Small Group Active Learning in a DS1 Evidence-Based Dentistry Course

Hoelscher, Diane, Michelle Wheater, and Anthony Neely

Dental schools are searching for ways to incorporate evidence-based dentistry (EBD) into curricula to develop competencies necessary for practice and also in response to CODA standards requiring graduates to be competent in applying critical thinking and EB decision making skills.  Previous courses at the school of dentistry taught research methodology, but provided little opportunity to access, critically appraise and apply scientific literature to patient care situations.  Additionally, the relatively large class size (87) presented challenges to implementing active learning strategies.  To address these issues, a new course was developed at the School of Dentistry as the first in a series of evidence-based dentistry (EBD) courses.  Goals of the new course include 1) introduce students to EBD principles and EB decision making in an active learning environment, 2) teach search strategies including development of PICO questions 3) support development of critical thinking skills through critical appraisal of scientific literature, 4) provide clinical context for EBD through application to cases.

Key features of this innovative course are 1) interdisciplinary approach, 2) extensive small group work, 3) minimal time spent lecturing, 4) case-based activities 5) all course materials available on-line, 6) case-based final exam employing actual search and application of all EB decision making steps.

A biomedical sciences faculty member, periodontist and general dentist taught this one credit hour course and modeled integration of biomedical, behavioral and clinical sciences.  During the first class session, students were divided into groups of 5-6 students and were given an assignment to develop a clinical question and search for scientific literature to help answer it.  Students stayed with the same group for the entire semester.  The course ran for half of the DS1 fall semester for 2 hours, during which time students did a variety of activities including small group work, debriefs, question and answer and mini lectures.  A “small groups within a large class” model was used with the three faculty circulating among groups to answer questions, focus student activity and challenge students to think critically during the group work.  A relaxed and open atmosphere was established to encourage student participation in both group and whole class discussions.  Structured activities and online quizzes were provided to assure learning objectives were being met.  Activities included development of PICO questions, PubMed and other online search strategies, critical appraisal and application to patient care situations via cases.  The final exam required students to develop a PICO question related to a clinical case, search for an article meeting stated criteria, rank the level of evidence, answer questions regarding the suitability of research methods used, assess whether the conclusions were appropriate and explain whether and how the results could be applied to the clinical case.

An 18 item pre-/post-test of basic research concepts, online student course evaluations and the case-based written final exam were used to evaluate outcomes of this course.  Of 87 students, 84 completed both the pre- and post-test.  The mean pre-test score was 10.39 (median 11) and post-test was 14.52 (median 16) and 86% of students improved their score post-test.  Paired t-test shows the difference between pre-test and post-test was statistically significant (t=11.04, p<0.001).  Concepts students scored best on pre-test were random (89.3% correct), bias (91.7), and hypothesis (89.3).  Pre-test scores were lowest for correlation (1.2% correct pre-test/71.4% correct post-test), PICO (23.8/90.5), meta analysis (25.0/60.7) and case control (26.2/86.9).  Student course evaluations were generally good with 74% of students agreeing or strongly agreeing (A/SA) they gained a good understanding of concepts, 77% A/SA instructional methods contributed positively to learning and 83% A/SA course concepts and principles integrated basic science/clinical concepts to clinical practice.  Open-ended responses included ten positive comments regarding teaching methods and group activities.  A number of students made comments indicating confusion regarding the purpose of the course or that they already had a research methods course, and some did not like that the course started halfway through the semester.  All but one student passed the final exam involving a case of a patient with history of smoking, diabetes and hypertension seeking dental implants.  91% wrote an acceptable PICO question, 100% found a scientific article appropriate to the case and meeting criteria set by the faculty, 99% demonstrated the ability to critically appraise the chosen article and apply it to the case. 

After completing this course DS1 students understand EBD and research principles, are able to conduct a search and critically appraise scientific literature at a beginner level.  They are prepared to apply these skills in subsequent courses in the dental curriculum.