Proposal of e-learning strategy to teach Atraumatic Restorative Treatment (ART) to undergraduate and graduate students
© Camargo et al.; licensee BioMed Central Ltd. 2014
Received: 13 February 2014
Accepted: 23 June 2014
Published: 17 July 2014
The aim of this study was to evaluate e-learning strategy in teaching Atraumatic Restorative Treatment (ART) to undergraduate and graduate students. The sample comprised 76 participants—38 dental students and 38 pediatric dentistry students—in a specialization course. To evaluate knowledge improvement, participants were subjected to a test performed before and after the course.
A single researcher corrected the tests and intraexaminer reproducibility was calculated (CCI = 0.991; 95% IC = 0.975–0.996). All students improved their performances after the e-learning course (Paired t-tests p < 0.001). The means of undergraduate students were 4.7 (initial) and 6.4 (final) and those of graduate students were 6.8 (initial) and 8.2 (final). The comparison of the final evaluation means showed a statistically significant difference (t-tests p < 0.0001).
The e-learning strategy has the potential of improving students’ knowledge in ART. Mature students perform better in this teaching modality when it is applied exclusively via distance learning.
Dental caries prevalence has declined in recent years  but still causes negative impact on patients’ quality of life . Currently, undergraduate dental education has been widely discussed in many countries with the aim of modernizing the curriculum in cariology. Undergraduate dental education should enable students to become professionals with critical potential who are able to perform early diagnosis and have a wider understanding of the caries process according to the best scientific evidence available [3, 4].
New options for preventive measures, as well as operative and non-operative treatments, have been described and should be taught as they present scientific evidence of effectiveness [5–8]. Among these options, we can emphasize Atraumatic Restorative Treatment (ART), which was advocated in the early ‘80s and was officially adopted by the World Health Organization in the ‘90s . ART is a definitive restorative treatment that is low cost and is based on minimal intervention involving prevention, early interception and tooth structure preservation .
An interesting strategy to face the current challenges of contemporary education is the inclusion of e-learning in the undergraduate curriculum [11, 12]. It enables the merger of face-to-face learning activities with online learning experiences that allow student-centered learning and efficient use of time . It is effective and presents results that are similar to [14, 15] or even better than the traditional methodology . Some studies also showed that e-learning can enhance the learning experience when it is used as a support to presentational teaching [17–19]. Besides that, it is well received by dental students, which makes it desirable for undergraduate courses [20–22].
In a previous study , we evaluated the benefits of an e-learning training course on ART that was applied to practicing dentists and found encouraging results. In this study, we applied this same course to undergraduate and graduate dental students to evaluate the potential of an e-learning strategy in teaching ART.
The Local Ethics Committee in Research (Ethics Committee in Research –UNIP – Paulista University) approved this study (protocol 97.085 – 09/08/2012) and the participants received written information and signed a consent form.
The Departments of Pediatric Dentistry and Telemedicine – University of São Paulo elaborated a DVD training course in ART (about 40 minutes). This e-learning course combined many resources, such as the “Virtual Man project,” clinical videos, interviews with ART experts, clinical pictures and radiographs. Its elaboration was better described in the previous study .
The test consisted of multiple-choice and open-ended questions in three sections. Section 1 comprised questions on theoretical/conceptual/cognitive skills, with fifty sentences that could be true or false, addressing various topics of ART. Section 2 had written tests that comprised cognitive reasoning-contextualization, with five clinical situations illustrated with photographs and radiographs. Section 3 also had a written test regarding observation in the clinical setting, with five short films from clinical videos and/or the Virtual Man project. The film sections were exhibited twice for all participants at the same time, with an interval of thirty seconds between each exhibition. The three sections, combined, assessed the dentists’ theoretic-scientific knowledge on the topic, evaluated their ability to make decisions in different circumstances, and tested their adeptness in identifying aspects of different ART-related situations and procedures. The maximum time allowed for each section was thirty-five minutes.
In a previous study , due to the subjectivity involved when correcting the written answers, two researchers underwent a calibration exercise. One of these researchers performed the correction of all tests in the present study (intraexaminer reproducibility CCI = 0.991; 95% IC = 0.975–0.996).
To evaluate the performance of each student, a paired t-test was used to compare the means between grades from Assessment 1 (before course) and 2 (after course). To compare the groups’ performance (undergraduate and graduate), we applied the Student’s t-test to the Assessment 2 mean (after the course),
One hundred and twenty undergraduate students were invited to participate in the study. Thirty-eight of these performed the evaluation process completely; and, of 41 graduate students invited, 38 finished the survey (Response rate: undergraduate group 38%; graduate group, 93%). Thus, the e-learning strategy was evaluated through the performance of 76 students who attended the course.
Personal data from the undergraduate and graduate groups
Students’ background in ART
Have used ART before
Never used ART
Lack of training
Lack of restorative material
Negative previous experience
Did not answer
Does not defend ART
Did not answer
Use only as urgent/temporary treatment
Use as definitive treatment
Did not answer
The mean grades of each student before and after the course were compared, initially considering each sector of the test and also the means of these three sectors, showing a statistically significant difference (p <0.001). Students from both groups showed ART knowledge improvement at all levels of comparison performed.
Students’ grades from the evaluation process
Average of the 3 sections
The comparison of the final evaluation grades between the two groups showed a statistically significant difference (p < 0.0001), indicating that graduate students finished the course with better performance than undergraduate students.
It is clear that dental students need systematic and consistent education in cariology ; e-learning can contribute to this process by providing advantages such as ample autonomy regarding where, how and when the student will dedicate himself to the educational process [18, 25, 26]. However, self-motivation, technical problems and lack of interaction between teachers and students when content is offered exclusively at distance are difficulties with the potential to cause negative impact upon the students’ performances [23, 25]. Therefore, our goal was to evaluate the e-learning strategy in teaching ART for undergraduate and graduate students.
One finding of this study was that half of the undergraduate students, at baseline, showed an inadequate concept of ART and believed that it was a temporary and/or emergent treatment. This points out the need to properly teach ART in undergraduate courses , as the construction and consolidation of misconceptions with the student are more difficult to correct later on .
Our results demonstrate that a significant improvement of the students’ knowledge occurred after using the e-learning strategy. This improvement shows that a well-structured e-learning course can be a good alternative in teaching ART and helping implement scientific evidence-based treatments in clinical practice. Besides, graduate students achieved higher grades in the final evaluation (8,2) when compared to undergraduate students (6,4). We hypothesize that there is a relationship between students’ performance and their motivation in a distance-learning course, as observed previously .
It is noteworthy that the same learning strategies were able to sensitize and motivate the graduate students, but were not as effective with the undergraduate students. Also, the lack of using ART in clinical practice during their undergraduate courses may possibly have contributed to the poor performance presented by this group; conversely, the graduate group was composed of pediatric dentistry students, and one of the major indications of ART is its use in children to decrease anxiety levels .
Thus, in order to improve the undergraduate students’ performance, other teaching strategies should be linked to the learning process. Interaction with tutors should provide motivation, guidance and support to these students. This practice integration characterizes blended learning .
In conclusion, the e-learning strategy has the potential of improving students’ knowledge of ART. Mature students perform better with this teaching modality when applied exclusively via distance learning.
We would like to thank for CAPES (Coordenação e Aperfeiçoamento de Pessoal de Nível Superior) for PhD Scholarship, CNPq (Conselho Nacional de Desenvolvimento Científico e Tecnológico) and FAPESP (Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) for supporting our study.
- Bonecker M, Ardenghi TM, Oliveira LB, Sheiham A, Marcenes W: Trends in dental caries in 1- to 4-year-old children in a Brazilian city between 1997 and 2008. Int J Paediatr Dent. 2010, 20: 125-131. 10.1111/j.1365-263X.2009.01030.x.PubMedView ArticleGoogle Scholar
- Abanto J, Carvalho TS, Mendes FM, Wanderley MT, Bönecker M, Raggio DP: Impact of oral diseases and disorders on oral health-related quality of life of preschool children. Community Dent Oral Epidemiol. 2011, 39: 105-114. 10.1111/j.1600-0528.2010.00580.x.PubMedView ArticleGoogle Scholar
- Bottenberg P, Ricketts DNJ, Van Loveren C, Rahiotis C, Schulte AG: Decision-making and preventive non-surgical therapy in the context of a European Core Curriculum in Cariology. Eur J Dent Educ. 2011, 15 (Suppl 1): 32-39.PubMedView ArticleGoogle Scholar
- Buchalla W, Wiegand A, Hall A: Decision-making and treatment with respect to surgical intervention in the context of a European Core Curriculum in Cariology. Eur J Dent Educ. 2011, 15 (Suppl 1): 40-44.PubMedView ArticleGoogle Scholar
- Mickenautsch S, Yengopal V, Banerjee A: Atraumatic restorative treatment versus amalgam restoration longevity: a systematic review. Clin Oral Investig. 2010, 14: 233-240. 10.1007/s00784-009-0335-8.PubMedView ArticleGoogle Scholar
- Ahovuo-Saloranta A, Forss H, Walsh T, Hiiri A, Nordblad A, Mäkelä M, Worthington H:Sealants for preventing dental decay in the permanent teeth. Cochrane Database Syst Rev. 2013, 28: 3-CD001830. doi:10.1002/14651858.CD001830.pub4,Google Scholar
- Ricketts D, Lamont T, Innes NPT, Kidd E, Clarkson JE: Operative caries management in adults and children. Cochrane Database Syst Rev. 2013, 28: 3-CD003808. doi:10.1002/14651858.CD003808.pub3Google Scholar
- Raggio DP, Hesse D, Lenzi TL, Guglielmi CAB, Braga MM: Is Atraumatic restorative treatment an option for restoring occlusoproximal caries lesions in primary teeth? A systematic review and meta-analysis. Int J Paediatr Dent. 2012, 28: doi:10.1111/ipd.12013Google Scholar
- World Health Organisation: Atraumatic Restorative Treatment (ART) for tooth decay. 1998, Geneva: World Health OrganisationGoogle Scholar
- Frencken JE, Makoni F, Sithole WD: Atraumatic restorative treatment and glass-ionomer sealants in a school oral health programme on Zimbabwe: evaluation after one year. Caries Res. 1996, 30: 428-433. 10.1159/000262355.PubMedView ArticleGoogle Scholar
- Means B, Toyama Y, Murphy R, Bakia M, Jones K: Evaluation of evidence-based practices in online learning: A meta-analysis and review of online learning studies.http://www.sri.com/sites/default/files/publications/imports/EvaluationEvidenceBasedPracticeOnlineLearning.pdf,
- Handal B, Groenlund C, Gerzina T: Dentistry student’s perceptions of learning management systems. Eur J Educ. 2010, 14: 50-54.Google Scholar
- Faraone KL, Garrett PH, Romberg E: A blended learning approach to teaching pre-clinical complete denture prosthodontics. Eur J Dent Educ. 2013, 17: 22-27. 10.1111/j.1600-0579.2012.00753.x.View ArticleGoogle Scholar
- Gega L, Norman IJ, Marks IM: Computer-aided vs tutor-delivered teaching of exposure therapy for phobia/panic: Randomized controlled trial with pre-registration nursing students. Int J Nurs Stud. 2007, 44: 397-405. 10.1016/j.ijnurstu.2006.02.009.PubMedView ArticleGoogle Scholar
- Peroz I, Beuche A, Peroz N: Randomized controlled trial comparing lecture versus self studying by an online tool. Med Teach. 2009, 31: 508-512. 10.1080/01421590802203504.PubMedView ArticleGoogle Scholar
- Abutarbush AM, Naylor JM, Parchoma G, D’Eon M, Petrie L, Carruthers T: Evaluation of traditional instruction versus a self-learning computer module in teaching veterinary students how to pass a nasogastric tube in horse. J Vete Med Educ. 2006, 33: 447-454. 10.3138/jvme.33.3.447.View ArticleGoogle Scholar
- Boyton JR, Green TG, Johnson LA, Nainar H, Straffon LH: The virtual child: evaluation of an internet-based pediatric behavior management simulation. J Dent Educ. 2007, 71: 1187-1193.Google Scholar
- Reynolds PA, Rice S, Uddin M: Online learning in dentistry: the changes in undergraduate perceptions and attitudes over a four year period. British Dent J. 2007, 203: 419-423. 10.1038/bdj.2007.896.View ArticleGoogle Scholar
- McCann AL, Schneiderman ED, Hinton RJ: E-teaching and learning preferences of dental and dental hygiene students. J Dent Educ. 2010, 74: 65-78.PubMedGoogle Scholar
- Bynum AB, Irwin CA, Cohen B: Satisfaction with a distance continuing education program for health professionals. Telemed J E Health. 2010, 16: 776-786. 10.1089/tmj.2010.0005.PubMedView ArticleGoogle Scholar
- Thurzo A, Stanko P, Urbanova W, Lysy J, Suchancova B, Makovnik M, Javorkav V: The web 2.0 induced paradigm shift in the e-learning and the role of crowdsourcing in dental education. Bratisl Lek Listy. 2010, 111: 168-175.PubMedGoogle Scholar
- Kavadella A, Tsiklakis K, Vougiouklakis G, Lionarakis A: Evaluation of a blended learning course for teaching oral radiology to undergraduate dental students. Eur J Dent Educ. 2012, 16: 88-95. 10.1111/j.1600-0579.2011.00680.x.View ArticleGoogle Scholar
- Camargo LB, Aldrigui JM, Imparato JCP, Mendes FM, Wen CL, Bönecker M, Raggio DP, Haddad AE: E-learning used in a training course on Atraumatic Restorative Treatment (ART) for Brazilian Dentists. J Dent Educ. 2011, 75: 1397-1402a.Google Scholar
- Schulte AG, Pitts NB, Huysmans MCDNJM, Splieth C, Buchalla W: European Core Curriculum in Cariology for undergraduate dental students. Eur J Dent Educ. 2011, 15 (Suppl 1): 9-17.PubMedView ArticleGoogle Scholar
- Neuhaus KW, Schegg R, Krastl G, Amato M, Weiger R, Walter C: Integrated learning in dentistry: baseline data and first evaluation at the Dental School of Basel. Eur J Dent Edu. 2008, 12: 163-169. 10.1111/j.1600-0579.2008.00513.x.View ArticleGoogle Scholar
- Tan PL, Hay DB, Whaites E: Implementing e-learning in a radiological science course in dental education: A short-term longitudinal study. J Dent Educ. 2009, 73: 1202-1212.PubMedGoogle Scholar
- Camargo LB, Fell C, Bonini GC, Marquezan M, Imparato JCP, Mendes FM, Raggio DP: Paediatric dentistry education of atraumatic restorative treatment (ART) in Brazilian dental schools. Eur Arch Paediatr Dent. 2011, 12: 303-307. 10.1007/BF03262828.PubMedView ArticleGoogle Scholar
- Carbonaro M, Dawber T, Arav I: A comparison of students’ performance under full-time, part-time, and online conditions in an undergraduate nursing microbiology course. J Distance Educ. 2006, 21: 51-61.Google Scholar
- Holmgren CJ, Roux D, Doméjean S: Minimal intervention dentistry: part 5. Atraumatic restorative treatment (ART) - a minimum intervention and minimally invasive approach for the management of dental caries. Br Dent J. 2013, 214: 11-18. 10.1038/sj.bdj.2012.1175.PubMedView ArticleGoogle Scholar
- Garrison DR, Kanuka H: Blended learning: uncovering its transformative potential in higher education. Internet High Educ. 2004, 7: 95-105. 10.1016/j.iheduc.2004.02.001.View ArticleGoogle Scholar
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