The Tooth Morphology Board Game: An Innovative Strategy in Tutoring Dental Technology Learners in Combating Rote Learning AnisaVahed1 1Department
of Dental Sciences, Dental Technology Programme, Health Sciences Faculty, Durban University of Technology (DUT), Ritson Campus, Durban, South Africa Email:
[email protected]
Abstract: The difficulty of learning voluminous content in Tooth Morphology – Module 3 has proven to be extremely taxing to learners, particularly to those who are inadequately prepared, as it involves very high cognitive and abstract theoretical content. This is further compounded by accompanying learner anxiety toward the voluminous material. Consequently, this encourages rote learning and is often approached with much negatively as learners are unable to conceptualise their learning material. In an attempt to remove learners’ mental block on this module critically required innovative ways of learning. One such intervention, namely the Tooth Morphology Board Game (TMBG) was developed for first year learners studying towards a diploma in Dental Technology.
The board game was designed to promote literacy and retaining with understanding the content area of Tooth Morphology, a discipline that requires a significant amount of memorization, recall, association and application. The chief element of the board game is that the abstract content is merged with game characteristics and learners are able to repeat cycles within the game context, making them active participants in knowledge acquisition.
Whilst educational gaming is gaining popularity in medical education, very little has been explored in dental education. This study aims to describe how the use of the board game, followed by the didactic teaching of Tooth Morphology- Module 3, facilitates students learning voluminous content by their active engagement in tutorials.
Data from the past two years of tutoring first year Dental Technology learners were used as a diagnostic tool to determine whether 1. the game assists learners in acquiring the literacy practice in their discipline 2. learners performance in tests improved and 3. generic skills were fostered from playing the game. Module 3 test scores were further used to determine whether incorporating the board game improved learning.
Data gathered by means of questionnaire surveys, direct observations and test scores showed that the board game impacted positively on learners’ attitudes towards Tooth Morphology and served as a part of an overall strategy to reinforce information presented in lectures as learning was embedded in a motivating setting. This report may be of value to dental educators who wish to offer a creative and interactive alternative to traditional tutoring or classroom activity so as to improve not only the recall of abstract knowledge, but provide a learning environment that fosters the acquisition of different skills whilst improving general skills.
Keywords: Dental Technology education; knowledge acquisition; active engagement; skill acquisition; motivation
1. Introduction A growing concern from the past to the present is that large volumes of learning material and conventional instructional teaching of abstract decontextualised content encourages learners to become passive absorbers of facts for only a short time period until the test is written. Consequently, the retainment of such knowledge gradually diminishes over time. In contrast to traditional curricula however, educators are now encouraged to facilitate learning through the learner’s experience of the subject by searching for strategies that will enhance student’s retention and application of information. The development of the Tooth Morphology Board Game (TMBG) was designed as a tutoring strategy to motivate learning in a fun and interactive manner whilst enhancing retention of knowledge. It is envisaged that such strategy will influence future improvements to teaching modalities in Dental Technology education.
Tooth Morphology fundamentally involves learning the morphological form of individual teeth and to apply it practically, hence it is a prerequisite to the Crown & Bridge discipline in the second year Dental Technology programme. The voluminous content in Tooth Morphology – Module 3 has proven to be extremely taxing to Dental Technology learners, particularly to those who are inadequately prepared, as it involves very high cognitive and abstract theoretical content. Consequently, this encourages rote learning and is often approached with negativity as learners are unable to conceptualise learning material.
The decision to employ an informal tutorial play
approach to the transmission of learning content is supported by observation of Dental Technology learners’ whose learning as described by Biggs (1996) occurs either unistructurally, where one or a few aspects of the task are picked up and used, or multistructurally where several aspects of the tasks are learned but are treated separately (understanding as knowing about).
Only a small
percentage of learners are able to apply, reflect and metacognitively understand the course content.
In an attempt to promote deep learning identified by Biggs (1996) as relational and possibly extended abstract learning, the board game was designed to provide a climate conducive to engaging learners with core knowledge (Allery, 2004), facilitating the synthesis of new knowledge, encouraging the sharing of knowledge in a group, allowing those who do not learn best by didactic methods to have a complementary means of learning (Ballon and Silver, 2004) and accommodating for the acquisition of different skills whilst improving general skills.
Whilst educational gaming in medical education is increasing in popularity (Allen et al, 2008; Beylefeld & Struwig, 2007; Meterissian et al, 2007 and Persky, 2007) very little has been explored in dental education. The aim of this research paper is to determine whether the use of the board game, followed by the didactic teaching of Tooth Morphology - Module 3, facilitates students learning
quantitative content by their active engagement in tutorials. It is hypothesised that the game would empower and engage Dental Technology first year learners in combating rote learning.
2. Methods 2.1 Game Design The TMBG derives its ideas from a repertoire of board and card games such as Trivial Pursuit TM, Monopoly TM, Cluedo TM and UNO TM in order to engage learners’ with core knowledge in Tooth Morphology – Module 3.
This paradigm shift of learning away from the tutor as knowledge
disseminator and expert required the structured experience, its delivery and debriefing to emanate learning (Allery, 2004). Consequently, the decision to design a competitive and/or collaborative board game proved challenging.
2.2 Competitive versus Collaborative design of the TMBG Competitive games require players to form strategies that directly oppose the other players in the game whereas collaborative players have only one goal and that is to share in the rewards or penalties of their decision. The challenge for players in a collaborative game is working together to maximize the team’s utility (Zagal et al., 2006: v37: 25 & 26).
The idea when designing the
board game was to feature a balanced combination of competitive and collaborative game mechanisms. Persky, et al (2007) reported that competition between groups can increase the focus on the group goal (i.e. learning) and thus increase personal involvement and positive attitudes. Competition was further supported by the abstract content being merged with game characteristics (Pivec et al., 2003) such as a physical artefact, rule or type of interaction that implements an action in the game. Capturing points with an action is an example of a competitive game mechanism.
Learners were able to repeat cycles within the game context, making them
active participants in knowledge acquisition.
2.3 Aims of the TMBG The learning objectives of the game were to promote literacy in the content area of Tooth Morphology,
reinforcing
concepts
and
enhancing
understanding
thereby
promoting
comprehension and learning, applying the knowledge learnt to Dental Technology Practicals, developing various strategies from playing the game, providing a forum in which learning would take place and achieving the intrinsic satisfaction derived from attaining knowledge in a fun manner (Beylefeld & Struwig, 2007). The study therefore aims to address the following research questions: 1. Did the game assist learners’ in acquiring the literacy practice in their discipline? 2. Were generic skills fostered from playing the game? 3. Did learners’ performance in Tooth Morphology - Module 3 test improve?
2.4 Study Population The study population consisted of first year Dental Technology learners from the past two years (n= 32 in 2006 & n=20 in 2007) who had completed the didactic instructional learning for Tooth Morphology – Module 3. The board game was played over 4 consecutive 40 minute periods.
2.5 Constituents of the board game The physical components of the game (Figure 1) comprised a board, which used graphically depicted square blocks in correspondence to the playing cards. The graphics represented the three categories namely 1. high and 2. low cognitive multiple choice questions and 3. rewards and penalties. A full mouth maxillary model (Figure 2), dice and acrylic molar teeth with correct morphological detail, which made suitable playing tokens, were also included.
Playing Tokens
Playing Cards
Figure 1: Tooth Morphology Board Game
Figure 2: Full mouth maxillary model
2.6 Rules of the TMBG Each team is presented with a full mouth maxillary model that is made up of a base and 14 dyes. Each dye is numbered, which corresponds to the number on the base. Remove all dyes from the base prior to commencement of the board game. ▪
For every correct answer the team is to return a numbered dye to its corresponding numbered base.
▪
For every incorrect answer the team is to remove a dye from the base.
▪
The team that return all the dyes correctly to its corresponding numbered base and completes the full maxillary model is declared the WINNER.
Players within a team are to consult with each other before answering.
The answer given will
be taken as the FINAL answer. Learners are permitted to consult their notes and textbooks. The cards that have been played should be placed at the bottom of the pack.
2.7 Players There are two teams per board game. Each team should consist between 2 – 3 players. Teams were randomly selected in order to accommodate male/female blends as well as foundation/ mainstream learner combinations. This was principally done to encourage learner personal development by helping to establish dialogue and break social and cultural boundaries. (Pivec, 2005)
2.8 How to play the TMBG ▪
Both teams place their tokens on the “tooth figure” marked “START”.
▪
Each team has a turn to roll the dice.
▪
The first team to roll “SIX” on the dice will be called Team 1 and they will start the game.
▪
Team 1 rolls the dice and moves left on each figure the number of spaces as indicated by the dice.
▪
Team 2 picks up the card that corresponds to the picture on the board where Team 1 has landed & proceeds to question them.
▪
If Team 1 answers correctly they would be allowed to return a dye to the model base and proceed to roll the dice again.
▪
If Team 1 answers incorrectly, Team 2 would then be allowed to roll the dice.
▪
The game continues in this manner until all dyes are returned to the base, which completes the full maxillary model.
2.9 Data collection and analysis Data gathering on learners’ experience of the board game is an approach that resembles the evaluation of research methods described by Mouton (2001) and is therefore predominantly characterised as qualitative (Beylefeld and Struwig, 2007). After the tutorial session learners completed a 14 question anonymous survey questionnaire detailing several demographic variables and 3 closed questions measured by a four-point Likert scale (the force choice response scale) to assess learners’ opinions on the board game as educational tools and their overall opinions of the board game itself. The responses from the Likert scale questions were coded from 1 to 4, with “strongly agree” being labelled 4 and “strongly disagree” being 1. The direction of scoring can be determined from the average values comparison per question, i.e. both groups scored closer to 4 or both groups scored closer to 1. In addition, 5 open-ended questions were also included to allow learners to further elaborate on instructional design likes, dislikes and suggestions.
Statistical Approach Both Descriptive and Inferential Statistical analysis are covered in this research. Descriptive statistics describes the organising and summarising of quantitative data. Univariate analysis is concerned with measures of central tendency for e.g. mean and measures of dispersion for e.g. standard deviation. The average scores reflect the learners’ level of perception of the TMBG.
Inferential statistical analysis is concerned with the testing of hypothesis. The independent t-test is the most appropriate parametric test for interval measurement. This tests any significant difference between the mean scores of two groups. Primary data was collated and analysed and comments and concluding discussion are thereafter based on the results obtained.
Hypotheses tests: P-VALUES AND STATISTICAL SIGNIFICANCE The traditional approach to reporting a result requires a statement of statistical significance. A pvalue is generated from a test statistic. A significant result is indicated with "p < 0.05" when the testing is done at a level of significance of 0.05.
Graphs Various graphical methods such as bar and organizational charts were used to present the data.
Statistical Software The analysis was performed using the following statistical software packages: SPSS (version 15) Statgraphics Centurion
Nvivo data Analysis (QSR, Australia) Nvivo was used to organise and analyse data from the open ended questions by searching for themes and clustering these specific themes to search for trends. Coding included phrasing or paraphrasing the words of the participants so that themes could be identified. The second level of coding refined these themes to incorporate them into either positive or negative clusters. (Meyer et al., 2007) Direct observation of learners during the game also assisted in the analysis of the qualitative data.
Test Scores Major test 3 scores were further used as a proxy measure on the effectiveness of the game in order to corroborate whether learners’ subjective experiences of the board game positively impacted on their learning. Test scores were compared against the 2005 learners who did not use the board game and were statistically analysed using t-test with p 0.05), with the exception of the technical design question, “I like the color combinations and picture on the board game”, as reflected in Table 1: Column 2, p < 0.05.
Although the latter possibly suggests that there are individual differences in the way
learners perceive a design of a game, majority of learners did qualitatively report that the board game was “visually stimulating”.
Research question 2 - Were generic skills fostered from playing the game? Qualitative evidence of positivism generated by the TMBG Figure 10 reveals the most common open-ended idioms that were captured into themes via Nvivo to reflect the trends. The positive comments focussed on the novelty of the tutoring approach by transforming the lecture room into a community of interactive learning where teamwork encouraged the development of interpersonal skills.
TOOTH MORPHOLOGY BOARD GAME
LEARNING
SKILLS
TECHNICAL DESIGN
Fun, Motivational & Easy Links to Tooth Morphology Practicals, Retainment of knowledge
Collaboration Critical Thinking Communication Competitive
Simple & Easy Design Visually Stimulating Organised Cute Tokens
Figure 10: Learners’ positive perceptions of the board game
Direct observations showed that collaboration promoted healthy competition between teams and cognitive discussions (negotiation and decision making) between team players was evident by their frequent referral to their lecture notes or textbooks.
The negative comments focused on the technical issue of placing timelines for answering questions: ‘Include a timer, it would make the game more exciting’; ‘Give a time limit e.g. 2 minutes….’; ‘Must be time limit to finish a question’; ‘A time limit for answering the questions will help i.e. the eager participants would know and understand the questions and answers rather than a guestimation’.
Research question 3: Did learners’ performance in Tooth Morphology - Module 3 test improve? In comparing Module - 3 test scores, it appears that the results were better (p < 0.05) for the years in which the game had been used (2007: p = 0.048 & 2006: p = 0.032) in comparison to the previous year (2005) where it was not.
4. Discussion Research illustrates that the incorporation of games into a structured curriculum does enhance the learning experience provided it is well prepared, executed and evaluated. (Meterissian et al., 2007, Dieleman and Huising, 2006 and Allen et al., 2008) It may be considered that if this is achievable only then will it justly compliment didactic teaching to positively impact on the way students learn and later use the information in practice. Ultimately, this may even combat rote learning. However, very little has been published in the area of gaming as a tutoring tool in dental education.
The most significant and consistent finding of this study was that learners’ were highly receptive to the TMBG as a stimulating tutorial strategy (Figures 3 – 10). In a subject such as Tooth Morphology – Module 3, often challenged by the large volume of learning content, the TMBG is a useful adjunct to traditional didactic lectures. From a learner’s perspective of how the game influenced the manner in which they constructed meaning, it was evident that playing the TMBG encouraged them to think critically about the subject’s content and to use further reference materials (Figure 5). Not withstanding this, the game contextually permitted learners to critically link the theory with the Dental Technology Practicals (Figure 10).
This type of learning is
supportive of the researcher’s vision in designing the game that learner’s would cognitively link the theory with practice thereby deemphasizing the dominance of rote learning. In turn, this would essentially facilitate learners’ transition into the Crown and Bridge programme in the following year.
Studies (Burgos et al., 2007, Persky et al., 2007, Amory and Seagram, 2003) have further demonstrated that the use of educational games within lesson plans not only connect specific content but fosters generic skills within a friendly environment. Anecdotal evidence from the questionnaire responses (Figure 10) showed that the TMBG provided a good vehicle to establish social relationships as learners were encouraged to communicate, discuss and negotiate with their team mates. Consequently, this encouraged healthy competition as players within the team were collaborative. Playing games that facilitate communication and collaboration usually do result in better performance and provides a sense of belonging to a team whilst breaking cultural barriers. (Dieleman and Huising, 2006)
Contrary to technical design question (Table 2: Column 2) not being statistically significant (p = 0.010), learners’ responses to the instructional and technical design of the game were extremely
encouraging (Figures 1, 3, 9 & 10). The former was not considered an area of concern as such differences in perceptions might be a function of different learners’ personal design styles.
Game design is a prerequisite for success. There is a high probability that learning will not be successful if there is lack of design mechanisms to motivate learners from playing the game. The design therefore concentrated around the different card categories, full mouth maxillary model and visually stimulating game mechanisms to facilitate fun and motivated learning, a theme that was central to the success of the TMBG. Entering the world of game based learning therefore improves mental agility (active learning) and increases motivation evident by virtue of the game being fun.
The preceding discussion appropriately lends itself to Dieleman and Huisingh (2006) attestation that another important part to success of games can be explained by the proper preamble to and careful instructions to playing a game. Learners’ unanimously agreed that in conjunction with the facilitator’s guidance (Figure 7) the instructional design had effectively prepared them in approaching the TMBG (Figure 3).
In corroboration with Persky, et al. (2007), games that are played for 75 minutes or longer accommodates more productive feedbacks as participants carefully gather their thoughts and clearly project their feelings about the game and type of learning that it supports, etc, as noted by one student “The game is motivational. Makes one see why it is important to recall knowledge and learn with understanding because when answering the questions you reason with what was taught”. The learning practice from the board game further characterizes action research as learners’ experiences were heard and documented, consequently accommodating for continuous improvements to the game. A future improvement of the TMBG as suggested by learners is the introduction of timelines when answering questions to further challenge players competitively.
Although there were no major changes to the content of the Module 3 major test from previous years, it is nonetheless challenging to quantify changes in learning in terms of Biggs’s theory (surface vs. deep learning). However, similar to Persky et al. (2006), major test scores served as potential indicators. There was evidence that learners performed better in tests (p < 0.05) with the introduction of the TMBG as the abstract Tooth Morphology content was merged with game characteristics that facilitated learners to repeat cycles within the game context, making them active participants in knowledge acquisition. However, this maybe an area for further research into how facilitators can pedagogically confirm that improved performance in major tests occurs by the effective and engaging learning experienced by playing contextually designed educational games.
In conclusion, this study clearly demonstrates that learners appreciated the tutorial strategy to support learning.
Dental educators therefore need to embrace game based technology to
harness learners’ active participation in the learning process and those that carefully evoke it will gain a complete appreciation of this innovative strategy. The TMBG game undoubtedly served as an effective tutorial strategy in not only enriching the content but promoting the link between theory and practice.
The cultivation of such games may serve as an invaluable tool in
empowering learners within the institution and other centres.
Acknowledgements: The author would like to express her sincere gratitude to the person who was not only catalytic in motivating her to tread the path of game based teaching but challenged her educational philosophies, Mrs Delysia Timm without whom this game would have not been possible. Special thanks to Mr Deepak Singh for his invaluable help in the analysis of the data and Dr. Sharita Bharuthram for her unfailing support at the inception of the game. Last but not least, a heartfelt thanks to the many unnamed “2006” and “2007” 1st year Dental Technology learners who unknowingly supported this work.
This work was financially supported by the Teaching
Development grant, an initiative by the Department of Education, South Africa.
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