Orthodontic wire-bending scores
The present study showed the effectiveness of personalised learning for teaching wire-bending skills either as LD or FC method. The FC method appeared to be the more effective way of teaching orthodontic wire-bending skills for two of the six components – Adams clasps and Z-spring. The former was the first wire tasked to learn by the inexperienced and unskilled students while the latter was one of the most complicated components to bend. Within the similar one-week submission deadline, the FC cohort had access to view the video demonstration and practise throughout the week before the classroom session and was able to attend the said session with prepared questions and some amount of acquired wire-bending skills. However, for the LD cohort, they could only ask questions during the two-hour classroom session where they watched the demonstration for the first time, and this was followed by a week of self-practice without any video guidance. Meanwhile, for the remaining four types of components, which may have required less wire-bending skills, our findings were in agreement with previous studies reporting that both LD and FC are equally effective in transferring the skills of orthodontic wire-bending [2]. The inter-group difference between the mean scores for Adams clasp and Z-spring were statistically significant but these values were not clinically significant.
The association of continuous formative assessment with orthodontic wire-bending scores
In the present study, the students’ performances improved over successive tasks regardless of the teaching method. This could be due to the use of formative assessment. However, the improved scores could be attributed to the students gaining skills, knowledge, confidence, and experience with increasing practise in wire-bending, allowing them to improve in performance over time. Formative assessment promoted personalised learning by providing feedback to the teachers and students to make any required improvement [8]. Students received their score and grade after each wire-bending session, which were also disseminated to the lecturers and laboratory technicians prior to the next demonstration session and enabled them to identify and assist students who required extra guidance. It might also have promoted the students to engage in a self-reflective process and work on improving their wire-bending skills [10].
Although all dental schools have some element of formative assessment in their curriculum, the effectiveness of formative assessment was not frequently investigated, let alone for an undergraduate orthodontic course [11]. Various approaches of formative assessment have been reported to improve dental students’ performance on other aspects of dental education, including the structured clinical operative test (SCOT), tutor assessment following problem-based learning, online formative assessment via online exam questions, mini-objective structured clinical examination (mini-OSCE), direct observation of procedural skills (DOPS), and competency-based formative progress assessment system [12,13,14,15,16,17]. Another new approach that has been attempted and well-received by schools includes a streamlined electronic formative feedback model (FFM) developed by Indiana University School of Dentistry (IUSD) [18]. Multisource feedback from colleagues and patients had been reported to be well-accepted by dental postgraduate students as an effective formative assessment tool to improve on professionalism [19]. The importance of formative assessment has slowly gained considerable attention by both dental schools and students. The result of our study suggested that continuous formative assessment may have an important and positive role in dental education especially in terms of teaching and learning clinical and laboratory skills.
It is observed that certain wire-bending tasks were more difficult and challenging e.g., Southend clasp and Z-spring. This explained the observation where certain pairwise differences on follow-up comparisons were not significantly different.
The frequency and correlation between usage of online video demonstration with students’ orthodontic wire-bending scores
The study demonstrated that instructional videos were not fully optimised by the FC cohort despite the perceived opportunities to learn from the videos at the students’ own time and pace. This may be attributed to their preference for learning styles or lack of complete satisfaction with the videos or access to them. Teachers intending to implement the FC method should bear in mind the challenges of implementing such instructional method. Even though not all FC students fully optimised the videos, the use of the videos had no association with their performance. It might be that the students picked up the concepts of the wire-bending through watching parts that they needed to learn and not necessarily the whole prepared video. These students also had opportunities to ask the teachers during the classroom sessions, which might have helped them understand concepts missing from the video. The finding of this study supports that learning is dynamic and can be taught in different ways, including the FC method. Past studies comparing traditional teaching methods with video-based teaching can achieve the same performance from students if the instructions were well-delivered [2, 20, 21].
Student’s perceived satisfaction on the wire-bending demonstrations
Both methods, LD and FC are suitable to teach wire-bending in orthodontics as both were received favourably by the students, although LD was rated significantly higher than FC. Students preferring LD may have been due to the limitation of the videos in presenting a three-dimensional procedure. The videos also did not allow direct engagement between the student and the technician before the classroom session. In terms of the tasks given, students initially were inclined towards LD for fabricating their wire components, but later FC was found to be equally accepted. Similarly, only at T1 did the FC cohort find the classroom arrangement to be conducive for the given task compared to LD at the end of the exercise. This may indicate that students require some time to familiarise with flipped learning before truly appreciating and embracing this teaching method [22].
Limitations of the study and recommendations
Ideally, a control group with students undergoing the orthodontic wire-bending sessions without formative assessment should be included to investigate the effectiveness of the formative assessment. However, it was deemed ethically inappropriate to withhold any student from the possible benefit of personalised learning in this cohort. Further quantitative or qualitative research into the effect of formative assessment on teaching orthodontic wire-bending is warranted.
A significant number of students were dissatisfied with the quality of videos provided on their online learning platform and some even preferred other similar videos available online. Future studies can use a mixed-method approach, incorporating interviews or focus group discussions with thematic analysis, to explore students’ perception, specifically why they preferred other similar videos online and how to improve the quality of the videos. Another suggestion is to involve students in the development of educational videos to incorporate elements that will appeal to end-users. Effective video development necessitates digital literacy, and additional educational technological support is crucial to assist in appropriate video integration in clinical teaching. Nonetheless, the students’ performances were unaffected by the video quality.