Technology and Faculty Development, School of Dentistry, University of Missouri-Kansas City; Dr. Singh is Adjunct Assistant Professor, School of Dentistry, University of Missouri-Kansas City; and Dr. Overman is Associate Dean and Professor, School of Dentistry, University of Missouri-Kansas City. Direct correspondence and requests for reprints to Dr. Cynthia C. Gadbury-Amyot, School of Dentistry, University of Missouri-Kansas City, 650 E. 25th Street, Kansas City, MO 64108; 816-235-2054 phone; 816-235-2157 fax;
[email protected]. Keywords: educational technology, educational methodology, distance education, online learning, dental education, dental hygiene education, allied dental education, oral histology Submitted for publication 1/22/12; accepted 7/12/12
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n recent years, leaders in dental and allied dental education have identified many challenges facing U.S. dental schools including declining funding, rising student indebtedness, and a shortage of faculty.1 In truth, these issues have faced dental education over a much longer period,2 and the real challenge has been actual adoption of change in response to the various problems.3 In 2005, the American Dental Education Association (ADEA) began an initiative to foster systematic and collaborative change in the U.S. dental education enterprise under the auspices of its Commission on Change and Innovation in Dental Education (ADEA CCI). By including representatives of academic and organized dentistry, as well as the accreditation and licensure communities, the ADEA CCI aimed to develop a blueprint for change in dental education overall and at specific academic dental institutions. ADEA CCI
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leaders identified a series of principles to help dental schools create an environment conducive to change. These principles include critical thinking, lifelong and self-directed learning, humanistic environment, scientific discovery and the integration of knowledge, evidence-based oral health care, assessment, faculty development, and collaboration with other health care professionals.4 The ADEA CCI’s efforts are reflected in the recently approved accreditation standards for dental education.5 The University of Missouri-Kansas City School of Dentistry (UMKC-SOD) adopted integration of technology as the theme of change projects to be carried out under the ADEA CCI umbrella, and implementation of some of these projects have been reported in this journal.6-8 In this article, the challenge of faculty shortages will be addressed along with how technology was used to creatively deal
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with this challenge. Not only are faculty shortages in academic dentistry well documented,9-12 but the particular difficulties in finding faculty members to teach in some specialty and basic science areas present ongoing challenges. When a UMKC faculty member who taught oral histology accepted a faculty position at another dental school, the challenge of finding a replacement presented itself as an opportunity to use technology. Although the former UMKC faculty member now lives in another state, the use of technology made it possible for him to continue teaching for the UMKC School of Dentistry as an adjunct professor during the semester in which the course is taught. This report describes the transition of an oral histology course from a traditional lecture face-to-face format to delivery through distance technology. Student learning outcomes along with faculty perceptions of the transition from traditional lecture format to distance, online teaching will be described.
Methods One of the coauthors (AHS) had previously taught oral histology in a face-to-face lecture format with dental and dental hygiene students. His departure to accept a position in another dental school provided the challenge of either replacing him or finding another solution. Under the leadership of the first author (CGA), UMKC has had extensive experience in using distance technology. The decision was made to transition the oral histology course to a distance online hybrid delivery format for 101 second-year dental and thirty-one junior dental hygiene students. This course has truly been a collaborate process among the three authors of this article and is an excellent example of what collaboration with others can achieve. The course is defined as hybrid because the examinations are administered on-site at the school, thereby requiring students to be on-site in order to participate in the course. The learning management system, Blackboard, provides the synchronous and asynchronous environment for the course. Course delivery includes a live orientation using synchronous two-way audio-video technology (Wimba); asynchronous course materials are housed in Blackboard; twelve one-and-one-half-hour PowerPoint lectures were prerecorded and archived in Blackboard; and office hours are held using the synchronous Wimba technology. Three question and answer (Q&A) sessions are scheduled during the evenings the week
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previous to each of the three course examinations again using synchronous technology. Office hours and Q&A sessions are captured as archived recordings, and students are able to access them 24/7 throughout the remainder of the course. In addition, the course director is available through both the Blackboard (during his pre-set evening office hours) and university e-mail, so that students are able to email questions and gain clarity through interaction with the faculty member. Technology allows the instructor to set office hours during evenings and other times when he is not committed to his current full-time position. (The Appendix consists of screen captures of the Blackboard course for the purpose of orienting the reader to the online delivery method and course set-up.) The course was purposefully designed to foster active learning and application of basic science to clinical practice. Following the first year of offering the course online, the principal author (CGA) suggested the addition of a team assignment to further increase the level of active learning, student-tostudent interaction, and application of oral histology to clinical practice. The students were divided into teams with an assignment to research a question that related course content to a clinical scenario (Table 1). The assignment is worth 5 percent of the students’ total grade. The teams were instructed to research and develop a two- to three-page document on their assigned topic to include clinical relevance. Wikis were created as collaborative work spaces for the teams since dental and dental hygiene student schedules differed and organizing face-to-face team planning events was challenging. Once developed, the assignments were posted in Blackboard for all course participants to review and learn from. Each team member was also required to evaluate his or her peers using a Team Participation form. Each team was asked to develop five questions on their assigned content area that was then e-mailed to the course director for use in the development of three online quizzes worth 5 percent of the students’ total grade. The remainder of the course grade was based on three comprehensive examinations (90 percent of the students’ total grade). Outcomes include students’ responses to an author-designed survey; course grades for the 2009, 2010, and 2011 online hybrid course compared to the 2006, 2007, and 2008 on-site course; and students’ performance on National Board Dental Examination (NBDE) Part I. The development and subsequent validity and reliability analysis of the survey used to
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Table 1. Two examples of assignments for the team project Directions: You have been assigned to a team of dental and dental hygiene students (11 team members total). You will be responsible as a team for completing the assignment. All assignments will be available on Blackboard for all students to access. In addition to the assignment, your team is also responsible for creating five multiple-choice quiz questions for submission. These questions will be compiled and used in the online Respondus quizzes that are scheduled. Please use your Blackboard Wiki to communicate with your team. Limit the length of your paper to approximately two pages and use APA formatting. Team
Topic
Assignment
1
Clefts Cleft palate patients are common and often have difficulty with speech, mastication, and swallowing. Using the text, suggested materials, and any clinical journal articles, please discuss the etiology of orofacial clefts, their prevalence in syndromes, and possible clinical managements. (Hint: see article in Facial Plast Surg 2002;18(3):147-53 regarding current understanding of cleft lip malformations.) 2 Amelogenesis This is a difficult type of patient to manage from a dental standpoint. Using the text, suggested materials, Imperfecta and any clinical journal articles, please discuss in detail the possible etiologies, progression, effects, and management of this condition. (Hint: see article in Cells Tissues Organs 2007;186(1):78-85 regarding enamel formation and amelogenesis imperfecta.)
capture student perceptions of the online hybrid oral histology course have been reported previously.7 Finally, perceptions of the course director and coauthor (AHS), who transitioned from teaching oral histology in a traditional onsite lecture format to an online hybrid format utilizing technology, were sought. Table 2. Demographics of dental and dental hygiene students participating in study, n=364 (classes of 2009, 2010, and 2011) Number (Percentage) Educational Program Dental hygiene students Dental students
76 (20.9%) 273 (75.0%)
Gender Male Female
197 (54.1%) 151 (41.4%)
Ages in Years 20-22 23-25 26-30 over 30
85 (23.3%) 188 (51.6%) 49 (13.4%) 26 (7.1%)
Race/Ethnicity Asian 17 (4.7%) White 305 (83.8%) Asian and white 3 (0.8%) Black or African American 5 (1.4%) American Indian/Alaska Native 1 (0.3%) Native Hawaiian and other Pacific Islander 1 (0.3%) Black or African American and white 3 (0.8%) Hispanic or Latino 11 (3.0%) Note: Due to rounding and differences in responding to questions, percentages may not total 100 percent. Race-ethnicity categories are those used in the U.S. census.
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Results A convenience sample of first-year dental and dental hygiene students for three consecutive years following implementation of the online hybrid oral histology course was used, with a survey response rate of 364/403 (90.3 percent). Demographics of this sample are shown in Table 2. The data illustrate that the student sample was predominantly white between the ages of twenty-three and twenty-five, with a greater percentage of males. Because the level of measurement for the survey data was ordinal in that it was capturing student perceptions, medians and interquartile ranges are reported in Table 3 as measures of central tendency and dispersion. The average median score for each of the dimensions of the survey was 5.0 with the exception of learner-learner interaction, which was rated 4.0. There was greater variability in student ratings in relation to resources, specifically library resources and reliability of the technology used to deliver the course. Overall, the ratings by students would indicate that student perceptions of the course were positive when considering that a scale of l (Poor) to 5 (Excellent) and 6 (N/A) was used. Of the 364 survey respondents, 124 made comments on the survey. Survey comments were coded by topic and affectivity (i.e., positive or negative). The coding by topic followed the dimensions used in the development of the survey (Instructor and Learner-Instructor Interaction, Course Organization and Learner-Content Interaction, Learner-Learner Interaction, and Support Services/Technical Support/ Delivery Method). In this study, Delivery Method Journal of Dental Education ■ Volume 77, Number 6
Table 3. Student assessment of online oral histology course: survey results by dimension Dimension
Median (IQR)
Instructor and Learner-Instructor Interaction Timeliness of instructor in responding to students. Instructor accessible or available when needed. Instructor demonstrates respect and concern for students. Stimulation of interest in course. Instructor able to coordinate the learning activities of this course with the technology. Instructor knowledgeable of the subject matter of this course. Encouragement of independent, creative, and critical thinking. Overall rating of instructor.
5 (1.0) 5 (1.0) 5 (0.0) 5 (1.0) 5 (1.0) 5 (0.0) 5 (1.0) 5 (1.0)
Course Organization and Learner-Content Interaction Course objectives and assignments were clearly explained. Performance expectations for course were clear. Grading/assessment process and grading scale clearly explained. The examination was related to course learning activities. The content of this course was up-to-date. The content presented in this course was at the appropriate level of difficulty. Appropriateness of assigned materials (readings, etc.) to the nature and subject of the course. Overall rating of course.
5 (1.0) 5 (1.0) 5 (1.0) 5 (1.0) 5 (1.0) 5 (1.0) 5 (1.0) 5 (1.0)
Learner-Learner Interaction Interaction opportunities with other students. Sense of community among students in this course. Contact with other students when needed.
4 (2.0) 4 (2.0) 4 (2.0)
Support Services/Technical Support/Delivery Method Appropriate library resources available during this course. Reliability of the technology used to deliver this course. Technical support’s ability to resolve technical difficulties. Material on the course Blackboard site was accurate.
5 (2.0) 5 (2.0) 5 (1.0) 5 (1.0)
Note: Scale based on 1=poor to 5=excellent with 6=NA.
broke out as a separate domain in the analysis. The final coding scheme and results are shown in Table 4. Overall, there were eighty-six positive comments and sixty-five negative comments (does not add to 124 since some students included both negative and positive comments). While the rating of the course was high as shown by Table 3, student comments provided insights for use in future revisions of the course. The team project presented difficulty for the students along with difficulties with the technology. On the positive side, comments related to the availability of the lectures online and the interaction in the synchronous live Q&A sessions indicate pedagogical approaches to teaching and learning in the online environment that should be maintained. The comparison of grades between the dental classes of 2006 through 2008, who took the traditional on-site lecture course taught by the coauthor (AS), and the dental classes of 2009 through 2011, who took the online hybrid version of this course also
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taught by the coauthor, appears in Table 5. Dental hygiene students’ grades are not included because their performance in oral histology is factored into their pathology grade resulting in one combined histopathology grade. The most notable observation in comparing dental grades from three years of faceto-face instruction of the course and three years of online hybrid delivery is that grades generally trended upward over time. To examine this further, students were grouped according to instructional modality (traditional vs. online), and grades were recoded into GPA equivalents (A=4.0, B=3.0, C=2.0). An independent-samples t-test was conducted to evaluate whether there was a significant difference in course grades between groups. The results indicated that the mean GPA for students in the online instruction modality (M=3.83, SD=0.40) was significantly greater than the mean GPA for students in the traditional instruction modality (M=3.68, SD=0.51), p
