Self-instruction guides in the undergraduate oral surgery curriculum Richard A. Smith, D.D.S.,* Newton C. Gordon, D.D.S., M.S.,** and Owen R. Beirne, D.M.D., Ph.D., ** San Francisco, Calif.

DEPARTMENT OF ORAL MEDICINE AND HOSPITAL DENTISTRY, UNIVERSITY OF CALIFORNIA SCHOOL

OF DENTISTRY

A study was undertaken to evaluate the self-instruction guides in oral surgery developed at the University of Washington School of Dentistry. The third-year dental class enrolled in the basic oral surgery course was divided into four groups. Group I received the traditional lecture series and textbook. Group II attended the lecture series, used the standard textbook, and were given the guides to study at their own convenience. Students in Group III received only the self-instruction guides and were assigned to review them in a study hall during the usual lecture hours. Members of Group IV were given only the guides to be studied at their own convenience. Scores on the midterm and final examinations and on the oral surgery section of the National Dental Board examination showed no significant differences in performance among the four groups, indicating that students can learn oral surgery from these self-instruction guides.

T he conventional didactic lecture series as a means of teaching basic oral surgery techniques and in- strumentation to undergraduates at our institution was unsatisfactory for several reasons. First, students were overburdened with lecture time. Second, because the standard textbook had no review sections, students had no efficient and rapid means of reviewing the essential principles before beginning their clinical rotations. Third, we needed to standardize the instruction and to quickly familiarize new and part-time faculty members with the principles and techniques taught to the under- graduates.

A series of self-instructional guides in oral surgery,? developed at the University of Washington School of Dentistry by James R. Hooley, D.D.S., and Robert J. Whitacre, D.D.S., M.S.,’ were highly recommended to us by faculty members using them at other institu- tions. These faculty members believed that the guides covered the essential principles of oral surgery and could be rapidly and easily reviewed.

*Associate Professor, Division of Oral and Maxillofacial Surgery. **Assistant Professor, Division of Oral and Maxillofacial Surgery. +These guides include: Instruments Used for Oral Surgery, The Re- moval of Teeth, Medications in Oral Surgery, Asepsis in Oral Surgery, Assessment of and Surgery for Impacted Third Molars, he-Prosthetic Surgery, Principles of Biopsy, and Diagnosis and Treatment of Oral Infections.

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Through a bibliographic search on programmed in- struction, obtained from the National Retrieval Service, we learned that self-instructional materials are being widely used in education and that their effectiveness has been well established in dentistry as well as in other fields. Cunningham2 reported four favorable charac- teristics of programmed instruction which are absent from many other methods: (1) the material to be learned is presented in small, sequential increments, (2) the learner actively participates in the program, (3) leam- ing is reinforced because the learner finds out if he is right or wrong as soon as he responds, and (4) the learner proceeds at his own pace.

In a pilot study, Weis, Berg, and Probst3 assessed the validity of programmed self-instructional learning sys- tems in permitting dental students to master preclinical laboratory techniques independently. The performance of students prepared solely by self-instruction was su- perior to the performance of students prepared by the conventional lecture-laboratory method, indicating that undergraduate dental students can and will learn dental techniques entirely from self-instructional systems. McCrea and Swanson4 compared the performances of two successive classes of freshman dental students in a combined general-oral histology and embryology course taught by the same instructors at the same in- stitution. One class was given a lecture-laboratory se- quence, and the other received programmed instruction

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Self-instruction guides in oral sugery curriculum 29

Table I. Performance on midterm Table II. Performance on the oral surgery section and final examinations of Part Two of the National Dental Board

examination Group * Midterm score + SDt Final score -t SD?

Score k 1 (23) 83.8

SD? 2 7.4 79.8

Group * _’ 7.3

2 (21) 81.3 + 20.8 82.8 k 5.0 l(19) 85.6 k 3.6 3 (21) 84.2 t 7.9 81.2 k 4.7 2 (16) 88.6 * 5.4 4 (21) 83.2 k 8.3 79.1 2 6.4 3 (19) 87.4 4 4.5

*Number of students in each group in parentheses. t Scores are reported as the mean percentage of correct answers ? standard deviation.

4 (16) 85.2 2 5.5

*Number of students who took the National Dental Board examina- tion in parentheses. t Scores are reported as mean percentile ? standard deviation.

with almost no lectures. The over-all performance of the programmed group was far better than that of the lecture-laboratory group. Besides being unnecessary, lectures took up twice as much time as programmed instruction and were not desired by students, who thought they did not encourage individualized pacing and learning.

Although the oral surgery self-instruction guides are in use at many American dental schools, no one has scientifically investigated their effectiveness. We be- lieved that such an investigation was necessary to jus- tify replacing the didactic lecture series with these guides. To that end, we compared a group of under- graduate oral surgery students who used the guides with a group who had the conventional lectures and textbook, in terms of their performance on identical midterm and final examinations and on the oral surgery section of Part Two of the National Dental Board examination.

METHOD

The third-year dental students were assigned ran- domly to one of four groups. There were about twenty- three students in each group. Students’ grade point av- erages were used as a check on randomization.

Group I received the traditional twelve, one-hour lec- ture series and used Kruger’s Textbook of Oral Surgery (The C. V. Mosby Company, St. Louis). Group II attended the traditional lecture series, studied the stan- dard textbook, and were given the guides to study at their own convenience. Group III used only the self- instruction guides and were assigned to a study hall during the usual lecture hours to review the guides. Group IV received only the self-instruction guides to study at their own convenience and pace. This group did not attend a required study hall or lecture series.

All groups had access to instructors for help and explanation of any questions that arose. The course objectives and test items were the same for all four groups.

A consent form listing the purpose and design of the

study, and its risks, benefits, and alternatives was dis- tributed to each of the students in the class. Any stu- dents who objected to participation in the group to which they were assigned would be given the tradi- tional course and their scores eliminated from the study, without jeopardy to their academic status. All students in the third-year class voluntarily participated in the study.

The performances of the four groups on the midterm and final examinations were compared. These students took Part Two of the National Dental Board examina- tion 1 year after the course, and these scores were also used to assess how well the four groups had learned the oral surgery material.

RESULTS

The students’ performances on the written multiple- choice midterm and final examinations (Table I) were similar for all four groups. An analysis of variance indicated that there was no significant difference (mid- term, P > 0.8; final, P > 0.2) between the scores of the four groups.

One year after finishing the course, the students took the National Dental Board examination. Fifteen of the eighty-six students in our study did not take the exami- nation. Chi-square analysis showed that these fifteen students were not predominantly from any one group (P > 0.2). Scores of the remaining students on the oral surgery section of Part Two of the examination (Table II) were also similar for all four groups. An analysis of variance showed no significant difference (P > 0.5) between the four groups. The average score for the class as a whole was 86.6 + 4.8 percent (SD). This is similar to the average of 87.3% + 2.2 percent (SD) for students in the four preceding classes who took the examination.

DISCUSSION

Since our results showed no significant difference in performance between students learning from lectures and textbook and students learning from the self-

30 Smith, Gordon, and Beirne

instruction guides, we decided to incorporate the guides into our curriculum. By doing so, we gained several advantages. Part-time faculty as well as students could easily review the principles and techniques being taught. Costs to the department for typing and duplica- tion of syllabi were reduced. Faculty were freed from having to create the syllabi and prepare the lectures. Therefore, they gained more time to help students on an individual basis and to serve as role models in a clinical setting. The guides also have certain unique features that benefit learners. One is that they provide feedback to help learners monitor their own progress. At the beginning, a section called “Overview and Objec- tives” outlines the knowledge and performance skills that one can expect to gain from reading the contents and completing the exercises.’ A pretest for each unit demonstrates to the learner what he does not know about the content of the unit. The study exercises, con- sisting of fill-in-the-blank questions, problem-solving questions, and questions simulating clinical practice situations, provide confirmation and reinforcement. Thus, the student is furnished with the needed informa- tion and helped to retain it.

Another feature is that students can study the mate- rial at their own pace and convenience. Also, the guides can serve as a useful reference in later practice. Finally, there is minimal use of “hardware” that may be available only in a media center.

Some precautions are necessary when self-instruc- tional materials are used. First, the educator must main- tain contact with the students. We recommend that a regular period of time be scheduled for students to ask questions or for faculty to clarify the content of the materials. In our present oral surgery curriculum, we offer a one-hour seminar each week for such discussion.

Oral Surg. July, 1981

Second, it is important to use didactic lectures and self-instructional materials appropriately. Courses that involve well-established principles and techniques, where frequent modification is unnecessary, are suit- able for programmed instruction. Courses involving content that is controversial or rapidly changing due to intense research are best handled with conventional, easily updated lectures. Of course, the two methods can be combined; in our basic oral surgery course, we have several lectures supplementing the self-instruction guides.

At present there is a consortium for effective oral surgery instruction which is sponsored by Dr. Robert Whitacre, one of the developers of the guides and con- sortium coordinator. The consortium is a national effort to update and revise the guides on a regular basis, to develop an examination question bank, and to create new self-instructional guides in different subject areas.

The authors would like to thank Evangeline Leash for edit- ing this paper.

REFERENCES

Whitacre, R. J., and Hooley, J. R.: A Self Instruction Guide to Oral Surgery in General Dentistry, Seattle, 1979, Stoma Press. Cunningham, P. R.: The Implications of Progmmmed Instruc- tions, J. Dent. Bduc. 35277-282, 1971. Weiss, M. S., Berg, C. R., and Probst, C. 0.: Programmed Self Instruction of Dental Techniques: A Pilot Study, J. Dent. Educ. 35: 455-462, 1971. McCrea, M. W., and Swanson, E. A.: Are Formal Lectures Re- ally Necessary? J. Dent. E&x. 33:424-430, 1969.

Reprint requests to: Dr. Richard A. Smith Department of Oral Medicine and Hospital Dentistry University of California School of Dentistry San Francisco, Calif. 94143