The response rate in each of the three years was 90% (n = 88), 83% (n = 98) and 97% (n = 78) respectively of consenting students.
The female to male ratio was 69:31. The mean age at the end of the study was 21 (SD ± 1.85) years. There were no significant differences in gender distribution for degree course (χ2(2, n = 97) = 4.952, p = 0.084), year of study (χ2(2, n = 250) = 1.67, p = 0.195), and lecture delivered (χ2(18, n = 97) = 20.67, p = 0.296).
The trends of change in lecture modalities over the three academic years are displayed in Fig. 2. Most lecturers (54%) chose Microsoft PowerPoint/Keynote as the presentation software for their pre-recorded lectures whereas 25% opted for Panopto. Lectures were disseminated by uploading on the Virtual Learning Environment (VLE) platform (46%), YouTube (42%) via email (17%) or via other routes (33%). Pre-recorded online lectures with online or in-person tutorials and then a blend of presentations and/or other printed materials via VLE platform were also provided. Tutorials were provided either sequentially slotted between pre-recorded lectures (30%), only when students requested them (30%) or not provided at all (18%). 22% of lecturers provided feedback either in person or via email. 64% of tutorials were held via an online platform, the rest were held in-person in a classroom setting.
Student Feedback
At the first questionnaire (Q1) (2019/2020), 74.5% of the student body agreed that online modes of teaching should be retained Fig. 3 presents the change in student responses regarding their experiences with online lecturing over the three academic years. Figure 4 depicts their preferences for teaching modalities at the end of the third year. 75% of all students preferred a variation including an online modality; 33% preferring online only and 42% opting for one of the variations of a blended approach. As for the rest, 22% preferred F2F and 5% notes only.
Further analysis of these findings revealed significant differences for gender, course of study and year of study as shown in Table 1.
Table 1
Group comparisons for preference of learning modalities
Online Learning Options
|
Gender
|
Course
|
Clinical/ Preclinical Year
|
Change Over Time
|
|
T2
|
T3
|
T2
|
T3
|
T2
|
T3
|
|
Receiving F2F lectures
|
0.003
(M > F)
|
p > 0.05
|
p > 0.05
|
p > 0.05
|
0.001 (NC > C)
|
p > 0.05
|
0.05
(T2 > T3)
|
Receiving lectures online
|
p > 0.05
|
p > 0.05
|
p > 0.05
|
p > 0.05
|
p > 0.05
|
p > 0.05
|
p > 0.05
|
Receiving lectures online and tutorials organised online or F2F
|
p > 0.05
|
p > 0.05
|
p > 0.05
|
p > 0.05
|
p > 0.05
|
p > 0.05
|
p > 0.05
|
Receiving Rec lectures online
|
0.025
(F > M)
|
p > 0.05
|
p > 0.05
|
p > 0.05
|
0.021 (C > NC)
|
p > 0.05
|
p > 0.05
|
Receiving Rec online and tutorials organised online or F2F
|
p > 0.05
|
p > 0.05
|
p > 0.05
|
p > 0.05
|
p > 0.05
|
p > 0.05
|
p > 0.05
|
Receiving presentations on VLE
|
0.038
(F > M)
|
p > 0.05
|
0.011
(B > MDS)
|
p > 0.05
|
p > 0.05
|
p > 0.05
|
p > 0.05
|
Receiving presentations on VLE and tutorials organised online or F2F
|
p > 0.05
|
p > 0.05
|
p > 0.05
|
p > 0.05
|
p > 0.05
|
p > 0.05
|
p > 0.05
|
Receiving notes on VLE and tutorials organised online or F2F
|
p > 0.05
|
p > 0.05
|
p > 0.05
|
p > 0.05
|
p > 0.05
|
p > 0.05
|
p > 0.05
|
Only receiving notes
|
p > 0.05
|
p > 0.05
|
0.013
(B > MDS)
|
p > 0.05
|
p > 0.05
|
p > 0.05
|
p > 0.05
|
Brackets denote group preference
M = Males, F = Females; NC = preclinical years, C = clinical years; B = Bachelor degree, MDS = Dental degree
Statistical Test: Mann-Whitney U Test
|
Group comparisons of students’ agreement with the statements on diverse aspects of online learning modalities are presented in Table 2. Significant differences were observed, with clear distinctions identified between clinical and preclinical years of study. Table I and Table 2also display how student preferences changed over time (T2 versus T3)
Table 2
Student agreement with statements about online learning
|
Gender
|
Course
|
Clinical/ Preclinical
|
Change between Time
|
|
T2
|
T3
|
T2
|
T3
|
T2
|
T3
|
|
|
Lecturing sessions are more suitable delivered with distance learning modalities
|
> 0.05
|
> 0.05
|
> 0.05
|
> 0.05
|
0.005
(C > NC)
|
0.008
(C > NC)
|
> 0.05
|
|
Clarification sessions are more suitable delivered with distance learning modalities
|
> 0.05
|
> 0.05
|
> 0.05
|
> 0.05
|
> 0.05
|
> 0.05
|
> 0.05
|
|
Clarification sessions are more suitable delivered in F2F meetings
|
0.040
(M > F)
|
> 0.05
|
> 0.05
|
> 0.05
|
0.007
(NC > C)
|
0.022 (NC > C)
|
> 0.05
|
|
The flipped classroom model, in which course material is first provided online prior to the instructors addressing the material during class-time, should be implemented in the faculty
|
> 0.05
|
> 0.05
|
> 0.05
|
> 0.05
|
> 0.05
|
> 0.05
|
> 0.05
|
|
I do not experience any IT connection problems during online learning
|
> 0.05
|
> 0.05
|
0.030
(B > MDS)
|
> 0.05
|
> 0.05
|
> 0.05
|
0.005
T3 > T2
|
|
I do not experience anxiety if I am asked questions during online learning
|
> 0.05
|
> 0.05
|
> 0.05
|
> 0.05
|
0.010
(C > NC)
|
> 0.05
|
> 0.05
|
|
I have more time to go through and read learning materials before group discussion with online learning
|
> 0.05
|
> 0.05
|
> 0.05
|
> 0.05
|
0.045
(C > NC)
|
> 0.05
|
> 0.05
|
|
I have more time to revise all of the learning materials after class with online learning
|
> 0.05
|
> 0.05
|
> 0.05
|
> 0.05
|
0.021
(C > NC)
|
> 0.05
|
> 0.05
|
|
I like online learning more than classroom learning
|
0.019
(F > M)
|
> 0.05
|
> 0.05
|
> 0.05
|
< 0.000
(C > NC)
|
0.030 (C > NC)
|
0.008
T3 > T2
|
|
I study more efficiently with online learning resources
|
> 0.05
|
> 0.05
|
> 0.05
|
> 0.05
|
< 0.000
(C > NC)
|
> 0.05
|
0.032
T3 > T2
|
|
Online learning motivates me to prepare learning materials for group discussion/s and to self-directed learning
|
> 0.05
|
> 0.05
|
> 0.05
|
> 0.05
|
0.002
(C > NC)
|
> 0.05
|
0.031
T3 > T2
|
|
Online lecturing should be implemented and maintained in the next academic year
|
> 0.05
|
> 0.05
|
> 0.05
|
> 0.05
|
< 0.000
(C > NC)
|
> 0.05
|
0.003
T3 > T2
|
|
Online learning gives similar learning satisfaction to classroom learning
|
> 0.05
|
> 0.05
|
> 0.05
|
> 0.05
|
< 0.000
(C > NC)
|
0.032
(C > NC)
|
0.031
T3 > T2
|
|
Communication with lecturers and fellow students is easier with online platforms
|
> 0.05
|
> 0.05
|
> 0.05
|
> 0.05
|
0.035
(C > NC)
|
> 0.05
|
> 0.05
|
|
Recorded lectures allows the student to listen to the lecture at a convenient time when the student is fully focused
|
> 0.05
|
> 0.05
|
0.001
(MDS > B)
|
> 0.05
|
0.026
(C > NC)
|
> 0.05
|
> 0.05
|
|
Recorded lectures resources allows the faculty to better utilise the contact time with students for clinical/preclinical skills sessions
|
> 0.05
|
> 0.05
|
< 0.0001 (MDS > B)
|
> 0.05
|
> 0.05
|
0.035
(C > NC)
|
> 0.05
|
|
The provision of lectures in between, or after, clinical/preclinical skills labs sessions is too tiring
|
> 0.05
|
> 0.05
|
> 0.05
|
> 0.05
|
< 0.0001
(C > NC)
|
> 0.05
|
> 0.05
|
|
Brackets denote group preference
M = Males, F = Females; NC = preclinical years, C = clinical years; B = Bachelor degree, MDS = Dental degree
Statistical Test: Mann-Whitney U Test
|
|
|
|
|
|
|
|
|
Student Grades
Table 3 displays the in between groupresults for type of lecture delivery (REC or F2F lecture), assessment type (SAC or MCQ), type of knowledge tested (CK or AK) obtained when comparing gender and level of training.
Table 3
Group differences in Correct Short and Multiple-Choice Questions between Genders and Years of Clinical Training.
Lecture
Delivery & Question
|
GENDER
|
MEAN RANK
|
p-value
|
CLINICAL TRAINING
|
MEAN RANK
|
p-value
|
Rec SAQ
|
Females
|
124.81
|
0.049
|
Preclinical
|
125.02
|
0.165
|
Males
|
106.83
|
Clinical
|
112.62
|
F2F SAQ
|
Females
|
113.5
|
0.567
|
Preclinical
|
133.05
|
< .001
|
Males
|
108.46
|
Clinical
|
93.84
|
CK-REC SAQ
|
Females
|
92.27
|
0.032
|
Preclinical
|
72.08
|
0.003
|
Males
|
75.52
|
Clinical
|
95.19
|
CK-F2F SAQ
|
Females
|
82.96
|
0.316
|
Preclinical
|
83.28
|
0.448
|
Males
|
75.49
|
Clinical
|
77.67
|
AK-REC SAQ
|
Females
|
89.97
|
0.175
|
Preclinical
|
86.62
|
0.894
|
Males
|
79.36
|
Clinical
|
85.59
|
AK-F2F SAQ
|
Females
|
80.51
|
0.863
|
Preclinical
|
78.33
|
0.7
|
Males
|
79.22
|
Clinical
|
81.18
|
Rec MCQ
|
Females
|
8.79
|
0.684
|
Preclinical
|
|
N/A
|
Males
|
7.63
|
Clinical
|
|
F2F MCQ
|
Females
|
8.96
|
0.521
|
Preclinical
|
|
N/A
|
Males
|
7.13
|
Clinical
|
|
CK-REC MCQ
|
Females
|
8.75
|
0.77
|
Preclinical
|
|
N/A
|
Males
|
7.75
|
Clinical
|
|
CK-F2F MCQ
|
Females
|
8.83
|
0.684
|
Preclinical
|
|
N/A
|
Males
|
7.50
|
Clinical
|
|
AK-REC MCQ
|
Females
|
9.08
|
0.446
|
Preclinical
|
|
N/A
|
Males
|
6.75
|
Clinical
|
|
AK-F2F MCQ
|
Females
|
8.67
|
0.862
|
Preclinical
|
|
N/A
|
Males
|
8.00
|
Clinical
|
|
SAQ- Short Answer Question; MCQ- Multiple Choice Answer Question; CK- Core Knowledge; AK- Applied Knowledge; Rec- Delivery of Lecture through Recorded Modalities
F2F- Face-to-face delivery of Lecture; IQR- Inter-Quartile Range (denoted in Brackets) Statistical Test: Mann Whitney U Test
|
Table 4 displays the same comparisons for within groupresults for gender (male and female) and level of training (preclinical and clinical).
Table 4
Within group differences in Correct Answers for Short and Multiple-Choice Questions according to Gender and Year of Clinical Training
Lecture Delivery
& Question Type
|
GLOBAL
|
GENDER
|
CLINICAL TRAINING
|
|
Median & IQR
|
p-value
|
Females Median & IQR
|
p-value
|
Males Median & IQR
|
p-value
|
Preclinical Median & IQR
|
p-value
|
Clinical Median & IQR
|
p-value
|
|
Rec SAQ
|
76.00
(66.00–84.00)
|
0.110
|
77.78
(68.00-86.17)
|
0.794
|
74.00
(61.00–80.00)
|
0.034
|
76.00
(68.00-86.67)
|
0.001
|
75.00
(64.00–82.00)
|
0.368
|
|
F2F SAQ
|
80.00
(64.00–88.00)
|
80.00
(64.00-88.08)
|
78.17
(64.25–87.67)
|
84.00
(73.33–86.59)
|
75.00
(58.00–84.00)
|
|
CK-REC SAQ
|
75.00
(62.50-90.91)
|
0.034
|
80.00
(65.00-93.33)
|
0.019
|
73.40
(60-38-86.20)
|
0.621
|
73.33
(55.21–86.59)
|
0.439
|
80.00
(66.67–93.33)
|
0.001
|
|
CK-F2F SAQ
|
80.00
(60.00–90.00)
|
76.47
(60.00–90.00)
|
79.20
(47.20-88.46)
|
84.61
(37.50-93.33)
|
79.00
(60.00-87.20)
|
|
AK-REC SAQ
|
75
(56.67–88.89)
|
0.043
|
76.47
(60.00–90.00)
|
0.330
|
72.20
(50.00- 88.22)
|
0.05
|
75.96
(35.85-92.00)
|
0.061
|
75.00
(61.54–85.71)
|
0.264
|
|
AK-F2F SAQ
|
80
(60.00-91.67)
|
75.00
(60.00-92.72)
|
80.0
(53.33- 90.00)
|
80.00 (48.75–91.67)
|
75.00
(60.36–90.20)
|
|
Rec MCQ
|
60.52
(52.63–68.42)
|
0.03
|
60.52
(52.63–72.36)
|
0.071
|
60.52
(46.05–67.10)
|
0.273
|
60.53
(52.63–68.42)
|
0.030
|
|
N/A
|
|
F2F MCQ
|
72.72
(65.91–81.82)
|
72.72
(65.91–81.82)
|
72.73
(59.09–79.54)
|
72.72
(65.90-81.82)
|
|
|
CK-REC MCQ
|
69.23
(55.77–84.61)
|
0.148
|
73.07
(55.77–84.62)
|
0.239
|
69.23
(57.69–80.77)
|
0.465
|
69.23
(55.78–84.61)
|
0.148
|
|
N/A
|
|
CK-F2F MCQ
|
80
(70.00–90.00)
|
80
(70.00–90.00)
|
80.00
(57.50–87.50)
|
80.00
(70.00–90.00)
|
|
|
AK-REC MCQ
|
40.62
(22.40-58.84)
|
0.658
|
41.67
(33.33-50.00)
|
0.723
|
33.33
(20.83–45.83)
|
0.713
|
33.33
(33.33-50.00)
|
0.659
|
|
N/A
|
|
AK-F2F MCQ
|
31.25
(13.03–49.47)
|
33.3
(17.36–49.24)
|
20.00
(0.0–75.00)
|
0.00
(0.00-100.00)
|
|
|
SAQ- Short Answer Question; MCQ- Multiple Choice Answer Question; CK- Core Knowledge; AK- Applied Knowledge; Rec- Delivery of Lecture through Recorded Modalities
F2F- Face to face delivery of Lecture; IQR- Inter-Quartile Range (denoted in Brackets)
Statistical Test: Related-Samples Wilcoxon Signed Rank Test
|
|
Question Type - On comparing males to females, the only significant finding was that females (Md = 124.81) scored better than males (Md = 106.83) when answering SAQs in general (U = 5502.5, z = -1.969, p = 0.049), and that female students answering SAQ for core knowledge (Md = 92.27) following recorded lectures scored better than male students (Md = 75.52) (U = 2753.5, z = -2.144, p = 0.032). No other differences were noted between genders for question type, content or lecture delivery type. Overall, students answering SAQ showed no statistically different results whether following recorded or F2F lectures. On the other hand, better global MCQ results were obtained following F2F lectures (Wilcoxon Signed Rank Test z = 2.172, n = 116, p = 0.030). Similar results were obtained when answering core knowledge, (Wilcoxon Signed Rank Tests z = -2.125, n = 144, p = 0.034) and similarly applied knowledge, (Wilcoxon Signed Rank Tests z = 2.022, n = 144, p = 0.043) topics with SAQ. There was no difference in grades for CK or AK following either recorded or face-to-face lectures when answering via MCQs.
Gender
In general, females were not affected by the mode of lecture delivery however scored better when answering SAQs following recorded lectures (Related-Samples Wilcoxon Signed Rank Test, (MD = 80) z = -2.348, n = 83, p = 0.019) as opposed to face-to-face lectures (MD = 76). Lecture delivery did not affect MCQ type assessments. Males on the other hand generally fared better with face-to-face lectures (Related-Samples Wilcoxon Signed Rank Test, (MD = 78), z = 2.116, n = 86, p = 0.034) as compared to recorded lectures (MD = 74) and when answering SAQ type assessments for applied knowledge (Related-Samples Wilcoxon Signed Rank Test, (MD = 80), z = 1.955, n = 61, p = 0.05) as compared to recorded lectures (MD = 72). Again, type of lecture did not affect MCQ type assessments.
Level of Training
Students in the preclinical years scored better for both SAQ (Related-Samples Wilcoxon Signed Rank Test, (MD = 84), z = 3.348, n = 100, p < 0.001) and MCQ (Related-Samples Wilcoxon Signed Rank Test, (MD = 72), z = 2.172, n = 61, p = 0.030) following F2F lectures as compared to recorded lectures (Md = 76, MD = 60.5, respectively) with no difference observed as to whether it was CK or AK being assessed. Clinical year student scores showed no overall differences however, scores for CK following recorded lectures (Md = 80) were significantly higher than following face-to-face lectures (MD = 79), p < 0.001). No MCQ type assessments are held in the clinical years.
On comparing preclinical to clinical year students for SAQ the preclinical students (Md = 133) fared better with face-to-face lectures when compared to the clinical year students (Md = 93) (Mann Whitney U Test, U = 3945.0, N = 222, z = -4.529, p > 0.001). There was no difference for recorded lectures. The clinical years scored better at SAQ type assessments for core knowledge following recorded lectures (Md = 95) as compared to the preclinical year students (Md = 72) for core knowledge subjects (Mann Whitney U Test, U = 4448.5, N = 171, z = 2.993, p = 0.003).
Discipline
Overall, grades in Prosthodontics were statistically better when assessed by MCQ following recorded lectures (Md = 75) as compared to face-to-face lectures (Md = 61, p = 0.03) and students scored statistically better results in SAQ for CK in Prosthodontics after receiving recorded lectures (Related-Samples Wilcoxon Signed Rank Test, (MD = 72), z = -2.692, n = 77, p = 0.007). Results were statistically better following face-to-face lectures in Orthodontics (Related-Samples Wilcoxon Signed Rank Test, Md = 72, z = 3.291, n = 44, p = < 0.001) and Special Care Dentistry (Related-Samples Wilcoxon Signed Rank Test, Md = 85, z = 2.158, n = 15, p = 0.031) as compared to recorded lectures (Md = 63, Md = 76, respectively). Grades achieved in assessment of applied knowledge in Operative Dentistry were statistically higher following recorded lectures (Related-Samples Wilcoxon Signed Rank Test, Md = 76, z = 2.197, n = 7, p = 0.028) as compared to face-to-face lectures (Md = 75).
Students’ Responses to open-ended questions (Q2 at T2–2020/2021)
Thoughts about Online Learning: 92% out of 98 respondents replied, of which (a) 25.6% favoured in-person lecturing since they viewed it as more engaging and allowed for student socialising. Out of these, 83% were preclinical year students; (b) 10% of respondents wanted a balanced approach between online and in-person lecturing, and; (c) 64% of respondents favoured an online approach, with (i) 21% specifically favoured pre-recorded lectures as this modality allowed for revision and viewing of the lectures at a convenient time, (ii) 2% because it kept them focused during lecturing and (iii) 41% as it allowed for better time management.
Suggested Improvements (Q2 at T2–2020/2021): 56% answered the question, of which (a) 66% reported an overall positive experience with online lecturing. Students suggested that tutors provide teaching resources in advance of the lectures so that they can prepare in advance; (b)15% reiterated the need for in-person lecturing because they view this approach as an opportunity to socialise and avoid mental health issues, and (c) 18% urged the faculty to schedule lectures better to facilitate their educational experience.
Comments I (Q2 at T2–2020/2021):
S17 “Social interactions before lectures and after the lecture ends helps me personally as I can catch up with my friends and de-stress a bit. With online lectures, this idea is lost as no one wants to be there early or stay after.”.
S62 “Since we have clinic, it is much more convenient to have recorded lectures and follow them when we are able to dedicate the time to listen carefully, take notes and study. One would be in a more ideal state of mind, then after a tiring day of clinic. Having the lecture notes, several lectures at a time, and the ability to pause and re-listen; one can understand and build concepts in mind more effectively”.
S86 “Even though I prefer face-to-face lectures as I tend to grasp certain concepts better, I believe that the faculty should really look into the idea of 'recorded lectures. I tend to understand best when watching recorded lectures since this gives us the freedom to;
1. Pause the video and research (the web, books etc) since sometimes lecturers might unknowingly speed through certain concepts
2. Rewatch the lecture in the future (especially prior to exams when we wish to refresh our memory)
3. Watch the lecture at the most suitable time (for instance, I'm a morning person who would much prefer studying in the mornings and listening to lectures in the evenings when I tend to be more tired). On the other hand, in person lectures are important since human contact is crucial. For this reason, I believe that we should have a mix of face-to-face as well as recorded lectures”.
S73 “Recorded lectures could benefit students with learning disabilities, as it would allow them to view the lecture at their own pace, which is helpful if they struggle to understand the lecturer or focus during the lecture”.
Students’ Responses to open-ended questions (Q2 at T3–2021/2022) II:
At the end of the third academic year (2021/2022), 44% of the respondents expressed no preference for changes to lecturing modes, 22% expressed a preference for a hybrid arrangement of specifically a combination of recorded and in person F2F lectures, 17% requested online lectures with a further 17% specifically requesting recorded lectures. There was one specific request for return to classroom-based lectures.
Comments (Q2 at T3–2021/2022) II:
S61: The introduction of online lecturing is a great idea, especially with recorded lectures…. Recorded has also helped me with revision- listening at a preferred speed, stopping it at any stage, and reading and making sense of the lecture.
S73: Online lecturing is superb. I like best the recorded lectures and tutorials. The recorded lectures can be followed when one is best focused… To be honest I was not too keen last year about it but now I really appreciated their use.
S77: Although I believe face to face lectures are a better and more engaging learning method than online lectures, given our hectic timetable, a mix between online lectures and face to face lectures would probably be the best option. Online lectures allow more freedom and time for studying, especially after clinical/pre-clinical sessions.