Despite reporting some issues with “virtual clerkship”, which is challenging in providing real patients experiences for medical students [3], combined mode of course on dental virtual clerkship seems to provide enough efficacy for both teacher and students and to be a key substitute component under this circumstance. 80.95% final-year students performed well on emotion category, suggested the strong desire to learn and apply the knowledge. Compared to non-final-year student who were also having online theory courses, score of the participation category was also higher which suggested the better engagement in this combined mode than that of non-final year online learners (Table 2, Figure 1A). Increase in DA in final-year students suggested the study process was performed well, meanwhile, the students were adapting to the online and student-centered learning gradually with the application of combined courses [21] (Table 3, Figure 1B). The self-efficacy of tutors was high and consistent with other research [22], indicating that tutors had good sense of the efficacy and the ability to direct the learning process of their student [23]. The majority of the respondents have a high efficacy in all three sub-dimensions of self-efficacy with no significant difference (Table 4).
The student engagement of online course is very important for the retention of online learners [24, 25]. With analysis of feedback on student engagement, it can be concluded that final-year students were interested in learning. Students thought they engaged in activities, focused on teaching materials, try their best, and deserved good scores [26]. The attitude towards grades on item 15 and 16 suggested that the expectation was higher than reality (Table 1). Some students reflected that there were many quizzes, which might be the reason for low score for item 15 and 16. Teaching assessment should be re-assigned and designed for students.
Learning approaches were usually indicated of learners’ perceiving, interaction with and responding to the learning environment [27]. Proper teaching methods are involved which could be applied allowing students to learn most effectively [26]. If students’ learning approaches have been identified, proper teaching formats could be implemented and applied [28]. In this study, mean scores of deep approaches including learning motive and strategy were found higher among students in years 5 (Table3, P<0.01). Our study is consistent with Newble and Gordon’s study, which reported that high scores were found on DA in senior medical students [29]. The observed higher DA score in years 5 students might suggest a carry-over from post-graduate examination that is both externally and internally driven and education background might be a key factor for learning approaches [30]. Different format of teaching might be another explanation [31]. Lectures in other grades are mainly micro-video class for theory, which was uploaded onto the online platform. Whereas, in the years 5, various types of study and teaching mode were carried on so as to simulate clinical practice as much as possible and some of them were PBL, which was proved to increase in a deep learning [32, 33]. In addition, workload or other factors, may be more as determinants than course type as well [21].
Though traditional by-chair clerkship is irreplaceable, the advantage for this combined virtual clerkship mode are as follows (Table 5). Taking SPOC, which could be repeatedly watched by the trainees, could greatly improves training effect [11]. The application of PBL and the exploration and practice of health management has been widely applied in Tongji Medical College [34], especially the dental health management and consultation from family or friend, making the role of dentist impressive. The clinic was reopened on April 8th, which make the live broadcasting available. Self-perceived student-to-tutor interaction was kept constant in both face-to-face and live broadcast [35]. Student Combined mode of SPOC, group talking, live broadcasting, health management for dental students’ relatives is utilization of network tools to present clerkship courses, which could simulate to the maximum of by-chair clinical practice, providing patient medical histories, oral examinations, medical recording, and the art of detective conversations.
We learned several lessons as well. First, make sure all potential users could use the application. It’s very challenging on the willingness of faculty to embrace the new technology [40]. Anything, including poor connection, or unfamiliar with apps operation should be taken into consideration first. With the reflection of such problems, teaching assistants helping both teachers and student to solve problems which often disrupt the flow of the class. Second, videos are encouraged to use for both teachers and students, which may improve the sense of interacting and engaging for both speakers and listeners. However, it’s better to blur the participants’ background for privacy protection, while unintended interruptions should also be avoided.
Difficulty in teaching dental practice via internet is still the main limitation. To learn these techniques, simulated patients are needed. Traditional by-chair learning is still a more effective way for medical education [7].
As social distancing is needed during pandemic, the combined virtual mode has significantly changed the way of teaching and engaging with our dental interns. Additionally, it has helped us to foster a sense of attenuating intern’s burnout and to some extent promote dental wellness especially during or after the isolation. Combined modes of courses on virtual learning program may play a important role in medical clerkship education during or after the pandemic.