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Table of Contents
ORIGINAL ARTICLE
Year : 2020  |  Volume : 16  |  Issue : 1  |  Page : 23-26

Assessment of effectiveness of integrated teaching in oral radiology among dental students: A comparative study


Department of Oral Medicine and Radiology, Amrita School of Dentistry, AIMS, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India

Date of Submission21-Jan-2020
Date of Acceptance09-Mar-2020
Date of Web Publication07-Jul-2020

Correspondence Address:
Dr. Beena Varma
Department of Oral Medicine and Radiology, Amrita School of Dentistry, AIMS, Amrita Vishwa Vidyapeetham, Kochi, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/AMJM.AMJM_2_20

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  Abstract 


Background: Basic science subjects are usually taught during the first and second academic years of the Undergraduate training with minimum or no integration with the clinical subjects, thereby creating a compartmentalization within the curriculum. The students have difficulty in understanding the concepts and depend on their ability to memorize facts for diagnosing various disease conditions. Aims and Objectives: To evaluate and compare the Effectiveness of Integrated teaching on diagnostic accuracy in Oral radiology among dental students. Material and Methods: A total of 46 students were randomly divided into 2 groups – Integrated basic science group (BSG) and segregated group (SG). Learning materials included sets of intraoral periapical radiographs and lecture based classes on radiographic features of a normal tooth, periapical abscess, periapical granuloma and periapical cyst. BSG students were taught regarding the radiographic appearance and the cause for such appearance in the radiograph. SG students were only explained regarding the radiographic features of these entities. Following the discourse, two tests - Diagnostic test (multiple-choice questions) on the day of lecture, followed by a memory test (spot diagnosis and match the following) one week later - were done to assess the level of understanding among the students. Statistical analysis was done using Students's t – test. Results: BSG students outperformed both in diagnostic test and memory test when compared to SG students. Conclusions: Integrated teaching has been found to be an effective method in enhancing diagnostic accuracy in Oral radiology and also improving the ability to memorize concepts among dental students.

Keywords: Basic science, integration, oral radiology


How to cite this article:
Nair AH, Varma B, Jose R, Aravind M S, Krishnan NA. Assessment of effectiveness of integrated teaching in oral radiology among dental students: A comparative study. Amrita J Med 2020;16:23-6

How to cite this URL:
Nair AH, Varma B, Jose R, Aravind M S, Krishnan NA. Assessment of effectiveness of integrated teaching in oral radiology among dental students: A comparative study. Amrita J Med [serial online] 2020 [cited 2020 Aug 5];16:23-6. Available from: http://www.ajmonline.org.in/text.asp?2020/16/1/23/289135




  Introduction Top


Oral radiology is an integral part of undergraduate dental training, whereby the students develop skills in interpreting intraoral and extraoral radiographs by graduation, which requires sound understanding of the basic or foundational sciences, i.e., the pathophysiology of a disease. Once the pathophysiology of disease is clear, students are introduced to the fundamentals of radiographic interpretation.[1] This is done on the assumption that the students are well versed in retaining and correlating this knowledge in their clinical situation.

The conventional system of education teaches the basic subjects in the 1st and 2nd years with the least interdisciplinary interaction, with a concept of preparing students for assessments. Thus, the process of integrating with clinical science is not always emphasized. Hence, the students have difficulty in correlating the concepts, which leads to a curriculum overload and they are able to devote only little time to other subjects.[2]

Several studies have been conducted to elucidate the role of basic sciences in medical and dental curricula with varying results.[3],[4],[5],[6],[7]

The aim of this study was to evaluate and compare the effect of integration of basic science with clinical science on diagnostic accuracy in oral radiology among dental students.


  Materials and Methods Top


This comparative study was conducted during the academic year 2015–2016 among the undergraduate dental students of 3rd-year degree at our institution.

Forty-six UG students in the 3rd-year BDS degree were enrolled for participation in the study, with no prior knowledge of the conditions/pathologies discussed in the study. This population was chosen specifically to ensure that the participants would be able to understand basic terminology and identify normal radiographic anatomy, but have minimal exposure to the specific diseases selected for the study groups or radiographic interpretation.

The learning materials included sets of intraoral periapical radiographs and lecture-based classes. The participants learned about the radiographic features of a normal tooth and three potentially confusable diseases: periapical abscess, periapical granuloma, and periapical cyst. The radiographic descriptions and the correlation of the anatomic changes related to the pathology for all the intrabony abnormalities were obtained from the textbook of Oral radiology: Principles and interpretation by White and Pharoah.

The participants were randomly divided into two groups, namely the integrated basic science group (BSG) and the segregated group (SG). To the integrated BSG, the radiographic features of each disease and the underlying pathophysiology for the radiographic features were explained. The SG, only the radiographic features were explained without the basic mechanism involved [Table 1].
Table 1: Example of radiographic features of a periapical cyst explained in the two learning groups

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The participants completed two tests as follows:

  1. Diagnostic test (on the day of the lecture): This test was used to assess the diagnostic ability of the participants. Twenty radiographic images were presented to them in random order and asked to choose the correct diagnosis from the list of multiple choice questions of the four learned entities
  2. Memory test (1 week later): This test was designed to assess the ability of the participants to retrieve the radiographic features for each intrabony abnormality. Participants were given series of Spot diagnostic tests and match– the– following questions.


Statistical analysis

To compare between the two groups, Student's sample t-test was done. Statistical analysis was performed using the IBM SPSS version 20.0 software Windows (SPSS Inc., Chicago, USA).


  Results Top


A total of 46 students were included in the study, with a total of 23 students in each group, respectively. On the diagnostic test, participants in BSG group obtained a mean score of 14 (standard deviation [SD] =2.84) and in the SG obtained a mean score of 13.74 (SD = 3.15) [Table 2]. The results of diagnostic test showed that participants in the integrated BSG outperformed those in the SG.
Table 2: Mean comparison of diagnostic test score

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On memory test, participants in the BSG obtained a mean score of 6.65 (SD = 1.8) and those in the SG obtained a mean score of 5.48 (SD = 2.48) [Table 3]. These results were suggestive of improved retentivity and performance of BSG when compared to SG [Figure 1].
Table 3: Mean comparison of memory test score

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Figure 1: Comparison of mean scores obtained by basic science group with segregated group in diagnostic test and memory test

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  Discussion Top


Basic science is a fundamental science that is usually taught in medical and dental colleges traditionally, by incorporating a discipline-wise model with high degree of compartmentalization into basic and clinical subjects without much correlation between the two.

Dr. William Gies in 1926 introduced this kind of disjunction of biomedical topics from clinical disciplines by promoting a 3–4-year course of study with early exposure to basic topics followed by clinical subjects.

According to Humphrey et al., the basic science curriculum aims at imparting a scientific basis for the clinical assessment so that the students' critical thinking and analytical ability are improved.[4]

The knowledge of basic science holds value only when it is applied in our daily clinical practice. Since these subjects are taught in the initial years without much emphasis on clinical significance, the students are forced to learn them just for clearing the examinations and are subsequently prone to be gradually forgotten.

The concept toward integrated teaching has been advocated by the Institute of Medicine.[4] According to Kumari et al., integration has been defined as “the organization of teaching matter to interrelate or unify the subjects which are frequently taught in separate academic courses or departments.”[5]

The present study showed an overall improved performance in diagnostic test and memory test by the students enrolled in the BSG group. The possible reason behind the improved performance could be that the students in this group were clearly explained regarding the causal explanations of the radiographic features. The result is similar to Baghdady et al. study, which showed that the integrated BSG showed an improved performance in the diagnostic test. A reduction in performance was seen in both the groups in the memory test. The result of the diagnostic test was correlating with that of our study, but BSG group showed an improved performance in the memory test in our study.[3] Patel and Dauphinee, in a similar study among medical students, have highlighted that segregation of basic science resulted in an explanation of clinical features incorrectly, but with the integration of the pathophysiology and causal explanation, links were readily created.[6] The results obtained by Woods et al. on potentially confusable neurologic diseases were similar to this study.[7]

Two theories were suggested as a possible mechanism for the improved performance of BSG. First, basic science forms a framework for organizing information. Naturally, well-organized facts will be easier to remember. If the natural organization is impossible, an external organizational strategy in the form of acronyms or algorithms can be used. Second, understanding the basic pathophysiology of a disease enables a student to create a logical schematic representation of diseases. They are capable of describing the features as well as understand why those features occur. This theory has been termed as “conceptual coherence” explanation for the role of basic science in enhancing diagnostic accuracy. Thus by this way, the students do not rely merely on memory to arrive at the correct diagnosis. Rather, understanding “why certain features occur,” enables the students to make the diagnosis that “make sense” instead of simply focussing on the presence or absence of individual features.[7]

In this study, when basic science was explained segregated from clinical science, it has failed to create a mental representation of the disease entity. This explains the role of basic science in creating the logical concept among students.[5]

Various methods for integrated teaching have been documented in the literature. These include problem-based learning, demonstrations, out of classroom teaching, group discussions, video presentations, interactive sessions, and so on.[8] Of which, problem-based learning shows about 60%–70% favorable response. Members of ADEA CCI also emphasized the need for integration when considering curriculum decompression and noted that for practicing evidence-based dentistry, it is pivotal that they understand research, are able to analyze and solve oral health problems and can apply basic science principles in day-to-day clinical scenarios.[9]

Association of American Medical Colleges has advocated that the curricula must include patient contact early in the 1st year concurrent with basic instruction, modernized content in the preclinical curriculum, and clinical principles integrated into basic science courses. Thus as part of the development of integrated teaching, various programs such as “Back– to– Basic science,” Integrated Life Sciences, etc., have been included in the final year curricula for exposure to basic science principles and appreciation for traditional research. It was also emphasized that revisiting the basic sciences in the clinical year can enhance understanding of clinical medicine and further students' understanding of how the two fields integrate.[9]

Limitations of the study

The potential limitations of this study include time constraints and a limited sample size. Further studies with a larger sample size with various disease entities and long-term evaluation must be done to evaluate the efficacy of the integrated teaching to the fullest.


  Conclusion Top


The basic science subjects must be given prime importance and must be taught to the students with a strict emphasis on the clinical implication. Such method of learning and teaching not only improves the performance of the student in examinations but also paves the way for inculcating professionalism among the budding students.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Baghdady MT, Pharoah MJ, Regehr G, Lam EW, Woods N. Integration of basic sciences and clinical sciences in oral radiology education for dental students. J Dent Educ 2013;77:757-63.  Back to cited text no. 1
    
2.
Gupta S, Gupta AK, Verma M, Kaur H, Kaur A, Singh K. The attitudes and perceptions of medical students towards basic science subjects during their clinical years: A cross-sectional survey. Int J Appl Basic Med Res 2014;4:16-9.  Back to cited text no. 2
    
3.
Baghdady MT, Pharoah MJ, Regehr G, Lam EW, Woods NN. The role of basic sciences in diagnostic oral radiology. J Dent Educ 2009;73:1187-93.  Back to cited text no. 3
    
4.
Humphrey SP, Mathews RE, Kaplan AL, Beeman CS. Undergraduate basic science preparation for dental school. J Dent Educ 2002;66:1252-9.  Back to cited text no. 4
    
5.
Kumari KM, Mysorekar VV, Raja S. Student's perception about integrated teaching in an undergraduate medical curriculum. JCDR 2011;5:1256-9.  Back to cited text no. 5
    
6.
Patel V, Dauphinee W. Return to basic sciences after clinical experience in undergraduate medical training. Med Educ 1984;18:244-8.  Back to cited text no. 6
    
7.
Woods NN, Neville AJ, Levinson AJ, Howey EH, Oczkowski WJ, Norman GR. The value of basic science in clinical diagnosis. Acad Med 2006;81:S124-7.  Back to cited text no. 7
    
8.
Callis AN, McCann AL, Schneiderman ED, Babler WJ, Lacy ES, Hale DS. Application of basic science to clinical problems: Traditional vs. hybrid problem-based learning. J Dent Educ 2010;74:1113-24.  Back to cited text no. 8
    
9.
Spencer AL, Brosenitsch T, Levine AS, Kanter SL. Back to the basic sciences: An innovative approach to teaching senior medical students how best to integrate basic science and clinical medicine. Acad Med 2008;83:662-9.  Back to cited text no. 9
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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Abstract
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