Blended learning for reinforcing dental pharmacology in the clinical years: A qualitative analysis.

OBJECTIVES: Blended learning has become the method of choice in educational institutions because of its systematic integration of traditional classroom teaching and online components. This study aims to analyze student's reflection regarding blended learning in dental pharmacology. SUBJECTS AND METHODS: A cross-sectional study was conducted in Faculty of Dentistry, Melaka-Manipal Medical College among 3rd and 4th year BDS students. A total of 145 dental students, who consented, participate in the study. Students were divided into 14 groups. Nine online sessions followed by nine face-to-face discussions were held. Each session addressed topics related to oral lesions and orofacial pain with pharmacological applications. After each week, students were asked to reflect on blended learning. On completion of 9 weeks, reflections were collected and analyzed. STATISTICAL ANALYSIS: Qualitative analysis was done using thematic analysis model suggested by Braun and Clarke.
RESULTS: The four main themes were identified, namely, merits of blended learning, skill in writing prescription for oral diseases, dosages of drugs, and identification of strengths and weakness. In general, the participants had a positive feedback regarding blended learning. Students felt more confident in drug selection and prescription writing. They could recollect the doses better after the online and face-to-face sessions. Most interestingly, the students reflected that they are able to identify their strength and weakness after the blended learning sessions.
CONCLUSIONS: Blended learning module was successfully implemented for reinforcing dental pharmacology. The results obtained in this study enable us to plan future comparative studies to know the effectiveness of blended learning in dental pharmacology.

Blended learning has become the method of choice for many students in education and training because of its systematic integration of an online component to traditional teaching [Figure 1].[1]

Figure 1

Blended learning

In our experience, dental students are taught pharmacology in their preclinical years and often forget the drug interactions and dosages in their clinical years. Hence, dental pharmacology is revised in 3rd and 4th year with an emphasis on clinical application. In our study, we have used the blended learning to reinforce dental pharmacology and qualitatively analyzed the student reflections regarding the same.

Subjects and Methods

One hundred and forty-five students of 3rd (78) and 4th (67) year BDS, who consented to participate, were involved in the study. The students were divided into small groups of 10–11, thereby forming 14 groups.

Blended learning module development: the blended learning module was prepared by two subject experts for the 14 groups according to the sequential model of blended learning and online activities proposed by Koohang.[2] This model illustrates how transitioning from traditional teaching to a model of online learning can be conducted.[3] A timetable of nine online sessions followed by nine face-to-face discussions was planned to replace the traditional course structure of 15 h of classroom teaching. Each online session addressed topics from dental pharmacology related to oral lesions and orofacial pain. The sessions were in the form of a quiz, MCQ’s, or scenario-based questions. Learning objectives were formulated for each session [Figure 2].

Figure 2

Blended learning model used in our study

At the start of the week, the online session was uploaded in Moodle, and students were given 1-week time to complete the exercise. Each weekly online assignment was commented on and assessed by the course instructor. At the end of the week, a face-to-face discussion was conducted by faculty who clarified the doubts and helped students correct their mistakes. After each week, the students were asked to reflect on the blended learning session under a standard format which included the following: (a) What happened? (b) So what? (c) What next?

On completion of 9 weeks, reflections were collected and analyzed. We followed Braun and Clarke’s six phases for conducting an inductive thematic analysis.[4]

Steps followed in thematic analysis [Figure 3]:

Figure 3

Thematic analysis by Braun and Clarke

Step 1: Familiarization with the data: We read the data a few times before identifying codes and themes

Step 2: Initial Coding: We identified repeated words in each reflection and coded them e.g. Dosage, prescription writing, blended learning merits, application to clinical practice, and my strength and weakness.

Step 3: Generating themes: The codes were organized into meaningful themes

Step 4: Checking for validity and reliability/reviewing themes generated: Two independent reviewers analyzed the data and derived themes. We compared our themes with those of the two reviewers, and conflicting aspects were discussed

Step 5: Defining and naming themes: After thematic analysis, we defined and named themes based on emerging trends

Step 6: Interpretation and producing the report: The themes were analyzed, and a report was formulated. Institutional Research and Ethical Committee approval was obtained.

Results

A total of 108 forms were collected, in which one was incomplete and two forms were illegible and hence were excluded from the study.

The four main themes identified were:

Merits of blended learning

Skill in writing prescription for oral diseases

Dosages of drugs

Identification of strengths and weakness.

Merits of Blended Learning

The potential merits of the blended learning module were emphasized in the students’ comments. In general, the participants liked blended learning structure. Greater flexibility, convenience, and time efficiency were reflected as major benefits in the participants’ comments. Further, it was mentioned that online learning activities helped to make learning more fun. Forty-six percent of the students reflected that blended learning was better than traditional classroom lessons with continuous lectures. They felt they were more prepared for the lessons and sessions were more fun. Seventy-four percent of the students opined that in blended learning, teachers have become facilitators and resource providers rather than just lecture givers [Table 1].

Table 1

Student reflections for merits of blended learning

Skill in Writing Prescription and Selecting Right Drugs for Different Oral Diseases

The students felt that their prescription writing skills improved. Eighty-five percent of the students opined that their ability to identify correct drug improved after the session. Twenty-three percent of the students reflected that due to reinforcement in online and face-to-face modules, students were able to remember better. Ten percent of the students also suggested that they mastered not only know the correct drugs to be prescribed but also what are not to be prescribed for patients with different medical conditions [Table 2].

Table 2

Student reflections for skill in writing prescription and selecting right drugs for different oral diseases

Remembering Dosage of Drugs

Thirty-three percent of the students could recollect the dosages better after the online quiz and face-to-face discussions. Reinforcement in different sessions was appreciated by them. Nine percent were more confident regarding dosages after this session and felt it was difficult to concentrate during lecture classes [Table 3].

Table 3

Student reflections for remembering dosage of drugs

Identification of Strengths and Weakness

The most interesting reflection identified was that the students received effective feedback during face-to-face discussions as well as online assessments. Comments from lecturers helped the students to identify their strengths and weakness. Forty-four percent of the students suggested that solving online assignments all by themselves made them realize where they lack and where they needed improvement. Fifteen percent of the students reflected that they were able to integrate and apply the subject learned in oral medicine and oral pathology for identification of diseases and its management pharmacologically. Fifty-six percent of the students felt the need to practice and read more [Table 4].

Table 4

Student reflections for identification of strengths and weakness

Discussion

Over the past few decades, there has been an exponential rise in the computing technologies leading to a surge in online teaching methodologies.[1] In spite of the technological advancements, many researchers, trainers, and teachers believe that face-to-face traditional teaching methodologies have their own merits and especially cater to the needs of the less independent students.[2] To overcome these issues, educational researchers have come up with an amalgamation of the traditional and modern teaching methodologies which led to the concept of blended learning.[256] Blended learning has been used widely in many medical and dental subjects.[78] Literature review by Rowe suggested that blended learning has a potential to improve clinical competencies among health-care students and they find it intellectually stimulating.[9]

The blended learning module had an overall positive feedback from the students. We chose the blended learning technique for the 3rd and 4th year students because they were exposed to the traditional pharmacology teaching in their preclinical years. Repeating the lectures for reinforcing such topics is time consuming. Moreover, the objective of revising dental pharmacology in clinical years is to emphasize on the clinical application. This was possible by introducing online sessions with case-based scenarios. Furthermore, the sessions were based on clinical scenarios rather than on individual drugs. The blended learning was received well by the students, who enjoyed the online sessions due to their techno-savvy inclination. Dividing the students helped us to conduct one-to-one sessions allowing us to give effective feedback. A similar finding was also reported in the study by Pahinis et al.[10] at the end of blended learning course.

Flexibility and location convenience were key matters in the students’ comments on a blended learning course.[11] Combined with online activities, the learning was more student centered and teacher acted as a facilitator. Rather than just a provider of answers and content, the teacher becomes a guide, resource provider, and expert controller. The blended learning module led to a change in teacher activity toward providing guidelines and creating learning environments where students are helped to arrive at their own conclusions.[6] These advantages were also highlighted by Goodyear.[12]

Studies have a stressed need for knowledge construction, problem-solving, critical thinking, communication skills, and lifelong learning to build good professionals.[1314] Blended learning has given students a chance to explore their knowledge all by themselves through the online sessions which included the components of problem-solving and critical thinking. Feedback given during the face-to-face sessions led to the reinforcement of knowledge as well as a self-realization of the students regarding their areas of improvement. Students had an active interaction during the discussions which led to peer learning and active communication.

Our findings suggest that a blended learning format could be successfully integrated into undergraduate dental education and provided a favorable transition from the preclinical to clinical years with enhanced flexibility, location convenience, and time efficiency. With the results obtained in this study, we are planning to analyze the effectiveness of blended learning in reinforcing dental pharmacology in comparison to traditional classroom teaching.

As suggested by Rosenbaum et al.,[3] the next generation of blended learning courses should enhance the function of the internet as an absolute repository for all teaching and learning activities and minimize or even replace the number of classroom settings with online video-based features, for instance, synchronous online video conferencing.

Conclusion

Blended learning module was successfully implemented for reinforcing dental pharmacology. The results obtained in this study enable us to plan future comparative studies to evaluate the effectiveness of blended learning in dental pharmacology.

Financial Support and Sponsorship

Nil

Conflicts of Interest

There are no conflicts of interest.