Currently, the use of computers is increasing in dental education [1]. Electronic education has moved away from the hard medium to an online environment due to increased internet speed, accessibility and connectivity [2]. In a review, medical students have stated they prefer web tutorials rather than traditional lecture-based classes. Advantages such as accessibility, ease of use, freedom of navigation, high quality medical images and the possibility of repeat practice are among the reasons mentioned for their preference. Web-based learning is an important tool in evidence-based medicine because it is continually being developed and updated [3].

Despite its advantages, the primary drawbacks to online learning are technical issues and student isolation. Some students miss the interaction in a regular classroom, whereas self-directed learners are more successful in online education [4]. These findings may be the reason that integration of electronic education with classroom problem solving sessions or other activities is necessary [5–7].

Interactivity of web-based learning or internet-based e-learning in addition to providing access to existing learning modules, regardless of time and location, has enabled numerous researchers to use different learning management systems such as ILIAS as an open source system [8] or an interactive digital tool [9].

Different methods and designs have been applied to evaluate web-based learning. Grimes, in a qualitative study entitled “Student Perceptions of an Online Dental Terminology Course”, has described and analyzed the experiences of participants to determine their satisfaction level with online education. Study participants identified four themes - convenience, technical issues, sense of belonging, and learning style [4]. Questionnaires used in a study conducted at the University Of Birmingham School Of Dentistry identified the opinions and expectations of web-based courseware as a supplement to traditional teaching. They concluded that web-based courseware was a useful, additional resource for students [10].

These studies have primarily been conducted in Western countries. There is limited research that examines the effect of e-learning in Iran. Considering the gaps in the literature, cost-effectiveness of these programs and the university’s vision to develop international programs by expansion of virtual learning, therefore this study investigates the effects of virtual learning on “Rotary Instrumentation of Root Canals” among fifth year dental students at Shiraz University of Medical Sciences.

This study enrolled 35, fifth year undergraduate dental students from the School of Dentistry, Shiraz University of Medical Sciences. Students’ GPA was 16.01. The mean GPA in the experimental (15.6 ± 0.86) and control (16.29 ± 1.05) groups did not significantly differ (Absolute difference = 0.69, P = 0.112).

The findings showed a favorable magnitude of difference for both post-tests in favor of virtual learning. This result was a valuable outcome because at the time of conducting this research our students had no previous experience with virtual learning.

We designed, implemented and evaluated the virtual learning method. Our experience in designing this method could be regarded as the starting point for the use of a virtual learning program in Iranian dental schools.

During implementation of the virtual learning program we encountered an intranet disconnection in one of the videoconference sessions. This session was scheduled for the next appropriate time. It appeared that the net disconnection did not interfere with students’ learning. Clark, in a review, stated that technologic problems did not interfere with the learning process. He mentioned that the teleconference-based and web-based delivery of educational content could be as effective as traditional classroom-based teaching [12]. In support, computer-managed instruction has been proposed by educators as an alternative teaching method to traditional classroom teaching without the sacrifice of quality education for certain courses [13]. Of note, it is believed that the development of such multimedia information and communication systems demands cooperative working teams of professionals who are able to master several areas of medical (dental) knowledge as well as the presentation of using different multimedia facilities [14].

We evaluated the effectiveness of this program by the administration of two post-tests. Although the subject of learning was practical-based we focused on cognitive, but not skill or performance acquisition. Studies have shown the effectiveness of a web-based course for skill development [3]. We considered students’ knowledge acquisition and knowledge retention by administering the same exam with a two-month interval. The results of the second post-test administered after two months showed similar knowledge retention when compared with the results of the first post-test. This result has supported the assumption that content provided by virtual and electronic learning can be better learned and retrieved.

Of note, the same teacher presented the lecture and online course. This might have impacted the manner in which the traditional lecture-based instruction was provided because the instructor was possibly influenced by the development of the virtual learning material. This instructor might have incorporated the online learning structure into the lecture-based instruction. The possible effect of the use of the same slides on the quality of lectures should not be undermined.

In the current study, the examination consisted of a combination of MCQs and essays to evaluate students’ knowledge. Written tests, if developed appropriately, measure higher order thinking. However if later stages of cognitive measurement such as “shows how” and “does” are expected [15] then other types of examinations such as the objective structured clinical examination (OSCE) are suggested [16]. Considering the positive correlation between knowledge and clinical performance, [17] we hope some changes may occur in participants’ clinical competence as the result of the knowledge they acquired.

Measurement of students’ satisfaction is another way to evaluate an online educational program [4]. In the current study, however, we have not measured students’ satisfaction with the program; rather, the willingness to complete this study reflected their perception regarding traditional and virtual learning methods. All students in the traditional group completed the study and three students in the experimental group expressed their willingness to attend the traditional sessions. Higher participation of the control group might have been attributed to the fact that students normally attend traditional lecture-based instruction, in which they feel more comfortable. Despite including computer literacy in our inclusion criteria, the unwillingness of three experimental group students to participate in the virtual learning environment might be due to their fear of using technology, and the possibility of failure in completing the course. In one study it was suggested that computer literacy among teachers and students was limited and should be enhanced [15].

Beside the necessity of preparedness of students for the use of online learning other factors may impact students’ preferences for online rather than in-class courses. Personality types, for example, have been highlighted by Daughenbaugh et al. According to these researchers, more extroverted students and those more sensitive than intuitive preferred the way the information was presented as well as the manner in which they were evaluated during online courses [18].

Although the experience of developing and using online learning was new in our dental school, the study results revealed that the program was feasible and had the better effectiveness.

The design of the current study was a post-test only design with the control group as a quasi-experimental design. Although these designs do not have extensive limitations, we propose to conduct further researches based on more rigorous designs such as experimental ones. In the current study the subject of teaching was practical, whereas the assessment was based on theoretical material. We recommend the assessment of practical ability in addition to the usual written tests. Our main limitation was the small number of participants. To generalize the findings and demonstrate more valid results, conducting this study with more participants is highly recommended.

Despite the difficulties encountered in designing the virtual learning environment, the study was conducted successfully. Based on the findings of this study the virtual learning was more effective than lecture-based training.