Assessment and evaluation of online education and virtual simulation technology in dental education: a cross-sectional survey | BMC Medical Education

Under the impact of the epidemic, Chinese medical schools have encouraged teachers to change teaching methods and conduct online teaching of theory courses to provide students with distance learning opportunities to minimize the impact of the epidemic on medical students’ learning. The Nanjing Medical University Stomatology School actively explored new teaching methods and developed a blended learning approach that combines online and virtual reality technology to ensure the quality of teaching for dentistry students. By administering questionnaires and comparing scores, we explored the teaching effect of the new teaching approach. We propose suggestions and opinions for future teaching reform.

Due to the impact of the epidemic, many digital teaching concepts and research findings have emerged in the field of medical teaching worldwide [16, 17]. Abbasi S et al. concluded that most students have a negative view of online learning, which may be related to internet familiarity and usage [18]. Cheng et al. showed that despite the impact of online learning as a new way of studying students’ learning styles and progress, most students still accept online learning [16]. This study revealed that students were more receptive to online courses. Most students believed that online courses were more conducive to developing students’ independent learning skills by changing their learning style. Nevertheless, some students felt that online courses were less efficient because they were not supervised by teachers on site, while other students were neutral about this viewpoint. This may be related to students’ study habits. For students with good self-discipline, the effect on learning efficiency of whether the course was supervised by a teacher or classmates was not significant.

The use of an e-learning platform to teach theoretical content can be divided into two forms, synchronous teaching and asynchronous teaching, according to whether teachers and students are online at the same time [19, 20]. Synchronous teaching mainly refers to online live teaching, which can achieve synchronous interaction in the teaching process. Teachers and students can interact in real time through questions and connections, and students can directly provide feedback on difficult knowledge points [21]. Asynchronous teaching is conducted through interactive teaching methods such as video, which is flexible in time and space. Teachers upload teaching resources to the teaching platform in advance, and students can arrange time to learn independently [22, 23]. Previous studies have shown that students are more interested in asynchronous learning, although it involves less teacher‒student interaction [24]. Our research showed that in asynchronous teaching classes, students could watch knowledge points repeatedly, which was conducive to consolidating the knowledge points and providing students with a pleasant learning experience through efficient and diverse extended learning. However, asynchronous teaching courses affect effective interactions between teachers and students, and most students believe that they cannot communicate with teachers face-to-face in online courses and that they cannot receive timely answers to their questions. The synchronous teaching course was convenient for real-time communication between teachers and students, but the live course was strongly affected by objective factors such as network speed and software, and some students believed that there were unstable networks and connection lags in online courses. The integration of synchronous teaching and asynchronous teaching can provide complementary advantages and improve the effectiveness of online teaching.

Online teaching is also a challenge for teachers [25]. It is difficult to transform teachers’ teaching concepts from traditional teaching to online teaching. Teaching spaces, teacher preparation methods, teaching methods, and teacher‒student interactions all need to be adjusted. Although the online network platform is rich in variety and relatively simple to operate, for some teachers, the operation of online teaching equipment and the use of the network platform affect the quality of teaching. It is difficult for teachers to optimize students’ learning using corresponding teaching software, which may further reduce students’ enthusiasm and initiative for learning. In this study, teachers’ attitudes toward online teaching were somewhat negative. Although the hardware and software conditions met the needs of online courses and teachers could use online teaching platforms proficiently, they believed that the teaching effect of online teaching was not necessarily better than that of offline classes. This might be related to factors such as the inability to support students in real time and the lack of communication between teachers and students. In addition, online class preparation was difficult, and long-term online teaching made teachers feel tired, which might also influence the teaching effect. The difference in the attitudes of teachers and students toward online classes might be related to the transformation of teachers’ teaching methods and concepts.

Dental education has its own characteristics and contains many practice-based courses, but online education cannot provide clinical teaching and practice experience [26]. Digital and multimedia teaching is gradually becoming a future trend to supplement classroom presentations and laboratory teaching. In recent years, digital interactive systems have played an important and unique role in the process of medical education [27, 28]. The virtual simulation teaching system has gradually been applied in various branches of discipline. Virtual simulation with three-dimensional software technology has been used to construct the human body model so that students can understand the anatomical structure more intuitively through a “roaming” interactive mode, not only to stimulate students’ interest in learning but also to concretize and visualize abstract content, which can improve student interaction [29,30,31]. In addition, through simulation, students’ basic knowledge can be consolidated more effectively. Carlos M. Serrano et al. assessed the educational implementation of virtual reality and haptics as well as school satisfaction and reported that most schools were satisfied with virtual reality haptic dental trainers [32]. In the past three years, our college has designed and developed virtual simulation teaching platforms for oral anatomy and physiology, endodontics, oral and maxillofacial surgery, prosthodontics and orthodontics and applied them in teaching practice during the epidemic. The results of the questionnaire showed that students were satisfied with the virtual simulation platform in terms of ease of use, effectiveness, and content abundance. Almost all of the students’ comments were positive. Most students agreed that the virtual operating platform could help them grasp the standard procedure and master the key points of operation and could effectively improve clinical diagnosis and thinking skills. The results indicated that the virtual operating platform had certain advantages and was suitable for continued application in teaching practical skills.

Blended learning is a mixture of traditional face-to-face learning and simultaneous or asynchronous online learning. This approach is regarded as a promising substitute for medical education because of its integrative nature [33]. Furthermore, this method has been reported to improve the clinical practice of medical students [34]. However, studies of blended teaching methods for online education and virtual simulation technology have rarely been reported. We compared and analyzed the student test scores for two grades to determine the teaching efficacy of the blended teaching method, which combined online learning with virtual simulation training. There was no significant distinction between the scores of students who received blended teaching and those who received traditional teaching for theory classes, suggesting that online education had an impact on learning that was comparable to that of offline education and that online education did not affect students’ learning outcomes.

In recent years, an increasing number of researchers have focused on empirical research on the role of virtual simulation or simulation-based serious games in improving the effectiveness of dental education [14]. Rasa Mladenovic et al. found that in the age of COVID-19, serious games involving local anesthesia can improve students’ knowledge and skills as an additional e-learning tool [35]. Lemos et al. found that serious play can lead to positive perceptions, can be used to motivate students to learn, and can achieve better learning outcomes than traditional learning [36]. In our study, the teaching effect of using the virtual simulation platform was marginally inferior to that of traditional offline skills training in terms of practical skills, which was potentially attributed to incomplete content coverage in the early stages of platform development and students’ unfamiliarity with the system. The virtual simulation platform can therefore be used in addition to traditional skills training but cannot replace offline skills training. Notably, previous studies have focused on the impact of one type of simulation on learning outcomes. In our study, our Virtual Education System for Dentistry consisted of two parts: a serious simulation-based game and a surgical simulator with a feedback system. The content of the simulation included clinical diagnosis and treatment simulation and clinical skill operation. According to Bloom’s taxonomy, there are six progressive levels of learning from the foundation to the top in the following order: knowledge, understanding, application, analysis, synthesis, and evaluation. Through the utilization of our Virtual Education System for Dentistry, we anticipate improvements in students’ clinical reasoning and operational proficiency through advanced training. Further research is being conducted on the application of the Virtual Education System for Dentistry.

Overall student performance did not differ significantly between the two teaching approaches, demonstrating that objective factors such as epidemic-related school closures had no impact on how effectively pupils learned. The blended teaching approach was able to offer a superior teaching outcome during the pandemic and played a significant role in its application. Considering the advantages of blended teaching methods, further research can be conducted on teaching practices promoted and applied in medical schools. In Kirkpatrick’s model, the evaluation system is divided into four levels: how participants respond to the project, what they can learn from the project, whether and how the project changes their practice behavior, and the far-reaching impact of the project on participants. In this regard, further research should focus on assessing the far-reaching impact of blended teaching models on students, similar to the third and fourth levels of Kirkpatrick’s model.

The generalizability theory is used to accurately estimate the reliability of complex tests that involve multiple sources of measurement error, including generalizability studies (G studies) and decision studies (D studies) [37]. The generalizability theory is suitable for the reliability analysis of tests involving many influencing factors, such as clinical skills. Most analyses included participant, evaluator, evaluator, and interaction as factors. At present, generalizability theory has become the mainstream theory of quality analysis for practical ability evaluation, and a plethora of studies have applied it to OSCE [38]. In our study, Cronbach’s coefficient was used to measure and evaluate the examination results. In future studies, generalizability theory should be considered to comprehensively evaluate the influence of various factors on students’ scores, further improve the test design and optimize the reliability of the test.


There were several limitations to our study, mainly in two aspects. On the one hand, there were limitations in the use of learning tools. Currently, no artificial intelligence teaching method can simulate real patient and diagnosis and treatment processes, and more informative projects need to be developed. The virtual simulation platform lacked mechanical feedback, and the current use of offline simulators with force feedback was limited by development costs and could not be promoted on a large scale. Additionally, the subjects of this study were fourth-year university students, but internship students were excluded. The teaching effect of virtual simulation on students in the internship stage needs further research. It may be more appropriate to compare learner performance among students in the same cohort because different effects come from different learning strategies, different groups of learners, or the difficulty level of tests.


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