The combination of a SPOC with evaluative interactive learning in dental adhesion education: a comparison with a lecture-based learning mode

Abstract

Background

Dental education focuses on the cultivation of students’ diagnosis and treatment ability, and improving the teaching effect is an important prerequisite for achieving this goal. This study evaluated whether the combination of a small private online course (SPOC) with evaluative interactive learning (EIL) could effectively enhance students’ engagement in learning and improve their ability to understand and apply knowledge pertaining to dental adhesion.

Methods

A total of 79 undergraduate students were divided into an EIL group and a lecture-based learning (LBL) group. Students’ levels of participation were evaluated in terms of the frequency of their speech and interaction. Students’ ability to apply their basic knowledge, competency knowledge, and operational skills were assessed with a written test and an operation test. Students’ perceptions were assessed via questionnaires.

Results

Students in the EIL group presented higher levels of engagement and interaction frequency than did students in the LBL group. The students in the EIL group outperformed those in the LBL group on the ability analysis test and operation test, whereas no significant differences were observed between the students in these two groups with respect to the basic knowledge test. In addition, the scores obtained by the students in the EIL group exhibited a notable shift toward a higher range. The students in the EIL group also exhibited a better ability to employ various effective bonding methods. The questionnaire results revealed that EIL can promote active learning among students without increasing the burdens that they face.

Conclusion

The use of this combination of a SPOC with EIL as an approach to education in dental adhesion can achieve good results, including significant improvements in students’ learning participation, clinical thinking, and operational abilities as well as their willingness to learn actively.

Background

Owing to the increasing popularity of higher education and the expansion of undergraduate enrollment in China, lecture-based learning (LBL) remains prevalent in dental education [1]. The LBL model has the advantages of saving teaching resources and imparting knowledge in an accurate, systematic and coherent way, and it can rapidly popularize and disseminate knowledge [2]. However, with the development of social and education, the LBL model has been impacted by several pressing issues that hinder the development of competency-based learning objectives in dental education. First, student participation in the learning process is insufficient. Interactions between teachers and students are limited, and the level of education efficiency is low, thus making it difficult to promote student-centered active learning [3, 4]. Second, efforts to cultivate students’ critical thinking ability are insufficient. Students do not question or think for themselves in passive learning, thus rendering them unable to analyze and address complex clinical issues. Third, the evaluation methods used for such education are singular and lack timeliness; furthermore, they rely primarily on offline terminal assessments, thus making it difficult for teachers to adjust teaching to promote acceptance and mastery among their students in a timely manner. These issues often cause students to neglect, misunderstand, or fail to address the application of their knowledge and skills, thus giving rise to a hidden danger with respect to their future clinical practice.

Scientific and technological advancements have driven the development of medical education [5]. Blended teaching with the assistance of internet technology has made teaching activities more flexible, teaching methods more engaging, and teaching evaluations more convenient [5, 6]. Blended teaching on the basis of a small private online course (SPOC) can improve teaching effectiveness and facilitate the development of offline participatory classrooms [7, 8]. The bridge-in, outcomes, preassessment, participatory learning, postassessment, and summary (BOPPPS) instructional model emphasizes participatory learning, in which students actively engage in the learning process under the guidance of teachers, thereby achieving learning objectives on the basis of activities such as discussions, collaboration, and practical exercises [9, 10]. Accordingly, we propose a combination of a SPOC with evaluative interactive learning (EIL, a learning model that integrates evaluation-based discussions and interactive competitions to increase student engagement and active learning). Via the XuetangX SPOC platform, we can effectively monitor students’ learning processes and feedback, thereby facilitating assessments of the implementation process. By dividing students into discussion groups in class and organizing intergroup competitions regarding students’ number of speeches, student participation can be promoted. We restructure knowledge, such as by organizing clinically relevant information into evaluative cases or videos that mix correct scenarios with incorrect scenarios. Through a progressive learning process that involves preclass SPOC self-learning, in-class interactive discussions and evaluations, and postclass online interaction, we aim to enable students to achieve the cognitive levels of comprehension, application, and analysis according to Bloom’s taxonomy. The model of the combination of a SPOC with EIL we innovatively proposed enhances students’ critical thinking and confidence in their decision-making in the context of clinical applications, thereby ultimately improving their understanding of and ability to apply knowledge.

In this study, dental adhesion was selected as a reform course, and students were randomly divided into two groups, employing the LBL and EIL teaching models. This study aimed to evaluate whether the teaching model of a SPOC with EIL was more effective at enhancing students’ willingness for active learning and critical thinking abilities than the LBL teaching model was by assessing students’ interaction frequency, examination scores, and questionnaire feedback on learning experiences.

Methods

Participants

This study was conducted from September 2024 to November 2024. This study featured a prospective randomized controlled design and was reviewed and approved by the Medical Ethics Committee of the School of Stomatology, China Medical University (Grant No. K2024022). All fourth-year undergraduate dental students at China Medical University were included in the study. The 3-hour course known as “Dental Adhesion” serves as the research context. The students included in the study passed all the assessments in basic dental courses, such as oral anatomy and oral histopathology, but they had not received education about dental adhesion prior to this study. The inclusion criteria for admission to the study were as follows: Informed consent for this study and completion of all teaching activities. Students who were unwilling to participate in the study, withdrew from the study for various reasons, or did not complete all the teaching activities were excluded. Since 2 students did not complete all teaching activities, they were excluded, and 79 students were included in this study. The included students were randomly divided into two groups: one group received traditional offline LBL, while the other participated in a blended approach that involved both online and offline EIL. These groups were labeled the LBL group (n = 39) and the EIL group (n = 40). To minimize potential grouping bias, we randomly selected three courses prior to dental adhesion and performed statistical analysis on students’ pretest scores following SPOC-based self-study. The absence of statistically significant differences between the LBL and EIL groups (Table 1) confirms that both groups had comparable baseline learning abilities.

Table 1 The result of academic performance test before class

Study design

In this study, both groups relied on the same textbook and syllabus and were taught and assessed by the same teaching team. The overall research protocol is illustrated in Fig. 1.

Fig. 1

Flowchart of the study design

The LBL group followed the sequence of knowledge pertaining to dental adhesion knowledge presented in textbooks, including the use of offline classroom lectures for teaching. (1) All foundational knowledge and clinical procedures were presented and taught in a positive logical sequence, which emphasized the interaction between the faculty and students during class. (2) The contact information of the faculty was displayed in the classroom, and the faculty expressed his or her willingness to communicate with students. After class, questions posed by students via WeChat were addressed promptly, attentively, and enthusiastically.

The EIL group was subjected to a blended online and offline evaluation-based interactive learning approach. (1) First, knowledge pertaining to the “Dental Adhesion” course was restructured into fundamental and clinical knowledge; namely, basic concepts such as dentin adhesion mechanisms, enamel adhesion mechanisms, and dental adhesion systems were distributed to students in video form via the XuetangX platform to support students’ self-studies, and a preclass test was administered to assess the effects of such self-learning. (2) Clinical knowledge, including the ability to identify different adhesion systems, adhesion procedures, and indications, was extracted and developed into a knowledge framework. Common errors and key points regarding which mistakes in clinical work were likely were identified and presented in the form of evaluation-based learning materials via mixed videos containing both correct and incorrect operational procedures or case studies. For example, as demonstrated in the video of the three-step Etch & Rinse adhesives illustrated in Fig. 2, the students were divided into six groups during offline classes. The discussions in which these groups were engaged were based primarily on these evaluative materials, and the number of speeches within the groups served as the criterion for intergroup competition, as indicated in Table 2. The lead faculty has to watch at least one recorded EIL class session and serve as an assistant faculty for EIL at least once. Classroom discussions must be led by the lead faculty and follow the 3 “cans” and 3 “avoids”: ①can master the flow of the entire teaching activity; ②can guide students to discuss within the established framework; ③can summarize the discussion content and provide constructive suggestions for further exploration; ④avoid excessive lecture-style teaching; ⑤avoid negating students’ statements; and ⑥avoid giving unique answers. (3) Contact information for the faculty was displayed in class, thus indicating the faculty’s willingness to communicate with students. The faculty responded to the questions posed by students via WeChat after class promptly, thoroughly, and enthusiastically.

Fig. 2

Examples of evaluative learning materials. (A) The bonding process pertaining to “three-step Etch & Rinse adhesives” that is shown in the video involves a mix of correct and incorrect operational steps. Images B-L illustrate the step-by-step operation: (B) Selecting the etching agent; (C) Enamel and dentin etching; (D) Finishing the etching; (E) Rinsing and drying; (F) Selecting the three-step Etch & Rinse adhesives; (G) Applying primer; (H) Air drying; (I) Light curing; (J) Applying the adhesive; K. Air drying; L. Light curing. M. These tips provide a detailed explanation of the specific errors made in the incorrect steps

Table 2 Rules for scoring interactive speeches in class

Data collection

The members of the research group recorded and counted the number of speeches made by the students in their classes. The number of students and interactions with the faculty via online discussion within 2 months following the class were also recorded and counted. One week after class, both groups received the written test and the questionnaire survey, which were followed by an operational test that was administered in the experimental class two weeks later. These tests were conducted by the same group of examiners. These tests were solely used for research analysis and did not serve as the students’ final grades.

The written test consists of 10 objective questions and 3 ability analysis questions. The objective questions mainly test students’ mastery of basic theoretical knowledge; these questions are associated with a total score of 50 points. The ability analysis questions mainly test students’ ability to understand, analyze, and solve practical clinical problems; these questions are also associated with a total score of 50 points. The ability analysis questions have a strong degree of distinction because of their greater difficulty.

With respect to the questionnaire design, we referred to previous studies [3, 11] and made adaptive modifications on the basis of the specific curriculum for this study (Supplementary file 1). To ensure the validity of the questionnaires, two dental education experts evaluated and repeatedly revised the questionnaire. Prior to the use of the questionnaire, a pilot study was conducted with 15 students to assess the clarity and feasibility of the questionnaire and to make modifications. The survey questionnaire included 13 scale questions (across five dimensions, i.e., efficient learning, active learning, learning flexibility, student preferences, and sense of burden). The questions were scored on a Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). The distribution, collection and collation of the questionnaire was performed through the online platform “Wenjuanxing” in China (https://www.wjx.cn).

The total score for the operational assessment was 6 points, and this assessment included six items: appropriate selection of bonding methods, appropriate selection of adhesives, proper operation of acid etching, evaluation of the level of drying after acid etching and rinsing, proper operation of adhesive agents, and evaluation of the level of drying after the application of the adhesive agent.

The study involved 4 faculty members. Two faculty members understood the new teaching model and performed teaching activities, test design and questionnaire design. The other two faculty members supervised the examination process and performed data collection and analysis after training on the evaluation criteria.

Statistical analyses

A reliability analysis of the scale questionnaire was conducted, and Cronbach’s α coefficient was used to calculate the levels of intragroup consistency and reliability. The α coefficient for the questionnaire used in this study was 0.916, indicating that the questionnaire met the requirements in terms of reliability. Exploratory factor analysis revealed adequate validity in the returned questionnaires (KMO = 0.914, P < 0.001). The written and operational scores were tested for normality and are expressed as the means ± SDs. Group differences in such scores were assessed via an independent sample t test. The questionnaire results did not follow a normal distribution and are presented as the median ± IQR. The Mann‒Whitney U test was used to evaluate intergroup differences (α = 0.05). The data were analyzed using SPSS version 25.0.

Results

Participants’ demographic information

Statistics regarding student age and sex in each group are presented in Table 3. The two groups of participants were roughly equal in terms of age and sex ratio.

Table 3 Participants’ demographic information

In-class and postclass interactions

In the EIL group, 26 students spoke during the offline class, in which context four students spoke more than 5 times, and the most active student contributed 16 times (Fig. 3A). Within the six subgroups of the EIL group, the average number of speakers per group was 14.2; these numbers ranged from a minimum of 7 to a maximum of 20 (Fig. 3B). In the LBL group, the teacher posed a total of 11 questions during the offline class, to which the students provided 12 responses. In contrast, in the EIL group, teachers posed 18 questions in class, to which students provided a total of 85 responses (Fig. 3C). The response rate in the LBL group was 1.09, whereas the response rate in the EIL group was 4.72 (Fig. 3D). In terms of students’ postclass participation in interactive activities, only one student in the LBL group engaged in such activities, whereas nine students in the EIL group did so (Fig. 3E). Additionally, the number of postclass interactions between teachers and students was 1 in the LBL group and 20 in the EIL group (Fig. 3F). These findings indicate that, both in class and after class, students in the EIL group presented higher levels of engagement and more frequent interactions than did those in the LBL group.

Fig. 3

Analysis of the data concerning in-class and postclass interactions. (A) The number of each student’s in-class speeches in the EIL group. (B) The number of each student’s in-class speeches in each group and the average number of in-class speeches per group in the EIL group. (C) Comparison between the number of questions and students’ responses in class between the LBL group and the EIL group. (D) Comparison between the LBL group and the EIL group in terms of the number of in-class responses. (E) The number of students who engaged in postclass interactions with teachers in the LBL group and the EIL group. (F) The number of postclass interactions that occurred between teachers and students in the LBL group and the EIL group

Analysis of students’ performance on the written examination

The basic knowledge scores obtained by students in the LBL group and those in the EIL group did not differ significantly (Fig. 4A). However, the ability knowledge test and total scores obtained by the students in the EIL group were significantly greater than those obtained by the students in the LBL group were (Fig. 4B, C). More students in the EIL group obtained scores in the high score ranges with respect to the basic knowledge test (Fig. 5A), the ability knowledge test (Fig. 5B), and total scores (Fig. 5C). Compared with that of the LBL group, the performance distribution curve of the EIL group shifted significantly to the right of the high-score range (Fig. 5). The pass rate on the basic knowledge test observed in the LBL group was 82%, and the corresponding figure in the EIL group was 85% (Fig. 6A); however, in terms of the pass rates on the ability knowledge test and total scores, the EIL group achieved values of 55% and 82.5%, respectively, both of which exceeded the corresponding values for the LBL group (i.e., 35.9% and 56.4%, respectively; Fig. 6B, C). These results indicate that the EIL group outperformed the LBL group on the ability analysis test, whereas no significant differences were observed between the two groups with respect to the basic knowledge test. In addition, the scores obtained by students in the EIL group were characterized by a notable shift toward higher ranges.

Fig. 4

Students’ performance on the written examination. (A) Basic knowledge scores. (B) Ability knowledge scores. (C) Total scores. ns P > 0.05, * P < 0.05, ** P < 0.01

Fig. 5

Proportion of students in each score range. (A) Proportion of students in each score range with respect to the basic knowledge test. (B) Proportion of students in each score range with respect to the ability knowledge test. (C) Proportion of students in each score range in terms of their total grades

Fig. 6

Students’ pass rates on the written examination. (A) Pass rates on the basic knowledge test. (B) Pass rates on the ability knowledge test. (C) Total pass rates

Analysis of students’ performance on the operation test

Six students in each group were randomly selected for the task of skill operation, and those in the EIL group obtained significantly higher scores than did those in the LBL group (Table 4; Fig. 7A). We analyzed these students’ application of various bonding methods in further detail. The students in the EIL group chose three different bonding methods. However, the students in the LBL group were more likely to choose the selective enamel etching technique (Fig. 7B).

Table 4 Operation test scores

Fig. 7

Results of the operational test. (A) Comparison of operation test scores. * P < 0.05. (B) Proportion of students who selected different bonding methods. SEA-1step indicates the one-step self-etch adhesives. SEE refers to the selective enamel etching technique. SEA-2step indicates the two-step self-etch adhesives

Questionnaire results

In the questionnaire analysis, the students in the EIL group obtained significantly higher scores than did the students in the LBL group in three areas: engagement in the learning process and effective self-evaluation. Although students in the EIL group generally obtained higher scores in other categories, these differences were not statistically significant (Table 5). However, a comprehensive analysis of satisfaction with educational quality indicated that students in the EIL group outperformed those in the LBL group in terms of active learning (Table 6). Furthermore, neither the LBL nor the EIL methods place additional burdens on students, and no significant differences were observed in terms of students’ effective learning, learning flexibility or preferences for the two learning approaches (Table 6).

Table 5 Questionnaire results regarding students’ responses to LBL and EIL

Table 6 Comparison of the average level of satisfaction with educational quality between the LBL and EIL groups

Discussion

Previous studies have proposed that LBL fails to facilitate interaction between teachers and students, reduces students’ interest in learning, fails to stimulate their creativity and innovation, and restricts their ability to internalize and apply knowledge [12, 13]. Research has reported that blended teaching methods are more likely to facilitate personalized and active learning [5]. Online self-study not only provides a theoretical foundation that enables students to participate in offline courses but also saves time than can be spent on additional offline teacher‒student interactions. Offline courses can facilitate student-centered participatory learning; increase students’ cooperation, motivation, engagement, and attendance; and positively affect their ability to understand and apply knowledge [11]. Therefore, we propose a new teaching method in which SPOC is combined with EIL and applied in the context of teaching dental adhesion; this method was applied to the EIL group.

The advantages of the SPOC online platform

In this study, we developed the SPOC platform via XuetangX [14]. In the context of this SPOC, students could complete activities pertaining to self-study and testing before class, and we were able to analyze the learning situation on the basis of their test results. Moreover, we can easily send evaluative videos and cases to students or share the results of group discussions through the SPOC during class. In addition, the theoretical test, the operation test, and the questionnaires were completed via the SPOC platform. These factors greatly reduce the difficulty associated with teachers’ supervision of the teaching process and are conducive to the multidimensional evaluation of students’ learning outcomes.

The advantages of interactive competitions in the EIL model

The design of offline participatory classes is a key aspect of blended learning. Group discussion effectively promotes student participation in the teaching process [15]. However, the most important issue that teachers must consider is how such discussions can take place. Simply dividing students into groups does not enable them to participate actively in the course. Thus, we use the number of speeches as an indicator in the scoring process. On the surface, the difference in the number of speeches may be used to grade the groups. However, we established a rule that each group could receive a full mark. This rule greatly promotes students’ sense of responsibility and competitiveness and makes it easier to identify students who are willing to play a leading role in this context [16]. Once such an active classroom atmosphere has been established, scoring is no longer the primary consideration for students, and the progress of the entire learning activity becomes smooth and efficient. The questionnaire feedback provided by the students in the EIL group also revealed that these students could maintain a consistent focus and actively participate throughout the entire learning process. Therefore, students’ scores were largely irrelevant in our research. Instead, we focused on ways of effectively activating group discussions on the basis of this interactive evaluation, thus allowing students to participate in teaching activities. In contrast, although the LBL group presented 12 speeches, almost all of these speeches were passive speeches assigned by the teacher.

The advantages of evaluative discussions in the EIL model

We relied on a gradually progressive third-order learning process. Preclass self-study in the context of a SPOC cultivates students’ self-learning ability and enables them to obtain a preliminary understanding of basic knowledge. In-class EIL strongly promotes the internalization of knowledge and cultivates students’ applied and analytical abilities. Postclass interactive communication further promotes deep thinking among students [17]. In particular, EIL solves issues pertaining to another focal point of group discussions, which involves discussing the topic of ‘what’. Although positive knowledge output is beneficial with respect to students’ understanding, it is also likely to be forgotten. The presentation of negative, erroneous knowledge often leaves a deep impression [18]. Accordingly, we integrated clinical knowledge of dental adhesion to develop numerous evaluative cases and videos that contain both correct and incorrect information. These evaluative materials include various indications, steps, and methods associated with dental adhesion. On the basis of these evaluative materials, students are encouraged to engage in discussions in class, which can enable them to establish complete connections regarding their self-learned basic knowledge, improve their critical clinical thinking, and enhance their confidence with respect to diagnosis and treatment [19]. Although no differences were observed between the EIL group and the LBL group in terms of their scores on the basic knowledge test, students in the EIL group obtained significantly higher scores on the ability analysis test and the operation test than did those in the LBL group. Students in the EIL group could freely choose three different adhesive methods in the context of their operations, whereas those in the LBL group tended to choose the relatively universal technique of selective enamel etching. These findings indicate that the students in the EIL group were more proficient with respect to the clinical application of dental adhesives, which is closely related to the three-stage learning process, especially with respect to the EIL used in class.

The EIL model promotes student engagement and active learning

We also conducted a questionnaire survey with the goal of investigating students’ subjective evaluations of the learning process, mainly in terms of efficient learning, active learning, learning flexibility, student preferences, and sense of burden. The results revealed that students in the EIL group evaluated active learning significantly more highly than did those in the LBL group. The one-way teaching mode associated with LBL decreases the individual visibility of students in class [20]. Students thus choose simply to receive the knowledge taught by the teacher without asking questions, thus gradually causing them to lose their ability to analyze and solve problems independently. This approach may also be characterized by distance between students and teachers, such as when LBL group students sit at the back of the classroom during class. These two aspects caused students in the LBL group to exhibit insufficient motivation to engage in self-directed learning. The low number and frequency of postclass interactions between students in the LBL group and their teachers can also reflect this issue. In contrast, as a result of the preclass self-learning and in-class EIL experiences of the students in the EIL group, their willingness to learn actively increased greatly, thereby improving their learning outcomes as a result of their higher levels of initiative. This finding was reflected not only by the questionnaire results but also by the postclass, multiperson interactions, which highlighted the deep thinking and continued learning exhibited by students in the EIL group after class. In conclusion, the EIL model is more effective than the LBL model in promoting student interaction and active learning.

Challenges of the EIL model

EIL places tremendous demands on teachers, which require them to consider the logic underlying their teaching deeply and to arrange teaching activities reasonably [5, 21]. However, EIL imposes small burdens on students before class, and students are not required to prepare reports in advance, which was reflected in their responses to the questionnaire. However, in terms of individuals’ preferences regarding learning modes, EIL is not superior to LBL. The classroom atmosphere in LBL can be perceived as dull; however, students are not averse to such an atmosphere, which is consistent with the results of previous research [22]. The learning effect of EIL is significant, but the students included in this research did not exhibit obvious preferences in this regard. This finding was probably because undergraduate education in stomatology in China has relied on LBL for many years, and students have become accustomed to this labor-saving learning mode [23]. Hence, students do not enjoy when the reliability of this traditional teaching approach is impaired as a result of reforms. Additionally, some students may resist the EIL model, favoring passive listening over active engagement. To better understand their preferences and support diverse learning needs, we plan to employ qualitative methods such as interviews or focus groups in future research. In conclusion, in light of the ongoing (albeit gradual) transition in stomatology education toward a demand for competence, the processes of reshaping the orientation of undergraduate education policies and implementing synchronous education reforms across all disciplines may be conducive to the essential transformation of students’ learning concepts.

Limitations

This study has several limitations. The size of the sample investigated in this study is relatively small, and in the future, this sample size can be increased to reduce potential bias. In particular, the evaluation of skills needs to cover all participating students in the future to support our conclusions more rigorously. Furthermore, long-term evaluation indicators—including faculty assessments, clinical performance outcomes, and knowledge retention measures—could provide a more comprehensive understanding of students’ ability to retain and apply knowledge. Additionally, qualitative approaches such as interviews and focus groups may offer valuable insights into the learning process and further support the assessment of educational impact. Moreover, the EIL group was better than the LBL group in terms of understanding and applying dental adhesion. To ensure educational equity, we will use the new teaching model to reteach the LBL group on dental adhesion in the spring semester of the year. In addition, this study investigated only the effectiveness of SPOC combined with EIL in dental adhesion courses. In the future, we will validate the applicability of the EIL model in different disciplines and courses to further clarify the universality of this teaching model.

Conclusion

In summary, the combination of a SPOC with EIL is an innovative teaching model that stimulates students’ participation and critical thinking more than traditional LBL teaching does (Fig. 8). The EIL teaching model promotes student-teacher in-class and postclass interactions and improves students’ theoretical and operational performance. In terms of subjective evaluation, the EIL teaching model promotes students’ active learning without increasing the learning burden. Owing to the advantages of the combination of a SPOC with the EIL teaching method revealed in our study, this approach has high potential for application in other stomatology subjects in the future.

Fig. 8

The combination of a SPOC with EIL improves education in dental adhesion