What You See, What You Get? Unlocking Psychomotor


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W h a t Yo u S e e , W h a t Yo u G e t ? U n l o ck i n g P s ych o m o t o r V i d e o Demonstr ations

Shalizeh Patel, DDS Assistant Professor

Ryan Quock, DDS Associate Professor

The University of Texas School of Dentistry at Houston Restorative Dentistry and Prosthodontics

Objectives

• Understand objective and subjective results of a study conducted at the presenters„ institution, with an emphasis on implications for effective usage of video demonstration in any curriculum • Identify and understand challenges/opportunities related to implementing demonstration videos in a pre-clinical course • Identify potential for faculty scholarship and growth that can accompany the development and/or implementation of educational innovations

Objectives

• Understand objective and subjective results of a study conducted at the presenters„ institution, with an emphasis on implications for effective usage of video demonstration in any curriculum • Identify and understand challenges/opportunities related to implementing demonstration videos in a pre-clinical course • Identify potential for faculty scholarship and growth that can accompany the development and/or implementation of educational innovations

Current dilemma

To help students transfer complex restorative theories into dental motor skills in the technique laboratory, dental educators have heavily relied on demonstration setups during laboratory sessions, where a group of students “hover around” a faculty member as the procedure is being presented.

The large number of procedures requiring demonstration and the high student-to-faculty ratio make these teaching methods, though ideally effective, difficult and time consuming. Furthermore, students learn at different rates, some requiring more instructions/guidance and practice time.

proposed solution by s tudents

The University of Texas School of Dentistry at Houston, Pre-Clinical Lab, 2013

To enhance students„ learning experience and improve understanding and retention of material in the preclinical operative course, a series of surgical technique videos have been developed.

I n s t r u c t i o n a l t e ch n i q u e v i d e o s

I n s t r u c t i o n a l t e ch n i q u e v i d e o s

Students seem to be especially interested in the ability to review theory and techniques as many times as necessary before, during and after pre-clinical exercises.

The University of Texas School of Dentistry at Houston, Simulation Clinic, 2013

I n s t r u c t i o n a l t e ch n i q u e v i d e o s • These videos are intended to be presented as a further teaching tool in the context of a comprehensive operative dentistry curriculum. • These videos demonstrate techniques used for specific preparation or restoration steps. • Within these videos, concepts are conveyed via a variety of manifestations: text, photos, still-images and live video, all with audio narration.

MedEdPORTAL; 2013. Available from:www.mededportal.org/publication/9396

I n s t r u c t i o n a l t e ch n i q u e v i d e o s The University of Texas School of Dentistry at Houston, Lecture Room 4340, 2013

These videos can be easily paused during presentation to engage in reflection on and discussion of presented information in lecture.

Subjective Results Viewing these videos in advance, students are more attentive during lectures, and seem to ask better questions, are more efficient during laboratory sessions and are able to finish assignments on time.

Students have become active learners!!

Video demonstrations study: R e s e a r ch d e s i g n

R e s e a r ch d e s i g n First year DDS candidate students (n=100) were invited to take part in the study (Spring of 2014)

The University of Texas School of Dentistry at Houston, Lecture Room 4310, 2014

B a ckg r o u n d

Instructional Resources: Lectures

Instructional Resources: Lab Handouts

I n s t r u c t i o n a l t e ch n i q u e v i d e o s

Peer-reviewed & published on MedEdPORTAL

Lab Criteria Sheet

Green markings: Assessment by two calibrated and blinded faculty Black markings: Self-assessment by student #27

Post-questionnaire

Statistical analysis Performance on procedures and self-assessment • Statistical analysis were performed using the SPSS™ statistical software package. • Initially, descriptive analysis were performed for the pre-video viewing and post-video viewing subjects with respect to their outcome variable, test scores. • The second level was performed using non-parametric statistical methodologies. o The Mann-Whitney U test was used to compare test scores of prevideo viewing and post-video viewing test subjects with respect to performing an (1) occlusal preparation, (2) occlusal amalgam restoration and (3) occlusal composite restoration. o The Spearman rho test was employed to determine if there was a correlation between the students perceived assessment of their work versus the grade presented by the instructor.

Statistical analysis

Post-questionnaire • Analysis was performed to determine student agreement as reported on the post-questionnaire. o A chi square analysis was performed.

results

Performance on procedures and self-assessment The Mann-Whitney U test did not exhibit any differences between the blinded examiner scoring for control and experimental groups with respect to performing a Class I preparation (77.1 vs 77.8), Class I amalgam restoration (82.7 vs 82.8), or Class I composite restoration (79.7 vs 78.0).

Mean values and twice the standard deviations

results Performance on procedures and self-assessment • Spearman rho test revealed that the experimental (pre-viewing) group demonstrated a stronger correlation between the students perceived assessment of their work with the assessment presented by the blinded examiner than the control (post-viewing) group. • This was true for 13 out of 23 rubric criteria categories.

results Post-questionnaire • A 2x2 chi square analysis was performed on both questions of the questionnaires for all three operative procedures (control vs experimental groups): o The analysis of the results for the first question, which related to perception of video helpfulness in preparation for operative procedures, yielded significant results for the amalgam preparation (X2 =4.8, p<0.03), the amalgam restoration (X2 =12.4, p<0.001), and the composite restoration (X2 =11.3, p<0.001). o However, the second question, which related to perception of the overall value of videos in the operative curriculum, yielded a significant difference in responses only for the composite procedure (X2 =11.4, p<0.001).

Objective results • The first null hypothesis, that there would be no difference in technical performance of procedures between the two groups, as evaluated by blinded examiners using a standardized rubric, is accepted (Mann-Whitney U test). • The second null hypothesis, that there would be no difference in comprehension of concepts regarding the procedures, as evaluated by comparing student self-assessment and blinded examiner assessment of work on standardized rubrics, is rejected (Spearman rho test). o Improving self-assessment is a critical part of learning and illustrates a deeper comprehension of concepts. • The third null hypothesis, that there would be no difference in student perception of the impact of the videos, as evaluated by a post-questionnaire, is rejected (Chi-square statistic).

Objectives

• Understand objective and subjective results of a study conducted at the presenters„ institution, with an emphasis on implications for effective usage of video demonstration in any curriculum • Identify and understand challenges/opportunities related to implementing demonstration videos in a pre-clinical course • Identify potential for faculty scholarship and growth that can accompany the development and/or implementation of educational innovations

U n d e r s ta n d i n g o u r f i n d i n g s The results of this study suggest that as far as first-time performance on operative procedures in an institution is concerned, peer-reviewed and published instructional videos may not make an immediate objective difference - this seems counter to the results of previous similar studies: • Nikzad S, Azari A, Mahgoli H, Akhoundi N. Effect of a procedural video CD and study guide on the practical fixed prosthodontic performance of Iranian dental students. J Dent Educ 2012;76(3):354-9.

• Aragon CE, Zibrowski EM. Does exposure to a procedural video enhance preclinical dental student performance in fixed prosthodontics? J Dent Educ 2008;72(1):67-71. • Tani Botticelli A, Schittek Janda M, Botticelli D, Mattheos N, Attstrom R. The effectiveness of video support in the teaching of manual skills related to initial periodontal therapy tested on phantoms. Int J Comput Dent 2005;8(2):117-27.

Visual Technology in classroom is not a new concep t

Image courtesy of www.funnystatus.com

U n d e r s ta n d i n g o u r f i n d i n g s The abundance of human and non-video instructional media (pictorial stepwise procedure handouts, lecture notes) available to the students in this operative course may have offset some of the anticipated benefits of the videos.

E vo l u t i o n i n t h e c l a s s r o o m

Image courtesy of www.eduboard.com

Image courtesy of www.jasohill.com

• This cohort of students, moving through current educational system, are by far the most visually stimulated generation our dental school has ever had to teach. • They have matured with the presence of cable television, video games, computer software, and the internet and are truly visual learners. The visual effects used in this study are not “revolutionary” or “memorable” due to their continual exposure to visual cuing in their childhood development. • This study„s population demographic consisted of United States, primarily millennial generation, dental students, which contrasts with some earlier studies.

U n d e r s ta n d i n g o u r f i n d i n g s There was a positive demonstrated impact on the students„ ability to accurately selfassess their work: • Students in the experimental group reported a self-assessment score much more closely correlating to those of the blinded examiners, especially in categories that the authors anecdotally observe novice students to regularly have difficulty mastering: preparation isthmus width, preparation retention form, preparation refinement, and restoration margins.

U n d e r s ta n d i n g o u r f i n d i n g s Furthermore, based on the questionnaire, the control group reported a significantly stronger impression of the value that the videos would have provided in helping them prepare and understand all of the operative procedures (as compared to the experimental group).

• The control group had a significantly stronger impression of the value of videos in the overall curriculum only as it regarded the composite restoration, although the majority of responses for both groups in all procedures favor the presence of videos in the curriculum. • The students favor the ability to view technique videos, both in a formal classroom environment and informally on their own: o Production and eventual publication of our videos came at the request of our students.

Opportunities related to implementing demonstration videos

• Make videos available ahead of procedures to be done for the first time, for independent student viewing – based on the results of this study, student comprehension of concepts will be enhanced.

• Instructor led viewing and discussion of videos in a large group format (lecture hall or pre-clinical lab) to supplement traditional teaching. • Post videos online for on-demand viewing by students – anecdotally, our students report reviewing these videos (and handouts) before major preclinical (practicals) and clinical (board exams) experiences. Despite this finding relating to first-time performance of operative procedures, it is likely that psychomotor video demonstrations have potential for long-term positive impact on our students

Challenges related to implementing demonstration videos

• Time • Resources • Funds

This proposal was accepted as a recipient of a Dean's Small Grant for 2013-2014 academic year.

The funding was instrumental in producing the media and procuring the materials utilized in the study.

Objectives

• Understand objective and subjective results of a study conducted at the presenters„ institution, with an emphasis on implications for effective usage of video demonstration in any curriculum • Identify and understand challenges/opportunities related to implementing demonstration videos in a pre-clinical course • Identify potential for faculty scholarship and growth that can accompany the development and/or implementation of educational innovations

G l o b a l I m p a c t o n d e n ta l e d u c a t i o n Patel S, Quock R, Barros J, Gonzales D, Woernley T, Orozco M, Frey G. Class I Preparation: Instructional Video. MedEdPORTAL; 2013. Available from: www.mededportal.org/publication/9396 Total Number of Downloads: 50 Total Number of Countries Downloading Publication: 8

Patel S, Quock R, Barros J, Gonzales D, Woernley T, Orozco M, Frey G. Class I Amalgam Restoration: Instructional Video. MedEdPORTAL; 2013. Available from: www.mededportal.org/publication/9498 Total Number of Downloads: 63 Total Number of Countries Downloading Publication: 10

Patel S, Quock R, Barros J, Gonzales D, Woernley T, Orozco M, Frey G. Class I Composite Restoration: Instructional Video. MedEdPORTAL; 2013. Available from: www.mededportal.org/publication/9505 Total Number of Downloads: 35 Total Number of Countries Downloading Publication: 6

L o c a l I m p a c t o n d e n ta l e d u c a t i o n

This study was simply a reflection of daily life in the operative preclinical courses. All exercises performed by students were established core experiences already found in the syllabus.

Through analysis of the efficacy of our technique videos, we have gained: • Potent knowledge regarding our students' ability to acquire competency in preclinical operative course • Students„ trust in our commitment to improve the dynamic science of dental education

faculty scholarship

Summary Locally Although psychomotor video demonstrations did not affect immediate performance of selected operative procedures done for the first time in a preclinical environment, they are positively viewed by students and appear to improve accuracy of self-assessment and, thus creating long-term positive impact on students. Globally Implementing innovative teaching techniques can elevate students„ educational experiences and improve faculty„s abilities to better connect to this generation of students is interested in an on-demand, convenient, self-pacing and interactive learning methods.

Special Thanks Dean John Valenza Associate Dean Karen Novak The Operative Team Dr. Juliana Barros Dr. Christina Clark Dr. Gary Frey Dr. Charles Streckfus Dr. Martha Orozco* Dr. Timothy Woernley*

UTSD„s Technology Services and Informatics Mr. Darrel Gonzales

School of Dentistry

UTSD„s Class of 2017

Questions?

Shalizeh Patel, DDS Assistant Professor

[email protected]

Ryan Quock, DDS Associate Professor [email protected]