Exploring the Relation Between Online Case-Based Discussions and Learning Outcomes in Dental Education

Materials and Methods

Ethical approval for this study was granted by the Ghent University Hospital Ethics Committee. The undergraduate dental curriculum at Ghent University is a five-year educational program (three years of bachelor-level study and two years at the master’s level). In years two and three, the curriculum incorporates two consecutive periodontal courses. These courses introduce students to a variety of periodontal-related topics from the basic principles to more advanced diagnostics, treatment planning, and various modalities of periodontal therapy.

The introduction of online case-based discussion groups to these periodontal courses was grounded in social constructivist learning theory, which considers that learners actively build their own knowledge, rather than passively receiving information via transfer.¹⁷ Consequently, educational strategies following social constructivist principles focus on creating an environment that stimulates this process in learners, including active participation,¹⁸ critical thinking and reflection,⁷ collaboration,¹⁹ and authenticity of content.²⁰

The combination of theoretical lectures and online case-based discussion groups resulted in a course with a blended learning approach. Patient cases were introduced to present the course content in an authentic clinical situation, stimulating students to review their previous knowledge and seek additional information in the discussion process. Students were allocated to small groups of five to provide the best opportunity to fully participate in the case discussions.¹⁵ At the onset of the course, students received an in-class introduction about the online discussion groups. Subsequently each week, a new case was provided online in a structure proposed by Johnsen et al.;²¹ the case included a patient history and demands, intra- and extraoral pictures, periodontal charts, and radiographic status. Guiding questions that had to be addressed were incorporated to organize the student discussions.

Students were instructed to provide at least two contributions to the case discussion each week. Each group discussion was supervised by the author of the case, who was also the treating periodontist of the patient. This allowed students to ask questions related to the case in a broad sense. Online feedback was provided regularly by the author of the case, who could redirect discussions if necessary to stimulate students to critically analyze all elements in the patient case and to answer more specific treatment-related questions beyond the students’ current knowledge. The actual treatment of the patient was disclosed to all students during a seminar at the end of the course.

Evaluation occurred during an end course exam. Open-ended questions were used to evaluate students’ knowledge of periodontics. A patient case, similar to the one used in the discussion groups, was introduced to assess students’ ability to apply knowledge in a clinical context. After a written preparation, students had to discuss their answers to the questions and the patient case with an examiner.

To investigate the hypothesis of our study, a retrospective analysis was conducted. All students in the periodontal courses in years two and three and the online case-based discussion groups used during three consecutive academic years (2009–12) were identified and screened. To ensure a structured approach, a conceptual research framework (Figure 1) was developed to illustrate the relation among all variables in the hypothesis. Since group dynamics, individual student contribution, and supervision are important variables that influence the learning effect in group discussions, data on each variable were collected. The total number of posts in the discussion and the number of views by all participants were identified as indicators for group dynamics; these were the same for all participants in a discussion group. Individual student contribution was defined by the number of individual posts in the discussion group by a student, which could include introduction of a new element, a question, or a reaction to another post. Supervision was investigated by the numbers of posts by the supervisor and the supervisor’s questions to the students. These group discussion variables were related to the end course results as indicators of learning outcomes.

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Figure 1

Conceptual research framework

Kolmogorov-Smirnov tests and Q-Q plots were used to evaluate the distribution of the data.¹⁷ As results showed an absence of normal distribution, Spearman’s rank correlations were calculated to analyze the relation between the group discussion indicators and learning outcomes.²² All statistical analyses were performed using SPSS 22.0 (IBM Corp., Armonk, NY, USA) with a significance level set at p≤0.05.