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Year : 2017  |  Volume : 7  |  Issue : 2  |  Page : 30-36
Traditional lecture versus video/discussion-based instruction and their effects on learning behavior guidance techniques

1 Department of Pediatric Dentistry and Community Oral Health, College of Dentistry, University of Tennessee Health Science Center, Memphis, TN, USA
2 Department of Restorative Dentistry, College of Dentistry, University of Tennessee Health Science Center, Memphis, TN, USA

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Date of Web Publication12-Dec-2018


Purpose: The purpose of this study is to compare the traditional lecture-based instruction to a contemporary format, which simulated the flipped classroom, on student learning of behavior guidance techniques (BGTs). Both types of instruction included video examples of BGTs. The secondary aims were (1) to examine the students' preference of learning style on test performance and (2) to determine the student perceptions about the methods of instruction with videos.
Subjects and Methods: Videos of practitioners performing BGTs were recorded. Dental students in their third year of training were recruited to participate (n = 70). Students were randomly divided into two groups as they entered the facility: (1) contemporary instruction (CI) and (2) traditional instruction (TI). The CI group watched a 20-min “mini-lecture” that simulated an online module and then divided into discussion groups led by calibrated pediatric residents and faculty. The TI group received 50 min of traditional lecture with videos incorporated in the presentation. At the completion of the course, students completed a questionnaire, which assessed the student's learning of the objectives of the course and his/her perceptions of the learning experience.
Results: The CI group performed significantly better on the posttest questionnaire (P = 0.001). After instruction, students felt most comfortable employing Tell-Show-Do and Positive Reinforcement. Students' perception of the usefulness of video examples of BGTs was high with mean 4-point Likert scores of 3.53 CI and 3.52 TI.
Conclusions: The CI format improved the students' learning of the topic as assessed by test scores. Behavior guidance education for predoctoral students could be enhanced by the use of videos and discussion-based learning.

Keywords: Educational technology, pediatric dentistry, professional education, teaching effectiveness

How to cite this article:
Douglas KM, Wells MH, Deschepper EJ, Donaldson ME. Traditional lecture versus video/discussion-based instruction and their effects on learning behavior guidance techniques. J Educ Ethics Dent 2017;7:30-6

How to cite this URL:
Douglas KM, Wells MH, Deschepper EJ, Donaldson ME. Traditional lecture versus video/discussion-based instruction and their effects on learning behavior guidance techniques. J Educ Ethics Dent [serial online] 2017 [cited 2023 Oct 4];7:30-6. Available from: https://www.jeed.in/text.asp?2017/7/2/30/247342

   Introduction Top

Behavior guidance techniques (BGTs) are an essential set of skills for treating children and those with special needs. The techniques enable practitioners to help patients learn correct responses to stimuli, communicate fears and anxieties, and cope with a difficult appointment. BGTs are meant to help patients have a positive view of dental appointments, which in turn fosters long-term relationships with dental practitioners and develops long-term investment in dental health. The communicative techniques include positive previsit imagery, direct observation, Tell-Show-Do, Ask-Tell-Ask, voice control, nonverbal communication, positive reinforcement and descriptive praise, distraction, memory restructuring, and parental presence/absence.[1]

Educators in the health-care profession are challenged with creating new ways to instruct a growing classroom of a tech-savvy generation.[2],[3],[4] In addition, it is difficult to keep a class engaged in learning through a passive,[2] traditional lecture-based format. Active engagement in learning has been shown to provide better results.[5] Activities provide students with the opportunity to construct scenarios that they can use later in real-life events because they have drawn from material which they have learned before class, interacted with others who may have a different perspective, and been provided with feedback in a safe environment from an instructor.[4],[6],[7] Curricula based on engaged learning have been met with high student satisfaction.[8]

Active learning can be implemented in many ways. Providing lecture materials before class delivers flexibility to students and allows class time to be used for review and active learning.[9],[10] This concept is referred to as a flipped classroom, which has shown improved student performance and perceptions of the learning experience by previous research.[11],[12],[13]

With active learning as the goal, videos of BGTs may provide a valuable tool for instruction. Videos in learning have been reported to be useful in many other studies.[2],[14],[15] Weeks and Horancite several benefits to using videos in instruction which include more enjoyment and engagement from the students, more authentic representations of clinical scenarios, and better use of technology familiar to this generation of students.[2] Furthermore, Hafen et al. noted that delivery of information through video might help convey the importance of certain topics and concepts often glossed over by students; for example, communication skills.[15] Video format can bolster a topic that is difficult to teach and can offer the chance to learn vicariously.[16] Furthermore, recordings of genuine scenarios can be critiqued and dissected by inexperienced students to improve their own performance on entering the clinic.[15]

The purpose of this investigation was to compare traditional lecture-based instruction versus video- and discussion-based instruction and their effects on student learning of BGTs and student perceptions about the methods of instruction with videos. The new instruction method would be supported by the study's primary aim, which was to show that the use of videos and discussion groups improve students' learning over the traditional lecture format often employed by educators. The secondary aims of the study were (1) to examine the students' preference of learning style on test performance and (2) to the determine student perceptions about the methods of instruction with videos.

   Subjects and Methods Top

A cohort study was executed to introduce a new method of instruction for teaching dental students BGTS for pediatric dental patients. The University of Tennessee Health Science Center Institutional Review Board approved the collection of videos (IRB: 15-03641-XP) and their use in the study (IRB: 15-04325-XP).

Videos of various seasoned pediatric dentists and dental staff performing BGTs were recorded. The videos were incorporated into two different types of instructional methods: (1) contemporary instruction (CI) and (2) traditional instruction (TI). The CI consisted of creating a 20 min voice-over PowerPoint (Microsoft® PowerPoint® for Mac 2011, Version 14.6.4) lecture that described each BGT and contained one example video. This presentation was created to simulate a presentation that could be available online for students before meeting in a classroom; however, it was not available to students before or after the CI session. For the purpose of the study, to ensure that all students in the CI group were exposed to the voice-over presentation, the presentation was played at the beginning of the CI session. In addition, for the CI group, discussion questions for four other videos of various BGTs were created. For the TI, a PowerPoint lecture was created, and the videos were incorporated within the lecture, with a video example following each topic of the presentation. Both types of instructions contained the same videos and didactic content, and the students were engaged in the learning format for approximately the same amount of time (50 min).

A questionnaire was developed that collected demographic data (age, gender, ethnicity), student preference of both learning style (audio, visual, reading) and learning format (individual or group), and current level and perception of the student's experience with pediatric patients. The questionnaire also collected the student's perceived comfort level with various types of BGTs after exposure to the course and the student's perception of the format of the course and the usefulness of the videos. A posttest was also created which collected correct and incorrect responses to didactic information that was presented in both types of instruction. Before use in the study, the posttest was piloted for the validity of measuring knowledge about BGTs.

The post-test portion of the course consisted of 12 questions. To validate the instrument, before the study, six pediatric dental residents and eight 1st-year dental students (D1) took the posttest without prior instruction. Pediatric residents were chosen because the residents should be familiar with BGTs. Residents took the test before being calibrated for the discussion groups and before seeing the instructional material. D1 students were chosen because they had not yet been exposed to any BGT instruction thus far in their curriculum. An independent samples t-test was completed to evaluate statistical significance between the groups, thereby demonstrating a difference between students that know and understand BGTs versus students that are not familiar with BGTs.

Dental students in their 3rd year of training were recruited to participate in the study (n = 70). The students were recruited via e-mail and flyers. Incentives for participating in the survey included an opportunity to learn more about BGTs, which could enhance their practice as dentists and an opportunity to earn clinical credit in the undergraduate pediatric clinic equivalent to about one point being added to their clinical average in that clinic. Furthermore, lunch was provided after the participants completed the study. The students were divided into two groups: (1) CI and (2) TI. Instruction was held in separate lecture rooms with projector and visual/audio capabilities. Participants were randomly and equally assigned to the groups as each participant sequentially presented for participation. No effort was made to equate the groups based on gender or ethnicity.

In the CI group, eight discussion subgroups existed. Students were given a number, one through eight, sequentially as they walked through the classroom door and joined the discussion subgroup accordingly. The discussion subgroups had three to six participants. To ensure that every student in the CI group would be exposed to the voice-over presentation, the CI group watched the voice-over presentation first, which contained one video. Following the presentation, videos of Tell-Show-Do, positive reinforcement, distraction, modeling, voice modulation, and an infant examination were played. Several videos contained more than one type of BGT for a total of four videos for the discussion section. After playing each video, 5 min were allotted for group discussion of each video. Pediatric dental residents and faculty who were previously calibrated led the group discussions.

For the TI group, the primary investigator delivered the 50-min traditional lecture which incorporated the videos as examples of each BGT but did not allow for any discussion of the videos. After completion of each course, the questionnaire and posttest were administered.

A multifactorial ANOVA was completed to examine the effects of teaching method (CI/TI), learning style (group/individual), and method of learning (reading/listening/visual) on the posttest scores. Separate one-way ANOVAs were completed to examine the effects of the method of learning (reading/listening/visual) and number of previous patient encounters on posttest scores. Independent samples t-tests were completed to evaluate statistical significance of posttest scores within the learning style (group/individual) groups and within the teaching method (CI/TI) groups. Also to validate the 12-item posttest, and before the actual study, an Independent t-test was completed to examine the difference between posttest scores in the dental resident group versus the D1 group.

   Results Top

Seventy questionnaires were collected. One was disqualified for incomplete data, resulting in 69 total surveys analyzed for this study. Forty-eight of the respondents were male and 21 were female [Table 1]. Seventeen of the 21 female participants were in the CI group. The average age was 25.9 years with a range of 23–36 years. The average student participant in this study had five to nine patient encounters in the pediatric clinic (range = 0–15+). Students reported a positive rating for these encounters overall (mean = 3.06/4; min = 2; max = 4; range = (1) extremely negative–(4) extremely positive). The average self-scored comfort level with treatment of children fell somewhere between uncomfortable and comfortable (mean = 2.71/4; min = 1, max = 4; range = (1) extremely uncomfortable–(4) extremely comfortable) [Table 2]. In addition, the majority of students reported that their favorite way to learn was by watching videos [Table 1].
Table 1: Demographics of student survey population

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Table 2: Mean of student perception among groups and overall

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Before conducting the study, the posttest was validated using 1st-year dental students, who had an average score of 3.5 out of 12, and pediatric dental residents, who had an average score of 9 out of 12. The difference between the groups was statistically significant with a P < 0.001.

Posttest scores for the CI group were significantly higher than for the TI group (P < 0.001). Independently, there was no statistical difference in posttest scores between method of learning (reading/listening/visual) (P = 0.310) or between learning style (group/individual) (P = 0.138). A three-way ANOVA was completed looking at teaching method (CI, TI), learning style (group, individual), and method of learning (reading text, listening to lecture, watching videos) and their effect on the posttest scores. The only factor that made any significant difference was teaching method. The other two factors' effects were not significant, and there were no significant interactions among the three factors on the posttest scores [Table 3].
Table 3: Comparison of specific groups to posttest score mean

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A series of perception questions were evaluated on a 4-point Likert scale [Table 2]. Students felt most comfortable (higher scores indicated higher comfort level) with Tell-Show-Do (mean = 3.28) and positive reinforcement (mean = 3.26). They felt least comfortable with voice modulation (mean = 2.78). CI students reported slightly higher satisfaction scores on teaching module usefulness, format of the course, and usefulness of the videos, but this was not statistically significant. The students' perception of the usefulness of the videos in contributing to their understanding of BGTs was high regardless of group assignment with scores of 3.53 CI and 3.52 TI. Furthermore, 53.6% of the students overall responded that the videos were “extremely useful” (score of 4/4). Another 44.9% of the students scored the video usefulness as a 3, “useful”. Only one student, who was in the TI group, rated the usefulness of the videos as “not useful” (score of 2/4). The same student also rated the module usefulness and satisfaction with the course as not useful (2/4) and unsatisfactory (2/4), respectively.

   Discussion Top

A recent survey of the preparedness of 1st- year pediatric dentistry residents showed that only 61% of program directors felt that 1st- year residents were adequately prepared with Tell-Show-Do on enrollment in the residency. Adequacy dropped precipitously for voice control and immobilization.[17] Assuming that the students entering pediatric dentistry residencies are likely the most motivated students to learn BGTs in dental school (and those most likely to seek additional pediatric experience), the Rutkauskas et al. study[17] highlights the inadequacy of predoctoral education in pediatric dentistry, even with the most basic BGT: Tell-Show-Do. Hence, attempting to improve student learning in this area is warranted.

The primary aim of this study was to compare traditional lecture-based instruction with more interactive, discussion-based instruction on student learning of BGT. To compare the two methods of instruction, a posttest was designed to test knowledge gained through BGT instruction. The posttest did show a significant difference between groups (D1 students vs. pediatric dental residents). Although the sample group for validation was small, the extreme gap between the scores strengthened the conclusion that the posttest accurately showed a difference between the knowledge base of those that have been exposed to BGTs and those that have not yet learned BGTs.

The CI format simulated the flipped classroom concept, which has shown improved student performance and perceptions of the learning experience by previous research.[11],[12],[13] In a study by CB Ratta, students had higher satisfaction of a discussion-based instruction format when recorded lectures were provided for viewing before class. Hence, providing structured information to students before discussion sessions should positively impact the student's perception of the learning experience.[4] Offering PowerPoint-style learning modules with voice over instruction before class time creates better use of class time for discussion and interaction to reinforce learning.

The discussion part of the format was not meant to provide students with specific answers, but rather to encourage them to become comfortable with communicating with children through various BGTs and implement them in a way the individual found effective. Communicative management as a whole is a process that resembles an art form as well as a science; therefore, there are many acceptable ways to implement the skills that often reflect the personality of the practitioner.[1] Furthermore, active learning in discussion-based formats has been shown to help students commit knowledge to long-term memory leading to higher scores at the end of a course.[18] Not all studies show improvement in test scores when active learning techniques are employed. One article regarding the use of the flipped classroom in a veterinary medicine skills course showed statistically lower scores for the flipped classroom cohort compared to the traditional classroom cohort.[19] The authors theorize that a greater quantity of content material can be covered in a didactic lecture as compared to a workshop of similar length. Therefore, periodic reassessment in the education process cannot be taken for granted.

One of the secondary aims of the study was to examine if students' preferred style of learning (reading, audio, visual) impacted student performance. Teaching method, when paired with a particular learning style, had no significant effect on the posttest scores. The only significant effect was teaching method. This lends evidence that the teaching methodology (CI/TI) seems to have a significant effect across different learning styles and methods of learning. The average score of the CI group (8.94) approached the average score of the residents (9.00) who took the test to validate the instrument. Furthermore, the CI group score mean (8.94) was significantly different from the TI group mean (7.30), which indicates a very strong association between the CI format and the group's learning outcome.

Another secondary aim of the study was to determine student perceptions about the methods of instructions with videos. With 98.5% of the students giving positive ratings (regardless of group assignment), the impressive majority of students found the videos to be a welcomed contribution to their learning of BGTs. Weeks and Horan used videos for instructing physical therapy students in Australia. The study showed that 98% of the students agreed that the use of videos facilitated their learning.[2]

Making resources, like videos of BGTs, available for instructor use may allow better teaching practices to be employed with less stress on the instructor, who may struggle to use different methods.[4] Students would also benefit from access to such resources that would provide reinforcement and examples of lecture materials. In addition, the use of software to make videos searchable or “interactive” may be an improvement to video instruction. Zhang et al. showed significantly better learning performance for students who were taught with interactive videos compared to students taught with noninteractive videos, no videos, or in the traditional lecture format.[20]

Another observation of interest was student response to the question, “As a result of this teaching module, how comfortable do you feel with utilizing the following techniques?” High comfort ratings were given to Tell-Show-Do, positive reinforcement, and distraction, indicating that there may be decreased anxiety implementing these techniques after the conclusion of the module. However, a pretest was not administered; thus, students could have self-reported high comfort ratings with these BGTs before the instruction. Although high ratings would seem unlikely given that the average student in this study had experienced only 5–9 pediatric patient encounters.

Similarly, an interesting question to include in the questionnaire might have been, “Do you have children?” Participants that have children may or may not have knowledge of behavior guidance gained from both instinct and experience from their own children. Wells et al. noted in a recent survey of pediatric dentists that over 70% agreed with the statement: “Parenthood has had a significant impact on my behavior guidance style with patients.”[21]

A primary limitation of the study was that gender groups were not evenly distributed, with more than twice as many males participating in the study, and 17 females of the 21 were in the CI group. This does create the possibility of introducing a confounding factor of gender if males and females inherently learn differently. It has long been recognized that females have a small advantage for verbal and written language in academic performance research.[22] It is possible that this could affect the validity of the results of the study; however, identifying differences in test performance based on gender was not an aim of the study, and thus, no effort was made to equalize the groups by gender. Given that it is possible that the overrepresentation of females in the CI group could have driven the CI test scores higher, additional statistical tests were run comparing the male and female test scores within each group, and the difference in test scores was not significantly different (data not shown). While this cannot prove that there was no gender effect, it strongly suggests that is unlikely. Furthermore, the students tested should relatively be of the same academic competence as evidenced simply by their acceptance into the dentistry program. However, without conducting another study to answer this question, we are unaware if this had any effect on the results. However, inferences can be applied to the human population without regard to gender, and this limitation of the study does not necessarily render its findings useless.

Another limitation of the study included “simulating” the online module in the CI group. Having all of the students watch the voice-over presentation in the CI group makes the assumption that every student will access the necessary online resources before a class meeting. Typically, some percentage of students will not complete the assigned classwork/online viewing. Hence, the improvement in learning would most likely only occur for those students who completed the entire coursework. However, one could argue that the same effect would be true for traditional lecture formats that have assigned readings of book chapters or articles; only the students who complete all of the assignments would receive the maximum benefit from the course.

Other limitations of the study include lack of time for reflection on the new knowledge, only one session of the contemporary teaching method as opposed to an entire course, and the lack of a pretest for comfort level with BGTs. Previous research has shown that reflection may be an important part of learned material becoming applied skills;[23] however, due to time constraints, this was not possible for this study. More information could be gathered about the effectiveness of the current study's teaching methodology if it were employed during an entire course. Finally, administering a pretest would have given a baseline perception level of the BGT comfort levels and didactic knowledge of the skills. This is an aspect that should be added to a future study.

The classroom contains individuals with different learning preferences and needs. Consequently, health-care educators may wish to pursue new technologies and teaching techniques that have the potential to support student learning. Better learning can close the gap between the classroom and clinical/work experience and enhance the future of any profession. Importantly, improved learning may lead to fewer initial mistakes by new physicians, dentists, nurses, and health-care personnel, leading to better service to the consumer, better consumer satisfaction, and decreased new practitioner anxiety.

   Conclusions Top

Education in the area of behavior guidance for students could be enhanced by the use of videos and discussion-based learning. The following conclusions may be drawn to support the use of videos and discussion groups in teaching methodology:

  1. The overall satisfaction of either course was high. Many students commented on the survey that the inclusion of videos was very helpful
  2. Students reported high comfort levels on some basic BGTs after viewing video examples further supporting the use of videos for teaching these skills
  3. The CI format, which simulated the flipped classroom format, proved to significantly impact the students' learning of the topic as determined by test scores.

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Conflicts of interest

There are no conflicts of interest.

   References Top

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Weeks BK, Horan SA. A video-based learning activity is effective for preparing physiotherapy students for practical examinations. Physiotherapy 2013;99:292-7.  Back to cited text no. 2
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Della Ratta CB. Flipping the classroom with team-based learning in undergraduate nursing education. Nurse Educ 2015;40:71-4.  Back to cited text no. 4
Bonwell C, Sutherland T. The actice learning continuum: Choosing activities to engage students in the classroom. New Dir Teach Learn 1996;67:3-16.  Back to cited text no. 5
Baviskar S, Hartle R, Whitney T. Essential criteria to characterize constructivist teaching: Derived from a review of the literature and applied to five constructivist-teaching method articles. Int J Sci Educ 2009;31:541-50.  Back to cited text no. 6
Chickering A, Gamson Z. Development and adaptations of the seven principles for good practice in undergraduate education. New Dir Teach Learn 1999;80:75-81.  Back to cited text no. 7
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Prober CG, Heath C. Lecture halls without lectures – A proposal for medical education. N Engl J Med 2012;366:1657-9.  Back to cited text no. 9
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Young TP, Bailey CJ, Guptill M, Thorp AW, Thomas TL. The flipped classroom: A modality for mixed asynchronous and synchronous learning in a residency program. West J Emerg Med 2014;15:938-44.  Back to cited text no. 12
Koo CL, Demps EL, Farris C, Bowman JD, Panahi L, Boyle P, et al. Impact of flipped classroom design on student performance and perceptions in a pharmacotherapy course. Am J Pharm Educ 2016;80:33.  Back to cited text no. 13
Kelly M, Lyng C, McGrath M, Cannon G. A multi-method study to determine the effectiveness of, and student attitudes to, online instructional videos for teaching clinical nursing skills. Nurse Educ Today 2009;29:292-300.  Back to cited text no. 14
Hafen M Jr., Siqueira Drake AA, Rush BR, Sibley DS. Engaging students: Using video clips of authentic client interactions in pre-clinical veterinary medical education. J Vet Med Educ 2015;42:252-8.  Back to cited text no. 15
Roberts D. Vicarious learning: A review of the literature. Nurse Educ Pract 2010;10:13-6.  Back to cited text no. 16
Rutkauskas J, Seale NS, Casamassimo P, Rutkauskas JS. Preparedness of entering pediatric dentistry residents: Advanced pediatric program directors' and first-year residents' perspectives. J Dent Educ 2015;79:1265-71.  Back to cited text no. 17
Takeuchi H, Omoto K, Okura K, Tajima T, Suzuki Y, Hosoki M, et al. Effects of team-based learning on fixed prosthodontic education in a Japanese school of dentistry. J Dent Educ 2015;79:417-23.  Back to cited text no. 18
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Zhang D, Zhou L, Briggs R, Nunamaker J. Instructional video in e-learning: Assessing the impact of interactive video on learning effectiveness. Info Manage 2006;43:15-27.  Back to cited text no. 20
Wells M, McTigue DJ, Casamassimo PS, Adair S. Gender shifts and effects on behavior guidance. Pediatr Dent 2014;36:138-44.  Back to cited text no. 21
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Correspondence Address:
Dr. Martha H Wells
Department of Pediatric Dentistry and Community Oral Health, College of Dentistry, University of Tennessee Health Science Center, 875 Union Avenue, Suite 212 Dunn Dental Building, Memphis, TN 38163
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jeed.jeed_22_17

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