Eur J Dent Educ 2004; 8: 43±46

All rights reserved

Instructional multimedia program versus standard

lecture: a comparison of two methods for teaching the
undergraduate orthodontic curriculum
M. Aly1, J. Elen2 and G. Willems1
1
Department of Orthodontics, School of Dentistry, Oral pathology and Maxillo-facial Surgery, 2Centre for Instructional Psychology and Technology,
Katholieke Universiteit Leuven, Leuven, Belgium

Aim: To compare the effectiveness of an interactive multimedia about knowledge, understanding, and application in the ortho-
courseware package versus standard lectures regarding knowl- dontic curriculum. However, both groups improved their scores
edge, understanding, and transfer of content, as well as problem- after the course. In one question investigating the extent of
solving skills in orthodontics. understanding the instructional content of the multidisciplinary
Methods: Pre- and post-test assessments of ®nal-year dental orthodontic treatment, the multimedia courseware package
students (n ˆ 26), who either used an interactive multimedia group scored signi®cantly better.
courseware package (n ˆ 15) or attended standard lectures Conclusion: In this study, the instructional interactive multime-
(n ˆ 11) on equivalent material of the undergraduate orthodontic dia program was found to be at least as effective as the standard
curriculum were carried out. Both groups were tested by written lecture of the orthodontic curriculum for undergraduate training in
and multiple-choice questions covering knowledge, understand- orthodontics.
ing, and application areas in the curriculum. A one-way ANOVA was
carried out in order to check statistical difference between the Key words: computer-assisted learning; orthodontics; self-
two groups. The P-value was set at 0.05. directed learning; multimedia applications; evaluation.
Results: There was no difference in prior knowledge between
the groups at baseline. Generally, no signi®cant difference was ß Blackwell Munksgaard, 2004
seen between the two groups in relation to answers to questions Accepted for publication 10 September 2003

C in health care and medical school curricula

HANGES
made computer-assisted learning (CAL) more
valuable than previously. Even though computers
tion. Early concern that CAL would be inferior to
traditional teaching methods has been countered by a
number of studies, which demonstrate that carefully
have been available for use in education for some time, focused CAL can be at least as effective as standard
their application has not evolved as quickly as many teaching methods for appropriately chosen subject
assumed it would (1). The heightened appreciation matters (4±7).
of independent learning and early patient contact Advances in technology and software allow instruc-
in the undergraduate dental curriculum has stimu- tors to design and create majority of the instructional
lated the academic authorities to emphasize self- multimedia programs themselves. A multimedia cour-
directed and problem-based learning approaches. seware package in orthodontics was developed in our
However, although these methods are seen as increas- teaching centre to provide dental students with an
ingly relevant to medical and dental education (2), they interactive means of self-study and self-evaluation.
can be expensive in terms of staff time. Moreover, low The developed courseware package consists of 14 pro-
staff to student ratio and demand for improved ef®- grams covering different topics of the undergraduate
ciency produce a situation where novel alternative orthodontic curriculum. Developing the courseware
forms of dental education are needed. package took approximately 2 years. Despite the fact
One alternative delivery method for self-directed, that the production of such multimedia courseware
problem-based teaching is the use of CAL. Multimedia package can be expensive, cost was kept minimal
CAL enhances learning (3), allowing the student full as all authors contributed to the educational design
control over content, time, place, and pace of instruc- and content of the courseware package. All authors

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Aly et al.

were involved in the overall programming of the material in the form of CAL package with didactic,
courseware. interactive, simple animation, and self-assessment
Previous assessment of the courseware package components. This group assisted at ®ve 90-min work-
showed that the developed module was generally ing sessions with 3-week intervals while using the CAL
liked, and improved understanding of the orthodontic course. The CAL package was available to the students
curriculum by the dental students was demonstrated. in the CAL laboratory between 08.30 and 20.00 h on
However, two-thirds of the students were seriously weekdays through the study period. If they wished to,
questioning whether this courseware package could they were also able to access the package at other times
replace lectures (8). Little researches in the ®eld of through the Internet. The undergraduate dental curri-
undergraduate orthodontic curriculum with regard culum has a semester structure that runs simulta-
to the comparison of teaching and training methods neously. After the ®rst semester, the courses of both
have been published (3). Hence, the development of an groups are exchanged. Group A received lectures and
evidence base to support such innovative technique was assessed at the end of the ®rst semester. From the
being introduced into undergraduate training is of second semester onwards, the CAL package was
prime importance (9, 10). installed in the CAL laboratory and made available
The purpose of this study is to compare the effec- to group B. This would ensure that the lecture group
tiveness of an interactive multimedia courseware pack- was isolated from the multimedia courseware package
age with that of standard lectures in orthodontics during the study.
regarding knowledge, understanding, and transfer of In both groups, before commencing with the lectures
content. or the CAL package, each student completed a 13-item
pre-test in order to evaluate the students' prior knowl-
edge in orthodontics. Also 3 weeks after the completion
of the course, a 13-item post-test was set up for both
Subjects and methods
groups. The tests were designed by all authors, and
Subjects questions were put independently from the instruc-
A total of 26 undergraduate dental students at the tional medium used.
school of Dentistry, Oral Pathology and Maxillo-facial The pre- and post-tests were aimed at measuring
Surgery, Katholieke Universiteit Leuven, were students' knowledge, understanding, and application
assigned to two groups. Group A consisted of 11 of the learned materials. The tests were assessed by
students who received standard lectures, while group calculating the total score of the correct answers.
B consisted of 15 students who received the same Statistical analysis was performed using the SPSS
content through a multimedia courseware package. statistical package (SPSS, Inc., Chicago, IL, USA). A
Students were alphabetically assigned to each group. one-way ANOVA was carried out in order to check for
They could not themselves select in what way to study statistical difference between the two groups. The
the subject matter. P-value was set at 0.05 for signi®cant differences.

Methods
The objectives of the teaching sessions, whether lecture-
or computer-based, were identical. The lecture group
Results
received 90-min lectures based on the orthodontic cur- There was no signi®cant difference in prior knowledge
riculum provided at this stage of the undergraduate between students in the two groups at baseline
course. Ten weekly lectures covered orthodontic diag- (Table 1).
nosis, cephalometric analysis, removable appliances, In general, there were no statistical differences in
biomechanics, treatment planing, and multidisciplin- acquiring knowledge, understanding the instructional
ary orthodontic treatment. The lectures were given in
the afternoon (around 13.30 h). Before the students TABLE 1. Pre-test mean scores to assess the baseline knowledge
started the lecture, they had approximately a 1-h break between the two groups. Post-test mean scores to determine the
amount of knowledge gained by each group (P > 0.05)
after their morning session (from 8.30 h) in different
clinical departments. The lectures were given in a Pre-test SD Post-test SD
mean score mean score
lecturing room, using both the classical blackboard in
addition to a PowerPoint1 presentation (LCD projec- Group A 48.6 15.1 79.2 19.2
Group B 54.1 10.9 86.2 27.3
tion). All the lectures were given in standardized con-
ditions. The students in group B received the same P-value 0.29 ± 0.46 ±

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 Instructional multimedia program versus standard lecture

TABLE 2. Post-test mean scores of one question assessing the improved post-test score of the instructional multime-
extent of understanding the instructional content of multi-
dia group after course completion concurs with the
disciplinary orthodontic treatment (P < 0.05)
previous studies, where participants improved using
Mean score SD
CAL and reported de®nite knowledge gain (15±18).
Group A 4.7 3.4 This may be attributed to the self-paced nature of
Group B 7.9 2.6 the instruction. Students are encouraged to take the
P-value 0.01 ± most ef®cient path to content mastery, skipping
areas of strength while investing more time in areas
content and application of the learned matter between of weakness.
the lecture versus the multimedia courseware package The signi®cantly better answer of the multimedia
groups (Table 1). However, in one question investi- courseware package group, concerning one question
gating the extent of understanding the instructional on understanding multidisciplinary orthodontic treat-
content concerning multidisciplinary orthodontic treat- ment, can be attributed to the possibility that the gains
ment, the CAL group scored signi®cantly better made by the CAL group were achieved partly, or
(Table 2). In both groups, the students scored signi®- wholly, as a result of peer interaction between the
cantly higher in the post-test after completion of the students. This interactivity between the students is
course compared to the pre-test. more likely to have been accentuated at the courseware
package group rather than the lecture group. Observing
the students' performance and participation in the CAL
group, students prefer to sit in groups (two or three)
Discussion while studying the subject matter. On the contrary,
This study demonstrates that the instructional multi- students in the lecture group were rather passive
media program was found to be at least as effective as receivers, even though they had been encouraged to
the standard course of lectures in orthodontics. This is interact with the lecturer. Furthermore, the nature of
in agreement with the ®ndings of reports published on the multidisciplinary orthodontic treatment under-
the ef®ciency of instructional multimedia programs in standing is greatly in¯uenced by the dental prior
dental teaching settings. Levine et al. (11), Turner and knowledge and previous experiences of the individual
Weerakone (12), and Clark et al. (13) showed no sta- dental student.
tistically signi®cant outcome differences between lec- Chadwick et al. (19) described the adoption of active
ture and instructional multimedia groups. Findings of learning in an undergraduate orthodontic program
the present study extend the widening body of evi- through a variety of teaching techniques, including
dence, which indicates that CAL is as effective as CAL. Instructional multimedia programs may be a
standard lectures in orthodontics and dental education. cost-effective way of conveying new knowledge,
Participants who used the instructional multimedia specially when shortage of academic staff in orthodon-
package were forced to respond to and interact with tics is becoming an issue. This approach proved to
the taught materials. Immediate interaction/feedback provide a ¯exible means of learning, and can free
provides constant, highly effective reinforcement of staff±student contact time while still providing the
concepts and content. The non-linear approach of using student with an effective teaching medium. Researches
the interactive multimedia package can accommodate have consistently proved that CAL is at least as good
students' diverse learning styles, experiences, and as conventional teaching and occasionally better.
knowledge bases. Although lectures are demanding of teachers' time
However, the exception was Hobson et al. (14), who and frequently supplemented with other resources,
investigated CAL when compared to a tutorial on care should be taken not to use instructional multi-
orthodontic diagnosis and treatment planning, and media programs exclusively. The multimedia course-
found that conventional lectures scored better than ware package should be seen as complementary to
CAL. The participants of that study felt that the pre- other contact teaching more suited to clinical skills
sence of an instructor at the CAL session to provide and attitudes (20, 21).
answers to any queries might have improved the out-
come of the teaching method.
During both instructional multimedia program
course and conventional lectures, the students gained
Conclusion
the targeted knowledge, understanding, and applica- Generally, the instructional multimedia courseware
tion of the subjects covered by the course. The package was found to be at least as effective as standard

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Aly et al.

lectures in teaching the undergraduate orthodontic 11. Levine RS, Harold-jones J, Morgan C. Comparison of
computer-aided learning with tutorial teaching in a
curriculum. CAL is an effective way of increasing
group of first-year dental students. Med Educ 1987: 21:
knowledge, understanding, and application in teaching 305±309.
orthodontics. As we move to the 21st century, educa- 12. Turner PJ, Weerakone S. An evaluation of a hypertext
tion must embrace instructional multimedia programs system for computer-aided learning in orthodontics. Br J
Orthod 1993: 20: 145±148.
as a method of learning provided that they are based on
13. Clark RD, Weekrakone S, Rock WP. A hypertext tuto-
a didactic and guided approach. In this contribution, rial for teaching cephalometrics. Br J Orthod 1997: 24:
educational designers have to focus more on planning 325±328.
and organization of the instructional multimedia pro- 14. Hobson RS, Carter NE, Hall FM, Atkins MJ. A study into
the effectiveness of a text-based computer-aided learning
grams. Further research is certainly needed on the
program in comparison with seminar teaching of
underlying instructional design (e.g. micro- and macro- orthodontics. Eur J Dent Educ 1998: 2: 154±159.
sequencing) that induces a cognitive process when 15. Stephens CD, Dowell TB. The acceptability of a compu-
using CAL in dental education. ter-aided instruction to the undergraduate. Br Dent J
1983: 154: 375.
16. Long AF, Mercer PE, Stephens CD, Grigg P. The evalua-
tion of three computer-aided learning package for
general dental practitioners. Br Dent J 1994: 177: 410±415.
References 17. Pollard DJ, Davenport JC. An evaluation of training
1. Caroll AE, Schwartz W. A comparison of a lecture and general dental practitioners in partial denture design
computer programme to teach fundamentals of the using computer-aided learning program. Br Dent J 1994:
draw-a-person test. Arch Pediatr Adolesc Med 2002: 177: 405±409.
156: 137±140. 18. Downes PK, Eaton KA. The evaluation of safequest ± a
2. Spencer JA, Jourdan RK. Learner-centred approaches in computer-aided learning program on cross-infection
medical education. BMJ 1999: 318: 1280±1283. control for the dental team. Br Dent J 1997: 183: 333±337.
3. Lowe CI, Wright JL, Bearn DR. Computer-aided learning 19. Chadwick SM, Bearn DR, Jack AC, O'Brien KD.
(CAL): an effective way to teach the index of orthodontic Orthodontic undergraduate education: developments in
treatment need (IOTN) ? J Orthod 2001: 28: 307±311. a modern curriculum. Eur J Dent Educ 2002: 6: 57±63.
4. Kulik CC, Kulik JA. Effectiveness of computer-based 20. Devitt P, Palmer E. Computers in medical education.
instruction: an updated analysis. Comput Hum Behav Part 1. Evaluation of a problem-oriented learning
1991: 7: 75±94. package. Aus N Z J Surg 1998: 68: 284±287.
5. Gathy P, Denef JF, Haumont S. Computer-assisted self- 21. Holt RIG, Miklaszewicz P, Cranstone IC, Russell-Jones
assessment (CASA) in histology. Comput Educ 1991: 17: D, Rees JP, SoÈnksen PH. Computer-assisted learning is
109±116. an effective way of teaching endocrinology. Clin En-
6. Stephens C, Grigg P. A computer-based orthodontic docrinol 2001: 55: 537±542.
learning package: report of a trial. Dent Update 1994: 21:
64±68. Address:
7. Handler TJ, Lynch P, Jaffe CC. Computer-aided learning Prof. Dr G. Willems
validation: a CAI-critical mission. Proc Annu Symp Department of Orthodontics
Comput Appl Med Care 1995: 19: 522±526. School of Dentistry
8. Aly M, Willems G, Carels C, Elen J. Instructional Oral Pathology and Maxillo-facial Surgery
multimedia programs for self-directed learning in under- Faculty of Medicine
graduate and postgraduate training in orthodontics. Eur Katholieke Universiteit Leuven
J Dent Educ 2003: 7: 20±26. Kapucijnenvoer 7, B-3000 Leuven
9. Petersen S. Time fore evidence-based medical education. Belgium
BMJ 1999: 318: 1223±1224.
10. Hutchinson L. Evaluating and researching the effective- Tel: ‡32 16 33 24 59
ness of educational interventions. BMJ 1999: 318: Fax: ‡32 16 33 24 35
1267±1269. e-mail: [email protected]

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