Study design
The study originated from need to compare knowledge acquisition and its retention between two groups of students. We used post-tests to analyze knowledge acquisition and its retention among students who, prior to the study, had not attended this course. We randomly assigned eligible fifth year dental students to the following two groups, experimental (virtual learning) and comparison (traditional learning).
The same lecturer used two different learning models (virtual and traditional) to plan a course on the topic “rotary instrumentation of root canals”. The study groups completed their courses over three consecutive weeks. Their improvement was assessed immediately and two months after completion of the course by a valid, reliable test.
Participants
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Selection criteria
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Participants of the study were fifth year dental students. All had passed a total of 180 credits. Students had completed the majority of theoretical and practical courses.
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Method for selection of participants (sampling)
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We officially invited 45 students to voluntarily participate. Of these, 40 students agreed to participate and were randomly assigned to either the experimental or control groups. We used the Mann–Whitney U test to measure grade point averages (GPA) to ensure similarity among participants. There was no significant difference between the GPAs of both groups (P > 0.05). Two students in the experimental group were injured in an accident on the starting day of the course and were unable to participate. Three other students from the experimental group stated their unwillingness to continue participation in virtual classes. They were invited to attend the control group class, but excluded from the study. Ultimately 35 students completed the entire course, including examinations.
The control group (n = 20) attended a traditional lecture designed coursework while the experimental group (n = 15) participated in virtual learning of the same course. Both groups successfully completed the courses and participated in the examinations.
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Recruitment of the subjects
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As the attendance was voluntary, we made some interventions to increase the likelihood that students would participate. Interventions included selection of the subject according to the student’s felt needs. We held a briefing session to provide students with the necessary information regarding their attendance. Students were reassured that the test results would not be used in their evaluations.
The study necessitated that students have the ability to use a computer and the internet, [11] therefore we assessed students’ competencies by a form that consisted of relevant questions. This assessment ensured each student’s ability in using the program.
Data collection
We controlled for variables by the following approaches:
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Educational level was set only for dental school students in their fifth year.
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Educational abilities were controlled by statistical analysis of students’ latest GPA.
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To provide the same level of IT tools for learning, we required all experimental group participants to attend a training session on basic IT requirements and the e-learning application interface.
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No participants had previous exposure to the course.
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The same lecturer planned and presented both courses.
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Both groups of students completed the courses in the same time frame.
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Both courses had the same content comprised of the same teaching movies and presentation.
For both groups, the basic variable taken into consideration was the method of teaching, conventional versus virtual education. Knowledge acquisition and retention were examined according to students’ scores in the designed post-test.
Educational methods
There were two methods in this study, conventional and virtual. In both, the learning objectives were designed by the same professor of endodontics who cited two common, important dental reference books.
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Conventional method
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The conventional method was a lecture-based course that included three, one hour sessions taught by a Professor of Endodontics. In this course, the sequence of PowerPoint slides and video were shown in the same order as the virtual learning method.
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Virtual learning method
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All of the learning objectives were designed the same as the conventional method, with the exception of the teaching method. We designed a virtual learning environment that included all corresponding flexibilities and user friendliness enriched with multimedia, as well as interactions among peers and the lecturer.
The sharable content object reference (SCORM) compliant LMS was equipped with online videoconference ability and a reporting system to follow students’ progress. Students in the experimental group were given a username and a password to login and the available options included the following: learning path (lessons), video conference environment, quiz and assignments, and contact with teacher and/or students.
Learning path (lessons) comprised a complete module that included the presentation and corresponding movies. This was designed such that users could not skip any slide, rather they were required to view the slides in order and time of the contents.
The video conference environment consisted of three online sessions scheduled for all attending participants.
Participants were required to complete two assignments. For each session, one online multiple choice question (MCQ) quiz was given to participants. Both activities were completed by feedback to participants in order to enable them to effectively understand the context.
All experimental group participants had access to a list of other participants and an online environment for sharing their ideas, either with or without the presence of the teacher through texts.
In addition to a training session, we developed a guideline for students to facilitate their use of e-learning. Using the guideline, students could easily learn how to access the website, login, submit their assignments, take the quizzes, and contact their teacher.
Method of assessment
A post-test that included MCQ and essay questions was designed according to the lesson plan. Validity of the test was confirmed by a panel of endodontists. Its reliability was assessed by KR20 (R = 0.74). We evaluated all participants upon completion of the courses and two months later. The latter was for measurement of students’ knowledge retention. For each MCQ and essay question, we assigned a point value of 0.5 and 2.5, respectively for a total possible score of 30 points.
Statistical analysis
Statistical analysis was performed by SPSS version 20. The Mann–Whitney U non-parametric test was used to compare participants’ GPAs. The effect size was measured to describe the magnitude of between group differences of the scores in the first and second post-tests.
Ethical considerations
Students participated voluntarily after official invitation. Participants were assured that test results were confidential and did not constitute a part of their formal assessment. GPAs were calculated according to student identification numbers and were anonymous.
After the second post-test, all students in the control group received a copy of a compact disc that included all resources which were available to the experimental group.
This study was approved by the Ethics Committee of Shiraz University of Medical Sciences (ECSUMS).
Study challenges
The experimental group was supposed to connect to the LMS from any location that had available internet access. However, participation in videoconference sessions was impossible from the home/dormitory environment due to a low speed internet connection. Thus, we used the intranet instead of the internet. We equipped 15 computers in different departments with microphones and webcams, then requested students to attend in sessions using the intranet. Other features of the LMS such as assignments, access to learning paths, quizzes, contact with the teacher and other students were accessed by students independent of time and location. Students also received a compact disc that contained the learning path of each session. Another challenge we encountered was an intranet disconnection in one of the videoconference sessions which was rescheduled at the next appropriate time.