|Year : 2022 | Volume
| Issue : 4 | Page : 877-880
Early clinical exposure: An adjunct teaching–learning tool in dental discipline
Hande Alka Harish1, Aarti Panchbhai2, Madhuri Nitin Gawande1, Swati Krishnakant Patil1, Preethi N Sharma1, Sonone Archana1
1 Department of Oral Pathology Microbiology, Medicine and Radiology, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University) Wardha, Maharashtra, India
2 Department of Oral Diagnosis, Medicine and Radiology, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University) Wardha, Maharashtra, India
|Date of Submission||10-Jun-2021|
|Date of Decision||16-Dec-2021|
|Date of Acceptance||15-Jan-2022|
|Date of Web Publication||10-Feb-2023|
Dr. Hande Alka Harish
Department of Oral Pathology and Microbiology, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), Wardha - 442 001, Maharashtra
Source of Support: None, Conflict of Interest: None
Background: Early clinical exposure (ECE) is a teaching–learning methodology which promotes the acquaintance of dental students to patients during their initial 1st year of learning. It comprehends in a socioclinical perspective which supplements learning of correlation of health and disease as well as the role of the clinician. Materials and Methods: Study population includes a Cohort of 96 students of 1st year of Bachelor of Dental Sciences (I BDS). From I BDS, 48 students (Group A = interventional group) were selected as cases and 48 as controls (Group B = control group) by simple random sampling. Group A students were exposed to a module of ECE prepared in a clinical/hospital setting. Group B students were exposed to didactic learning of the selected content of syllabus. After intervention, the students' understanding of the topic for both Group A and B was evaluated by a prepared questionnaire (posttest). The effectiveness of this adjunct learning tool ECE was calculated using the absolute learning gain (ALG), relative learning gain (RLG), and normalized gain. Results: The significantly enhanced posttest score was observed in Group A (7.72 ± 1.42) as compared to Group B (4.08 ± 0.64). The ALG, RLG, and normalized gain were higher with ECE as an adjunct learning tool as compared to didactic learning. On analysis of the perceptions after feedback, it was observed that overall, 92.05% of the students strongly agreed that the ECE was a very appreciable, practically oriented teaching–learning tool and validated the better learning experience. Conclusion: ECE could be a better and effective adjunct teaching–learning tool in the dental discipline.
Keywords: Adjunct teaching–learning tool, dental discipline, early clinical exposure
|How to cite this article:|
Harish HA, Panchbhai A, Gawande MN, Patil SK, Sharma PN, Archana S. Early clinical exposure: An adjunct teaching–learning tool in dental discipline. J Datta Meghe Inst Med Sci Univ 2022;17:877-80
|How to cite this URL:|
Harish HA, Panchbhai A, Gawande MN, Patil SK, Sharma PN, Archana S. Early clinical exposure: An adjunct teaching–learning tool in dental discipline. J Datta Meghe Inst Med Sci Univ [serial online] 2022 [cited 2023 Mar 28];17:877-80. Available from: http://www.journaldmims.com/text.asp?2022/17/4/877/369488
| Introduction|| |
In the conventional curricula of health-care professions education system, students acquire knowledge of theoretical aspects in preclinical setups without any clinical perspective. Furthermore in the course of their learning in clinical setup, they find it challenging to recall the important basic scientific concepts and their clinical applications. Learning is a process which comprehends enlightening knowledge, skill, and attitude, respectively, with intellectual, psychomotor, and affective purview of the learner. Accordingly, learning through clinical experience not only helps to integrate the basic science knowledge with its clinical application, along with understanding of the concept, acquirement of skills, and assertiveness but also augment their communication skill and professionalism in clinical settings. As well a clinical acquaintance is an important aspect of dental science curriculum. The efficacy of basic sciences learning may possibly be enhanced by certain approaches. Early clinical exposure (ECE) is one such innovative mode of learning that would augment the clinical education eminence. ECE is a teaching–learning methodology which promotes the acquaintance of dental students to patients during their initial 1st year of learning, in a socioclinical perspective which supplements learning of correlation of health and disease as well as the role of the clinician. In the curriculum of 1st year of Bachelor of Dental Sciences (I BDS), the students acquire knowledge of the anatomy of teeth and paraoral structures, along with they also learn the histology of oral hard and soft tissues in the subject of dental anatomy, embryology, and oral histology (DAEH). The module of implementation of ECE can be prepared in three basic forms of settings, classroom, clinical/hospital, and community. The morphological aspect of incisors, canines, premolars, and molars is studied in classroom settings. The learning of clinical aspects of oral mucous membrane, the thin moist covering of oral cavity and enamel, the outermost covering of tooth as well as the pattern of eruption and shedding of teeth may be augmented in clinical/hospital setting, whereas the anatomy and clinical application of occlusion and temporomandibular joint become more understandable through community settings. Through community-based exposures, it is possible to build a societal perspective in learners' minds which fosters their learning and attitudinal change. Thus, we design this interventional study to appraise the efficacy of ECE module in understanding the fundamentals of DAEH and to assess the opinion of students regarding the effectiveness of this new adjunct tool of teaching–learning.
| Materials and Methods|| |
This interventional study was conducted in the Department of “DAEH, Sharad Pawar Dental College and Hospital, DMIMS (Deemed to be University) Sawangi (M) Wardha, Maharashtra, India.” The concept of ECE and its application in learning and understanding of clinical sciences was elaborated to the I BDS students for their familiarization toward the new intervention. It was explained to students that participation in this project is voluntary and that they have the right to decline to participate. Further by simple random sampling procedure, the cohort of 96 students of I BDS was allocated into two groups, Group A – interventional group and Group B – control group. Written informed consent was obtained from all the participants. Students who were absent or not willing to voluntarily participate were excluded from the study.
A questionnaire consisting of 20 objective-type questions based on the selected content of syllabus was prepared to evaluate the students' understanding of the acquired knowledge of topics over didactic learning (pretest). Group A students (No. 48) were subjected to the module of ECE prepared in clinical/hospital settings. The module comprised the learning of oral mucous membrane, enamel and pattern of eruption and shedding of teeth. Group B students (No. 48) were subjected to didactic learning of the selected content of syllabus of oral mucous membrane, enamel and pattern of eruption and shedding of teeth. Then, the students' understanding of the topic for both Group A and Group B was evaluated by a prepared questionnaire (posttest).
Pretest and posttest
Pre- and posttests for the module of the ECE were prepared. Tests comprised multiple-choice questions. The same set of questions was used for the pre- and posttest. The key to the questions was verified from the standard textbooks. The highest possible test score was 20. The pre- and posttests were prevalidated by the School of Health Profession Education and Research (SHPER).
Students' feedback questionnaire
A questionnaire consisting of 9 items was prepared and prevalidated by SHPER, which were used to record students' perceptions about ECE as an adjunct teaching–learning tool. Items 1–8 were close-ended questions. The responses to items 1–8 were recorded on a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree). Item 9 was an open-ended question and students were asked to give their comments.
Data were analyzed using the Statistical Package for Social Sciences (SPSS-version 17 (SPSS Inc., Chicago, IL)). Descriptive analysis was performed in this study, including frequencies and percentage. Student's t-test was used to find out the statistical significance. A significance level of five percent was used for all tests.
Ethical approval for this study (DMIMS (DU/IEC/2018-19/7532) was provided by the Ethical Committee of Datta Meghe Institute of Medical Sciences (Deemed to be University), on 15 October 2018.
| Results|| |
The data collected were analyzed in accordance with established quantitative and qualitative research methodology, principal research questions, and the research methodologies that were designed to provide answers to the same were analyzed and interpreted.
The present study consisted of 96 randomly selected participants from I BDS which were divided into Groups A and B. The mean test score at pretest in Group A and B was 3.16 ± 1.36 and 3.44 ± 1.39, respectively. A significantly enhanced posttest score was observed in Group A (7.72 ± 1.42) as compared to Group B (4.08 ± 0.64). The comparison of scores in Group A and B at pre- and posttest was carried out by Student's paired t-test and was found to be statistically significant in Group A (P = 0.001) as compared to Group B (P = 0.80) [Table 1]. The variations of means of the posttest scores were also found statistically significant among Group A and B [Table 2].
|Table 1: Descriptive statistics of scores of Pre-test and Post-test of Group A and B|
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The effectiveness of this adjunct learning tool, ECE, was calculated using the absolute learning gain (ALG), relative learning gain (RLG), and normalized gain. The learning effectiveness index was calculated as ALG (%posttest score−%pretest score) and RLG (%posttest score−%pretest/%pretest score). Class-average normalized gain measures the ratio of whole group performance to the maximum achievable improvement and is used by many educators as a measure for course effectiveness. Hence, in our study, the effectiveness of intervention was evaluated by class-average normalized gain (g = [%posttest score−%pretest score]−[100−%pretest score]). A class-average normalized gain (g) of 0.3, i. e., 30%, was considered significant.,
In Group A, after using the ECE as an adjunct learning tool for the I BDS students, the ALG was 53.05%, the relative gain score was 131.37%, and the normalized score was 0.89, i.e., high gain. In Group B, through didactic methodology learning, the ALG was 30.55%, RLG score was 92.25%, and the normalized score was (0.24), i.e., low gain [Table 3]. The ALG, RLG, and normalized gain were higher with ECE as an adjunct learning tool as compared to didactic learning. The feedback regarding the new adjunct teaching–learning tool that is ECE was recorded on a 5-point Likert scale. On analysis of their perceptions, it was observed that overall, 92.05% of the students strongly agreed that the ECE was a very appreciable practically oriented teaching–learning tool and validated the better learning experience. Almost 89.90% of the students strongly agreed that the ECE should be integrated in the dental histology curriculum as a teaching–learning tool. It should be implemented for all the topics of DAEH in the classroom, clinical as well as community settings. The 10-point rating scale was used to assess the effectiveness of ECE. It was perceived as useful by 51% of the students, whereas 49% perceived its educational significance as very useful as recorded in the categorization of scores. The analysis of item number 10 was considered as the power of the intervention and wisdom recommended by the students. On analysis of these complimentary comments in the questionnaire, it was observed that 88% of students had a better understanding of the topics by incorporation of ECE. About 85% of students rated ECE as an exceptionally good teaching–learning tool.
|Table 3: Score of ALG (Absolute Learning Gain), RLG (Relative Learning Gain) & Normalize Gain in Group A and B|
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| Discussion|| |
Clinical experience is the significant element to reinforce the integrated basic sciences curriculum and enhance its value. The practical perspective of learning basic sciences and its significance in clinical applications is promising through ECE. It is one of the teaching–learning modalities which helps to associate basic sciences and clinical experience. ECE programs are an increasingly widespread element of undergraduate dental education. By having this integrated learning, which is supplemented by the undergraduate program, the learning outcome for students is greatly enhanced, and through this experience, students are given the opportunity to work collaboratively and to become effective communicators.
We assessed the efficacy of ECE by comparing scores at pre- and posttest in interventional (Group A) and control (Group B) groups. We observed a significantly (P = 0.001) increased posttest score in Group A (7.72 ± 1.42) as compared to Group B (4.08 ± 0.64). Furthermore, the comparison of scores in Group A and B at pre- and posttest observed a statistically significant difference in Group A (P = 0.001) as compared to Group B (P = 0.80). The ALG, RLG, and normalized gain were higher with ECE as an adjunct learning tool as compared to didactic learning. This demonstrates the improved learning and better understanding of the topics through ECE. Our study results are in accordance with Sathishkumar et al. and Rawekar et al., who stressed upon the significance of ECE in the understanding of clinical physiology. It could also make it possible for the students to reminisce about the topic better. In addition, ECE contributed to their profoundness of knowledge of the topic and also supported them to integrate the knowledge. Thus, ECE not only enhances the comprehension but also increases the sympathy and empathy toward patient's well-being. Thus, it enables the students to comprehend patients' social and emotional challenges., The integration of fundamental principles of basic sciences with pathophysiology of the disease and its clinical presentation is conceivable with ECE, as observed by Peacock JG et al. Furthermore, it facilitates the learners to develop clinical decision-making skills through differential diagnosis assignments. Apart from the application and comprehension of ECE in routine clinical practices, its usefulness in different aspects of geriatric dental care cannot be undervalued, as specified by Patil et al. On evaluation of the impact of ECE on the learning experiences of undergraduate dental students, Ali et al. observed positive perceptions with respect to the learning experiences with their environment and professional relationship. Positive effect on the scores of students in prosthodontics was observed by Shigli et al. by the implementation of ECE. This further indicated that ECE should be included as a part of the curriculum. Chimmalgi et al. put forth a premise that whether ECE and E-learning can also be effective alternate approaches of training for 1st-year medical students in the subject of anatomy. However, they observed that e-learning was not as effective as ECE in improving the test scores.
On recording the perceptions of students regarding the effectiveness of ECE, 92.05% of the students strongly agreed that the ECE was a very appreciable, practically oriented teaching–learning tool and validated the better learning experience. About 89.90% of the students strongly agreed that the ECE should be integrated in the dental histology curriculum as a teaching–learning tool. It should be implemented for all the topics of DAEH in the classroom, clinical as well as community settings. Our study results are in accordance with Ebrahimi et al., who believe that ECE can provide a background for the constructive and prosperous integration of the teaching and learning of basic sciences in a traditional program. It also benefits the learners to boost up their self-confidence, facilitate them develop an appropriate assertiveness toward their training, and better prepare them for imminent practice. On evaluation of the impact of an ECE program to enhance the student's inspiration of learning basic sciences in context to clinical medicine, Govindarajan et al. observed that ECE could help the students to develop a humanistic attitude toward the patients.
The 10-point rating scale was used to assess the effectiveness of ECE. It was perceived as useful by 51% of the students, whereas 49% perceived its educational significance as very useful as recorded in the categorization of scores. The analysis of item number 10 was considered as the power of the intervention and wisdom recommended by the students. On analysis of these complimentary comments in the questionnaire, it was observed that 88% of students had a better understanding of the topics by incorporation of ECE. Eighty-five percent of students rated ECE as an exceptionally good teaching–learning tool. It promotes active learning, challenging, and problem solving and helps to remember important points. It was an enjoyable experience also. The high point of this intervention leads to the comprehension of the significance and solicitation of understanding of preclinical knowledge in clinical scenario.
| Conclusion|| |
ECE encompasses all the settings of learning, namely., classroom, clinical/hospital, and community. It reinforces the learning and makes it more tangible and appropriate to clinical practice. ECE can function as a platform for providing the preclinical year students a variability of experiences which involves all the three areas of learning. Clinical exposure helps students develop their interpersonal and team-working skills, which are essential to function within the multidisciplinary teams which characterize the modern health-care environment. ECE enhances the application of basic sciences knowledge and develops the self-confidence to handle the patient's troubles in practice. Thus, the knowledge, skills, and attitudes are co-build at the chairside among the expert clinical supervisor/facilitator and the learner student. Apart from this, ECE facilitated them to develop a correct attitude toward their studies and better prepared them for imminent practice. Thus, ECE, if implemented effectively, has the potential to be the ultimate first stride in the making of a holistic dental surgeon.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Tayade MC, Bhimani N, Kulkarni NB, Dandekar KN. The impact of early clinical exposure on first M.B.B.S. students. Int J Healthc Biomed Res 2014;2:176-81.
Hande AH, Lohe VK, Chaudhary MS, Gawande MN, Patil SK, Zade PR. Impact of virtual microscopy with conventional microscopy on student learning in dental histology. Dent Res J (Isfahan) 2017;14:111-6.
Shigli K, Nayak SS, Sankeshwari B, Fulari D, Chopade S, Wadgave U, et al.
Effectiveness of an early clinical exposure module on the performance of second year dental students – A randomized controlled study. Ann Med Health Sci Res 2017;7:236-41.
Gaikwad N, Tankhiwale S. Crossword puzzles: Self-learning tool in pharmacology. Perspect Med Educ 2012;1:237-48.
Colt HG, Davoudi M, Murgu S, Zamanian Rohani N. Measuring learning gain during a one-day introductory bronchoscopy course. Surg Endosc 2011;25:207-16.
Prather EE, Rudolph AL, Brissenden G. Teaching and learning astronomy in the 21st
century. Phys Today 2009;62:41-7.
Ebrahimi S, Kojuri J, Ashkani-Esfahani S. Early clinical experience: A way for preparing students for clinical setting. GMJ 2012;1:42-7.
Sathishkumar S, Thomas N, Tharion E, Neelakantan N, Vyas R. Attitude of medical students towards early clinical exposure in learning endocrine physiology. BMC Med Educ 2007;7:30.
Rawekar A, Jagzape A, Srivastava T, Gotarkar S. Skill learning through early clinical exposure: An experience of indian medical school. J Clin Diagn Res 2016;10:C01-4.
Peacock JG, Grande JP. Patient exposure in the basic science classroom enhances differential diagnosis formation and clinical decision-making. Peer J 2015;3:e809.
Patil PG, Ueda T, Sakurai K. Influence of early clinical exposure for undergraduate students on self-perception of different aspects of geriatric dental care: Pilot study between two colleges from Japan and India. J Indian Prosthodont Soc 2016;16:288-93.
] [Full text]
Ali K, Zahra D, McColl E, Salih V, Tredwin C. Impact of early clinical exposure on the learning experience of undergraduate dental students. Eur J Dent Educ 2018;22:e75-80.
Chimmalgi M, Jose R, Chandra Kumari K. The effectiveness of early clinical exposure and e-learning in teaching anatomy. Int J Anat Res 2017;5:3398-03.
Govindarajan S, Vasanth G, Kumar PA, Priyadarshini C, Radhakrishnan SS, Kanagara V, et al
. Impact of a comprehensive early clinical exposure program for preclinical year medical students. Health Prof Educ 2018;4:133-8.
[Table 1], [Table 2], [Table 3]