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Efficacy of a Geriatric Oral Health CD as a Learning Tool

Key words: dentistry, special dentistry, education, aging, geriatrics

Submitted for publication 05/10/06; accepted 09/05/06

	Abstract

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To better prepare professionals to meet the needs of older patients, a self-instructional computer module on geriatric oral health was previously developed. A follow-up study reported here tested the efficacy of this educational tool for improving student knowledge of geriatric oral care. A convenience sampling procedure was used. Sample size calculation revealed that fifty-six subjects were required to meet clinical and statistical criteria. Paired t-test addressed our hypothesis that use of the educational tool is associated with improvement in knowledge. Fifty-eight first-year dental students and nine third-year medical students completed the pre-intervention test and were given the CD-based educational tool. After seven days, all participants completed the post-intervention test. Knowledge of geriatric oral health improved among the sixty-seven students included in this study (p=0.019). When stratified on the basis of viewing the CD-ROM, the subgroup of thirty-eight students who reported not actually reviewing the CD-ROM had no change in their knowledge scores, while the subgroup of twenty-nine students who reported reviewing the CD had a significant improvement in test scores (p<0.001). Use of a self-instructional e-learning tool in geriatric oral health is effective among those students who choose to employ such tools.

Immediate action is necessary to increase the proportion of dentists who are willing and qualified to treat older patients. Dental education programs must also provide more training opportunities to prepare dental professionals to meet the needs of these patients.² Our study addressed this issue by testing the efficacy of a self-instructional tool for oral health in older persons.

Historically, education in geriatric dentistry has been limited in both quantity and quality. More recently, a number of educational initiatives have been developed in response to the growing number of older adults and their changing oral health status and dental treatment needs. A survey of U.S. and Canadian dental schools examined curriculum trends and assessed the effectiveness of educational initiatives and the value of American Association of Dental Schools (AADS; now American Dental Education Association, ADEA) geriatric dental curricular materials.³ All schools responded. Compared to previous reports, more schools at that time had geriatric didactic course(s), clinical rotations, and faculty with geriatric dental training. Fifty-eight percent of dental schools supported geriatric dentistry in their budgets. The primary barriers to program expansion continue to be the lack of trained faculty members, a crowded curriculum, and fiscal concerns.³

In 2001, a new educational tool for oral health care providers was developed by dentists and medical educators. Oral Health in Older Patients is one of twenty-three clinical modules contained on a two CD-ROM product subtitled Self-Instructional Modules in Geriatric Medicine.⁴ This educational tool was conceived as an electronic syllabus in geriatric medicine, designed to augment clinical training of medical residents and other health care students, and was created using HTML software code appropriate for Internet and CD-ROM distribution. The oral health module was the educational intervention used in our study. This specific module is comprised of 195 "pages" of material and sixteen short video clips. While evaluation has been conducted on the overall set of modules,⁵ no specific evaluation has been performed on the oral health module or with dentistry trainees prior to this study.

The primary research question was: "Is access to a computer-based educational tool regarding oral health of older patients associated with a change in health care providers’ knowledge?" Our hypothesis is that a significant improvement in knowledge will occur after access to this educational intervention.

	Methods

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This is a prospective follow-up study using a pre- and post-intervention assessment. Students completed a pre-intervention questionnaire documenting their current knowledge of geriatric oral health. The same study population, after being given a week to review the self-instructional tool, completed the questionnaire again, providing evidence of how effective the educational tool was regarding knowledge improvement.

A convenience sampling procedure was used. All first-year D.D.S. students of the University of Oklahoma College of Dentistry (n=58) and all third-year medical students attending the geriatric clerkship at the College of Medicine (n=9) were invited to participate. Inclusion criteria allowed for both genders, all ethnic groups, and all ages of potential subjects. There were no exclusion criteria, besides unwillingness to participate. Questionnaires were coded to allow for paired analysis of change in scores on the knowledge-based test. Permissions were granted from the respective course directors to distribute the CD-ROM educational tool and to engage the dental and geriatrics students for approximately fifteen minutes to complete the pre- and post-questionnaires. This study was approved by the Institutional Review Board of the University of Oklahoma Health Sciences Center.

The pre-intervention questionnaire was comprised of 9-point Likert-like questions measuring familiarity with geriatric dentistry, attitudes regarding geriatric dentistry, and prior experience with computer-based education. A self-test then followed with twenty multiple-choice questions developed by the authors (a dentist and a researcher versed in questionnaire design) and based on the specific material available from the educational tool. Tests were scored by a simple tally of correct answers. Each participant received a complimentary copy of the Oral Health in Older Patients CD-ROM.

After approximately one week from the time the educational CD-ROM was distributed, the study population was asked to complete the post-intervention questionnaire to measure the teaching module’s effectiveness in improving knowledge of geriatric oral health. The post-intervention questionnaire repeated the same twenty questions regarding knowledge of geriatric dentistry that were used in the pre-test.

A full descriptive analysis was conducted on the data. A paired t-test analysis was used to evaluate our primary hypothesis that use of the educational tool was associated with improvement in knowledge. An alpha of 0.05 was used as the level of significance. Secondary research questions regarding usability and attitudes were addressed with descriptive statistics and subgroup analyses.

	Results

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The study population comprised sixty-seven students (fifty-eight, 86.6 percent, were first-year dental students; nine, 13.4 percent, were medical students). The mean age was 24.3 years (range=22 to 42). There were twenty-three (34.3 percent) female students and forty-four (65.7 percent) male students. CD-ROMs were deemed useful as educational tools by a clear majority of all participating students (forty-nine or 73.1 percent). Nevertheless, over half of the students chose to not review the educational tool, an option free of academic repercussion. Of the viewing subgroup, six students (9 percent) chose to review the CD-ROM as a group, and twenty-three (34.3 percent) students viewed it individually (Table 1). Both groups had a calculated mean score of 5 (1="not at all" to 9="a lot") for the question asking the extent to which geriatric oral health should be a part of the dental college curriculum.

View larger version (30K): [in this window] [in a new window]   Figure 1. Change in knowledge score

Out of the twenty-nine students who viewed the CD-ROM, twenty-two (75.9 percent) were male students, and twenty-eight (96.6 percent) were dental students. We found no significant association between change in knowledge by gender or trainee program, but the sample sizes were small.

	Discussion

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This study of a single computer-based educational tool designed to provide self-instructional opportunities to clinical trainees revealed that such interventions can be an effective tool in improving knowledge among some health care providers. There was a significant improvement in scores on a knowledge test regarding oral care of older patients. Furthermore, exploration of subgroups of trainees who used, versus did not use, the tool suggested that all of the improvement in test scores was attributable to actual use of the tool. We conclude that certain computer-based tools designed to augment clinical trainee education can be effective.

Further reflection upon the pre- and post-test scores illuminates two useful points. First, it is reassuring, if not overly novel, to report that students who actually use educational materials score higher on knowledge tests than students who do not use the materials. This finding also reinforces the requirement for education evaluation efforts to measure actual use of specified materials as part of any post-intervention testing. While less than half of our students reported reviewing the CD-ROM, the magnitude of their test score improvement was sufficient to produce a significant result for the entire pool of subjects. As might be expected, non-users showed no change in knowledge; however, that finding could have been left uncovered without subgroup comparisons. Second, the relatively disappointing post-test scores (12.59/20 or 63 percent) following a week of access to the educational tool suggests that the educational effectiveness of the tool was modest. One potential reason for the low post-intervention knowledge scores is that the educational tool was too large for students to fully review within a week. Students may have failed to encounter the specific material from which test questions were drawn. Developers of computer-based learning tools must take care to match the depth of material to the learner’s need. An alternate reason is that the tool itself was organized poorly, so that learners had difficulty finding sought-after material.

It is not clear why only one of the nine medical students reported taking the time to review the material. Though this data was not collected, dental students may have attached a higher sense of importance to the material or interpreted distribution of the free tool as evidence that faculty members of the College of Dentistry were promoting the special dentistry topic. Neither group considered geriatric oral health as a particularly important aspect of their training.

Limitations of this study include a relatively small sample size, a mixed cohort of dental and medical students, and a nonrandomized study design. Nevertheless, findings may be useful to clinical educators and investigators. Issues uncovered here suggest that future research should test various ways to improve the efficacy of such tools, for example, use by small groups versus individual learners. Educators may be prompted to introduce computer-based learning further into their curricula and may wish to emphasize the importance of geriatric oral health.

	Acknowledgments

 
The authors wish to gratefully acknowledge the work of Ronald Masters, D.D.S., in the original preparation of the educational tool.

	Footnotes

 
Dr. Teasdale is an Associate Professor, Donald W. Reynolds Department of Geriatric Medicine, College of Medicine; at the time of this work, Dr. Shaikh was a graduate student, Biostatistics and Epidemiology, College of Public Health—both at the University of Oklahoma Health Sciences Center. Direct correspondence and requests for reprints to Dr. Thomas A. Teasdale, Donald W. Reynolds Department of Geriatric Medicine, College of Medicine, University of Oklahoma Health Sciences Center, 921 N.E. 13^th (11G), Oklahoma City, OK 73104; 405-271-8195 phone; 405-271-3887 fax; Thomas-teasdale{at}ouhsc.edu.

	REFERENCES

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1. McNally M. Rights access and justice in oral health care: justice toward underserved patient populations—the elderly. J Am Coll Dent 2003; 70(4):56–60.[Medline]
2. Berkey D, Berg R. Geriatric oral health issues in the United States. Int Dent J 2001; 51(3 Suppl):254–64.[Medline]
3. Saunders RH, Yellowitz JA, Dolan TA, Smith BJ. Trends in predoctoral education in geriatric dentistry. J Dent Educ 1998; 62(4):314–8.[Abstract]
4. Masters R. Oral health in older patients: self-instructional modules in geriatric medicine. 4th ed. Teasdale TA, ed. Dallas: Baylor College of Medicine and Stanford University Geriatric Education Resources Center, 2001.
5. Teasdale TA, Madden R, Sebastian R. Redesigning CD-based self-learning modules in geriatric medicine. 57th American Geriatric Society Meeting, Nashville, TN, 2000.

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