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A novel extended flipped classroom model helps dental undergraduates blossom into dentistsRuikaiBa1✉Emailbaruikai880714@126.com
XinranFeng1
LixianYuan1
JuanTong1
JinghaoBan1
MeilingWu1
BingHan1
XinyueXu1
XinyuQiu1
HaoGuo1
KunXuan1Emailxuankun@fmmu.edu.cn
1State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases and Shaanxi Clinical Research Center for Oral Diseases, Department of Preventive Dentistry, School of StomatologyThe Fourth Military Medical University710032Xi’anChina
Ruikai Ba1#, Xinran Feng1, Lixian Yuan1, Juan Tong1, Jinghao Ban1, Meiling Wu1, Bing Han1, Xinyue Xu1, Xinyu Qiu1, Hao Guo1, Kun Xuan1#
1. State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration and National Clinical Research Center for Oral Diseases and Shaanxi Clinical Research Center for Oral Diseases, Department of Preventive Dentistry, School of Stomatology, The Fourth Military Medical University, Xi'an, 710032, China.
# Corresponding authors’ E-mail: baruikai880714@126.com; xuankun@fmmu.edu.cn.
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Funding information:
1. General Research Project on Higher Education Teaching Reform in Shaanxi Province in 2023 (23BY204); 2. General Project of Education and Teaching Reform in the School of Stomatology, Air Force Medical University in 2023 (2023kqjyyj-xk); 3 Medical Talent Promotion and Ranking Project of Air Force Medical University in 2024(2024RCJB07).
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Author Contribution
Ruikai Ba and Kun Xuan conceived and designed the study. Lixian Yuan, Juan Tong, Jinghao Ban, Meiling Wu and Bing Han performed the experiments. Xinyue Xu, Xinyu Qiu, Hao Guo and Xinran Feng analyzed the data. Ruikai Ba and Xinran Feng wrote the paper. Ruikai Ba and Kun Xuan revised the paper.
Conflict of interest statement:
The authors declare that they have no conflicts of interest or financial disclosures to report. There are no affiliations, financial relationships, or competing interests that could have influenced the conduct or reporting of the study. If any conflicts of interest arise in the future that could be relevant to this work, the authors commit to promptly disclosing them and taking appropriate actions as necessary.
Declarations
Ethics approval and consent to participate
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All methods were carried out in accordance with relevant guidelines and regulations. A
Informed consent was obtained from all participants at the beginning of the study. A
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All experimental protocols were adhered to the Declaration of Helsinki and approved by the Ethics Committee of the school of Stomatology in the Air Force Medical University (KQ-YJ-2024-261).Consent for publication
Not applicable.
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Data Availability
The datasets generated during and analyzed during the current study are available from the corresponding author
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Abstract
Background
The lack of the ability to flexibly and accurately apply theoretical knowledge learned in the classroom to clinical diagnosis and treatment has been one of the biggest barriers preventing dental undergraduates blossom into dentists. The flipped classroom model and simulation training system helping undergraduates with active learning by themselves have been a significant shift in medical education. Literatures about these topics are abundant, however, there is few practical flipped classroom model which could help dental undergraduates adapt to the status of dentists quickly. This study proposed a novel extended flipped classroom model (P-I-T-D-S Flipped Classroom Model) assisted by the simulation training system and verified its effectiveness.
Methods
The scores of sophomores majored in the Fundamentals of Stomatology at Air Force Medical University participated in the novel extended flipped classroom model and those participated in the traditional lecture model are compared. Moreover, a total of 39 participants (2023 cohort) were stratified and randomly assigned into a pre-class group and a post-class group based on the parity of their student identification numbers (even vs. odd) to explore better flipped classroom model. We descriptively analysed the quantitative data and thematically analysed the qualitative data.
Results
The scores of the undergraduates enrolled in the P-I-T-D-S Flipped Classroom Model (2023) are significantly higher than those taught under the Traditional Lecture-Based Model (2022). More interestingly, the scores in the pre-class group raised significantly higher than those in the post-class group, which might be related to the active learning model. What’s more, the undergraduates in the P-I-T-D-S Flipped Classroom Model showed higher willingness to participate in and satisfaction of the class.
Conclusion
The P-I-T-D-S flipped classroom medical education model, through active learning, can effectively stimulate the learning enthusiasm of dental students, thereby improving their learning efficiency of basic dental knowledge and clinical practice ability.
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1.Introduction
One of the biggest barriers preventing dental undergraduates blossom into dentists is the lack of the ability to flexibly and accurately apply theoretical knowledge learned in the classroom to clinical diagnosis and treatment(1–4). The main reasons include the following aspects: 1. Students lack comprehensive training in the analysis, diagnosis, and treatment plan design of complex cases using theoretical knowledge from subdisciplines such as prosthodontics, orthodontics, endodontics, and periodontology. 2. Dental undergraduates don’t have sufficient communication training leading to psychological pressure which makes it more difficult for them to communicate with dental patients effectively and gain their trust(5, 6). 3. The weak understanding of infection control, medical ethic and humanistic care are also huge obstacles for dental students to grow into qualified dentists(7, 8).
The core issue is to increase dental undergraduates' preclinical practice training(9–11).
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However, the fifth- year internship is scanty especially since most patients are unwilling for interns to perform oral treatment procedures on themselves. Therefore, we need to integrate the knowledge of oral diagnosis and treatment practice into the entire process of undergraduate education in dentistry, and provide sufficient simulation training, so that dental undergraduates can proficiently master the methods of communicating with and treating patients before entering clinical internships(12, 13). Virtual reality simulators make it possible(14, 15). Unidraw is one of the comprehensive dental simulators which combines virtual reality and haptic technology to provide students with immersive realistic diagnosis and treatment experience(16) (Supplementary Fig. 1). Dental situational clinical thinking training system in it utilizes virtual reality technology to construct dental 3D diagnosis and treatment scenarios and standardize oral disease patients. It can realistically simulate oral lesions and general situation, which enables students to connect key links throughout the diagnosis and treatment process in a virtual environment, and examines students' abilities of theoretical knowledge mastery, history taking, imaging examination result interpretation, medical recording, clinical diagnosis and differential diagnosis, treatment plan formulation, etc. (Supplementary Video 1)As a virtual simulation teaching assistance system, it also requires a scientific and reasonable mode to achieve the best educational effect(17–19). Inverted classroom which is also known as flipped classrooms have been popular in higher education in recent years(20–23). Nevertheless, it is still unclear which is the best model for helping dental undergraduates blossom into dentists. We propose a novel extended flipped classroom model called P-I-T-D-S flipped classroom model based on dental situational clinical thinking training system (Fig. 1). Each capital letter represents an implementing step for this model. ‘P’ represents patient and practice, which means case-based teaching and practice by dental situational clinical thinking training system. ‘I’ represents information and inspiration. Teachers assign self-learning tasks based on theoretical knowledge points and inspire students' thinking on practical clinical problems during the probation. Students can finish pre class preparation using information technology such as textbooks, MOOCs, PubMed, AI, etc.,(24) combined with pre class tasks. ‘T’ represents test and teach. Teachers conduct pre class tests on pre class tasks to identify students' concentration problems during self-study, and provide targeted and focused teaching. ‘D’ represents discussion and debate. Teachers raise issues to allow students to design specific cases, organize group learning and discussion. Students prepare presentation materials with the information collected before class, and report on them in groups as one of the assessment criteria for daily grades.
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This enhances students' enthusiasm and participation, deepens their understanding and practical application of knowledge points, and improves their teamwork and communication skills. Moreover, teachers should encourage students to debate different design schemes for the same case, cultivate their clinical thinking and flexible adaptability in handling different cases, and stimulate their innovative thinking. ‘S’ represents summary and search. Teachers help students summarize the core of the course, cultivate students' ability to summarize and generalize, and develop logical thinking. Based on the latest developments in the discipline, teachers and students propose appropriate treatment methods for real clinical cases, summarize the knowledge points involved in the cases, and summarize the key detailed treatment methods for this type of disease together. Teachers could introduce the latest scientific research progress, encourage students to engage in extended reading and learning after class, and cultivate their research abilities and interests. We apply this novel extended flipped classroom model in the Fundamentals of Stomatology for sophomores compared with traditional lecture-based mode to verify the improvement effect on learning. We also compared different using order of dental simulator and tried to make this novel mode more effective.Fig. 1
Study methodology flowchart.
2.Materials and Methods
2.1 Study Participants and Design
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This study was conducted to evaluate the efficacy of the P-I-T-D-S flipped classroom model assisted by the Oral Scenario-Based Clinical Reasoning Training and Assessment System (OSCRS; Beijing Unidraw Virtual Reality Technology Institute Co., Ltd.) in enhancing pre-clinical competencies among second-year dental undergraduates at Air Force Medical University. A
We compared the scores of undergraduates (2023, experimental group (N = 39)) participated in the novel extended flipped classroom model and the undergraduates participated in the traditional lecture model (2022, control group (N = 38)). All of the participants assumed to have equivalent baseline levels and majored in the Fundamentals of Stomatology. Moreover, a total of 39 participants (2023) were stratified and randomly assigned into a pre-class group (OSCRS used before the class, N = 19) and a post-class group (OSCRS used after the class, N = 20) based on the parity of their student identification numbers (even vs. odd) to explore better flipped classroom model. All participants provided informed consent for inclusion in this study. The Pre-class group received the OSCRS training and clinical observation module prior to the course, whereas the Post-class group received the same training after course completion. During the clinical observation component, students actively engaged in learning by observing real-time clinical procedures and asking questions, while instructors refrained from delivering direct knowledge or explanations during the session. A
This study was approved by the Ethics Committee of the school of Stomatology in the Air Force Medical University (KQ-YJ-2024-261).2.2 OSCRS Training
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The OSCRS platform employs virtual reality (VR), AI, and haptic feedback to simulate clinical scenarios featuring standardized patients with common oral pathologies, such as pulpitis, periodontal disease, and dental defects. Participants accessed a predefined pulp/periapical case (Case ID: 100136) via guest mode. The system workflow comprised AI-driven voice interaction for history-taking, utilizing a hierarchical question database (critical/general/non-essential) to evaluate query completeness and clinical logic. Haptic-enhanced oral examinations employed force-feedback devices (left hand: mouth mirror; right hand: probes/tweezers) to replicate tissue biomechanics within a 3D oral cavity model, with real-time visual cues highlighting pathologies such as caries or pulp exposure. Participants selected evidence-based auxiliary tests (e.g., periapical radiographs, vitality tests), with penalties for irrelevant or omitted choices. Diagnostic and treatment planning modules required submission of a primary diagnosis (supported by clinical findings), differential diagnoses, and clinically appropriate interventions. All procedural data were encrypted and synchronized to a secure backend database, enabling retrospective revisions.2.3 Effectiveness Assessment
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The Fundamentals of Stomatology is an innovative bridging course independently developed by our institution, aiming to integrate foundational clinical knowledge with practical clinical skills. The assessment framework of this course includes regular performance evaluations (60%) and examination scores (40%). The regular performance segment further comprises dental exam (30%) (Supplementary Fig. 2) as well as dental cavity preparation (30%) (Supplementary Fig. 3). A
In the dental examination module, students participated in role-play exercises, alternating roles as clinicians and patients. The dental cavity preparation module utilized advanced simulation tooth-preparation models(25). Upon course completion, students completed a structured questionnaire consisting of 19 objective items scored on a 1 ~ 5 Likert scale and one open-ended question. The survey evaluated multiple aspects including course content, instructional methods and their implementation, learning environment and support, self-regulated learning capabilities, clinical skills, professional competencies, and provided a section for open-ended feedback (Table.1, SupplementaryTable.1).
2.4. Statistical Analysis
All analyses were conducted in R (version 4.2). Continuous and Likert-type variables were summarised with medians and inter-quartile ranges, whereas categorical data were reported as proportions. Between group differences in continuous or ordinal outcomes were evaluated with the Wilcoxon rank-sum test after the Shapiro–Wilk test indicated departures from normality. Item-level Likert scores were compared with two complementary non-parametric procedures: (i) the Mann–Whitney U test to assess shifts across the full ordinal distribution and (ii) Pearson’s χ² test applied to a dichotomised “satisfied” threshold (scores 4–5 versus 1–3) to generate intuitive effect sizes for graphical overlays. False-discovery control across multiple questionnaire items was achieved with the Benjamini–Hochberg adjustment, accepting an adjusted p < 0.05 as statistically significant. For multivariate visualisation, item scores were rescaled to the 0–1 interval relative to the satisfaction cut-off and plotted as radar polygons to depict changes across pedagogical dimensions. Open-ended feedback was converted to term-frequency matrices and displayed as word clouds using a minimum frequency filter to highlight salient themes. All graphics were produced with the ggplot2, ggradar, and patchwork libraries.
3. Results
3.1. Comparison of Student Performance Between the Traditional Lecture-based Model (2022) and the P-I-T-D-S Flipped Classroom Model (2023)
A total of two cohorts were compared: students taught under the Traditional Lecture-Based Model (2022) and those enrolled in the P-I-T-D-S Flipped Classroom Model (2023). All results are reported as median [interquartile range], and comparisons were conducted using the Wilcoxon rank-sum test.
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As shown in Table 2, students in the Flipped classroom group achieved significantly higher scores in several key assessments. The Dental Exam score in the flipped classroom group was 90.0 [89.0–100.0], compared to 88.0 [83.0–93.0] in the traditional group (p = 0.003). Similarly, the Test score significantly improved from 76.0 [76.0–82.0] in the traditional model to 84.0 [79.0–89.5] in the flipped model (p < 0.001). The Total Score also increased significantly (p < 0.001), rising from 76.3 [73.9–78.7] to 81.9 [76.2–87.2].
Although the Dental Cavity Preparation score was higher in the flipped group (65.0 [52.5–80.0]) than in the traditional group (60.0 [60.0–68.8]), this difference did not reach statistical significance (p = 0.306).
These findings are visually supported by Fig. 2A, which illustrates consistent score improvements across all categories under the P-I-T-D-S model, highlighting its effectiveness in enhancing student academic performance in clinical dentistry.
3.2. Comparison of Student Performance Between the Pre-class Group and the Post-class Group within the P-I-T-D-S Flipped Classroom Model (2023)
To evaluate the effect of OSCRS training timing within the P-I-T-D-S flipped classroom model, student performance was compared between the Pre-class group and the Post-class group, both from the 2023 cohort. All values are presented as median [interquartile range], and comparisons were conducted using the Wilcoxon rank-sum test.
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As summarized in Table 3, the Pre-class group demonstrated significantly higher academic performance across multiple evaluation metrics. The Dental Exam score increased from 90.0 [85.0–94.0] in the Post-class group to 95.0 [90.0–100.0] in the Pre-class group (p = 0.00871). Similarly, the Test score improved from 82.0 [79.0–84.5] to 85.5 [82.0–93.2] (p = 0.04880). The Total Score, reflecting overall student performance, rose from 76.6 [73.1–82.9] to 84.1 [80.0–88.7], also showing statistical significance (p = 0.0101).
Although the Dental Cavity Preparation score was higher in the Pre-class group (70.0 [58.8–81.2]) than in the Post-class group (60.0 [47.5–77.5]), this difference did not reach statistical significance (p = 0.114).(Fig. 2B)
These results suggest that the structured deployment of OSCRS training within the P-I-T-D-S model may yield cumulative benefits to student learning outcomes. The OSCRS training and clinical observation module prior to the course should be a better model.
Fig. 2
Comparison of student performance between the traditional lecture-based model and the P-I-T-D-S flipped classroom model as well as between the Pre-class group and Post-class group under the P-I-T-D-S flipped classroom model.
A. The box plots represent median and interquartile ranges for each evaluation metric, including Dental Cavity Preparation, Dental Exam, Test, and Total Score. Data from the 2022 cohort (traditional model) and 2023 cohort (P-I-T-D-S model) are shown. Statistically significant differences were observed in the Dental Exam, Test, and Total Score (p < 0.01). B. Box plots represent the median and interquartile range of scores for each assessment item, including Dental Cavity Preparation, Dental Exam, Test, and Total Score. Statistically significant improvements were observed in the Dental Exam, Test, and Total Score following the full implementation of the instructional sequence (p < 0.05, Wilcoxon rank-sum test).
3.3. Results of the Student Satisfaction Questionnaire
3.3.1. Student-reported satisfaction
A comparison of student satisfaction rates between the traditional lecture-based model (2022) and the P-I-T-D-S flipped classroom model (2023) revealed a statistically significant improvement in favor of the flipped classroom. Among the 19 survey items, five questions showed significant differences based on chi-square tests after aggregating satisfaction scores of 4–5: Q17 (χ² p = 0.0032), Q9 (p = 0.0104), Q19 (p = 0.0234), Q11 (p = 0.0440), and Q18 (p = 0.0462). The largest improvement was observed for Q17 (mean score: 3.97 in 2022 vs. 4.67 in 2023), with a delta of 0.69.
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Additionally, Wilcoxon rank-sum tests indicated significant improvements in 18 out of 19 items (p < 0.05), supporting the overall enhancement in satisfaction following the implementation of the flipped classroom. Several questions (e.g., Q3, Q4, Q6, Q16) exhibited notable mean score differences exceeding 0.6 in favor of the 2023 cohort. These results highlight a consistent and broad-based increase in perceived satisfaction among students exposed to the P-I-T-D-S teaching model. (Table 4, Fig. 3A).
Within the 2023 P-I-T-D-S flipped classroom cohort, a subgroup analysis comparing the Pre-class group and the Post-class group showed no statistically significant differences in satisfaction scores based on chi-square tests across any of the 19 survey items (p > 0.05 for all items). Similarly, Wilcoxon rank-sum tests revealed no significant differences for the majority of questions, with the exception of Q7 (p = 0.048), where the Pre-class group reported a higher satisfaction mean (4.90 vs. 4.58), yielding a delta of + 0.32.
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Despite the overall lack of statistically significant differences, the Pre-class group exhibited consistently higher mean scores across most items. For example, Q11 (4.80 vs. 4.58), Q12 (4.95 vs. 4.79), Q16 (4.90 vs. 4.63), and Q18 (4.80 vs. 4.63) demonstrated moderate deltas ranging from + 0.16 to + 0.27. These trends suggest a potentially more favorable reception to the flipped classroom content when students were exposed to OSCRS training prior to in-class delivery, warranting further investigation in larger samples or across multiple semesters (Table 5, Fig. 3B).Fig. 3
Comparison of student satisfaction rates (scores of 4–5) between 2022 and 2023 cohorts as well as between Pre-class group and Post-class group in 2023.
A. Comparison of student satisfaction rates (scores of 4–5) between the traditional lecture-based cohort (2022) and the P-I-T-D-S flipped classroom cohort (2023). Each bar represents the percentage of students assigning a satisfaction score of 4 or 5 on a 5-point Likert scale for each questionnaire item (Q1–Q19). Red bars denote the flipped classroom group and blue bars denote the traditional group. Asterisks above the bars indicate statistical significance based on chi-square tests: **p < 0.001, *p < 0.01, p < 0.05, ns = not significant. Questions are sorted by item number; satisfaction was consistently higher in the flipped classroom group across most items. B. Comparison of student satisfaction rates (scores of 4–5) between the Pre-class group and Post-class group within the 2023 P-I-T-D-S flipped classroom cohort. Bars represent the proportion of students rating each item with a satisfaction score of 4 or 5 on a 5-point Likert scale (Q1–Q19). Red bars represent the Pre-class group and blue bars represent the Post-class group. No statistically significant differences were detected by chi-square tests across all items (ns = not significant). An asterisk (*) denotes marginal significance in Wilcoxon rank-sum test (Q7, p < 0.05), indicating higher satisfaction in the Pre-class group.
3.3.2. Radar Comparison of Key Teaching Dimensions Across Students Groups
Aggregating the 19 questionnaire items into five pedagogical dimensions showed that student satisfaction rose markedly after implementation of the P-I-T-D-S flipped-classroom model: overall mean Likert score increased from 4.25 ± 0.31 in the 2022 traditional cohort to 4.78 ± 0.22 in the 2023 flipped cohort (Δ + 0.53, p < 0.001); the greatest gain was in Instructional Implementation (4.19 → 4.81, Δ + 0.62, p < 0.001), followed by Clinical Competence Acquisition (4.04 → 4.62, Δ + 0.58, p < 0.001), Self-Regulated Learning Support (Δ + 0.49, p < 0.01) and Course Content & Structure (Δ + 0.45, p < 0.01), while Teacher–Student Interaction remained highest in both cohorts (4.70 → 4.93, Δ + 0.23, p = 0.012).
Within the 2023 cohort, no statistically significant differences emerged between the Pre-class group and the Post-class group across any of the five teaching dimensions (all p > 0.05), indicating that the flipped classroom design delivered uniformly high satisfaction regardless of the timing of OSCRS training. (Fig. 4)
Fig. 4
Radar Comparison of Categorized Teaching Dimensions Across Student Groups
Radar plot of mean satisfaction (scaled 4–5) across five dimensions for the Traditional Lecture-based Model (2022, blue), the P-I-T-D-S Flipped Classroom Model (2023, red), the Pre-class group (orange), and the Post-class group (green). Concentric rings correspond to Likert 4, 4.5, and 5, and a larger radial polygon denotes higher satisfaction. A single legend appears at the bottom to avoid redundancy across the five panels.
3.3.3. Student Feedback Keyword Cloud
To examine qualitative differences in student perceptions, word clouds were generated based on open-ended responses from the 2022 and 2023 course evaluations. As shown in Fig. 5A, the 2022 word cloud displayed a broader range of general teaching-related terms, reflecting student concerns regarding content clarity, instructional methods, and classroom engagement. In contrast, Fig. 5B illustrates that the 2023 responses were more thematically focused, with high-frequency terms such as "satisfaction," "interaction," and "effectiveness," suggesting enhanced student perceptions and greater acceptance of the revised instructional approach.
Fig. 5
Word cloud visualization of students’ suggestions from open-ended questionnaire responses in 2022 and 2023.
The figure displays the relative frequency of terms mentioned by students. Larger words represent higher frequencies. The 2023 responses(7B) show a more positive and cohesive focus compared to 2022(7A), reflecting increased satisfaction and engagement following instructional enhancements.
4.Discussion
4.1 Advantages of the P-I-T-D-S flipped classroom model
Increasing clinical training is a necessary guarantee for improving the clinical skills of dentists(26, 27). How to improve the clinical practice level of dental students while ensuring patient efficacy has always been a question that dental educators are considering(28, 29). In the previous clinical training mode, students were trained to operate treatment in plaster teeth, detached teeth, and simulated head models. After passing the examination by the clinical instructors, patients underwent clinical treatment by dental interns under the supervision of the instructors. This clinical internship method has many problems, such as affecting clinical work efficiency, hidden dangers in the early treatment effect of interns, and patients' resistance to interns' treatment. The emergence of virtual simulation clinical training systems provides the possibility to solve these problems(30, 31). How to integrate virtual simulation clinical training system into undergraduate education and construct a teaching plan that combines virtual and real elements to effectively enhance the clinical practice ability as well as diagnosis and treatment level of dental undergraduate students is a question that every dental educator needs to consider(32–34). The author integrates existing flipped classroom models with Oral Scenario-Based Clinical Reasoning Training and Assessment System and proposes a P-I-T-D-S flipped classroom medical education universal model based on oral clinical teaching practice and related research results. By introducing real clinical cases, utilizing information technology teaching methods and AI virtual simulation training system (Unidraw) to stimulate students' interest in learning, they can independently collect data, prepare basic knowledge before class, conduct clinical reception process and treatment practical training. Through classroom reports and case analysis discussions and debates, they can cultivate clinical diagnosis and treatment thinking and personalized treatment plan design thinking, enhance students' teamwork ability and comprehensive analysis and solution ability for common and complex oral diseases. Finally, by summarizing and condensing the key points of the course to deepen the memory of key content, while also exploring new research hotspots and thinking about innovative research directions, it lays a foundation for future graduate studies. Dental undergraduates who have undergone a comprehensive combination of virtual and real clinical teaching could effectively reduce the trial and error costs during clinical internships to treat real patients. The P-I-T-D-S flipped classroom medical education model is not only suitable for dental education, but can also be expanded into a standardized model for clinical medical education in the future, with good universality.
4.2 The relationship of active learning based P-I-T-D-S model with course experience, engagement, generic skills, and examination performance
The P-I-T-D-S flipped classroom medical education model can effectively improve the clinical teaching effectiveness of undergraduate dental students because its core concept is active learning. Arnaldo Perez et al. found that active learning can effectively improve the teaching effectiveness of dental undergraduates(35). The focus of this project is the relationship of active learning based P-I-T-D-S model with course experience, engagement, generic skills, and examination performance. The research results show that compared with undergraduate students of the same level in 2022 who adopt the traditional lecture teaching mode, the mean score of students in P-I-T-D-S model is significantly higher than that of the students in traditional lecture model. ‘High-yield’ learning techniques in the study time are preferred by students driven by a ‘cost–benefit’ analysis which balances assessment demands against efficient time management(36). OSCRS training system in P-I-T-D-S model provides students with time-saving and most clinically relevant real training scenarios, meets their needs for early clinical exposure, and stimulate their interest in exploration, thereby enabling them to improve their learning efficiency and effectiveness through self-directed learning and research. Higher mean scores and satisfaction rates shows the advantages of P-I-T-D-S model for improving the course experience, engagement, generic skills, and examination performance. Interestingly, we found that the scores in the Pre-class group were significantly higher compared to the Post-class group on both the test and the Dental Exam, which indicated that OSCRS training before class could stimulate students' learning enthusiasm and enhance their learning effect and clinical practice ability.
4.3 Strengths and limitations
The limited number of students leads to the need for further improvement in the scale of the experiment. But this experiment involved a wider range of student groups with different starting points and learning levels, such as five-year and eight-year programs. The corroboration between quantitative and qualitative data enhances the validity of the results. The mixed methods of this study also provides the possibility for enhancing the completeness, comprehensibility, and applicability of research results by obtaining quantitative information from larger sample sizes in the future, while qualitative data allows us to gain a more detailed understanding of the reasons why students have a special perspective on active learning. Due to the fact that we didn’t draw the dental cavity preparation simulation training module into our research, there was no significant difference between the experimental group (2023) and the control group (2022). In the future, we will compare the impact of the use of demand side systems on the teaching effectiveness of procedures such as cavity preparation and full crown teeth preparation in oral professional courses. In the next step of our research, we will further expand the sample size and application scope, and attempt to apply the P-I-T-D-S flipped classroom medical education model in clinical medical education, and study its application effect and possible problems. Through continuous improvement and enhancement, we aim to improve the P-I-T-D-S flipped classroom medical education model in order to achieve wider application and better teaching effectiveness. Help more dental and clinical students grow smoothly into effective dentists and clinical doctors.
Conclusions
The P-I-T-D-S flipped classroom medical education model, through active learning, can effectively stimulate the learning enthusiasm of dental students, thereby improving their learning efficiency of basic dental knowledge and clinical practice ability.
Electronic Supplementary Material
Below is the link to the electronic supplementary material
Supplementary Material 2
Supplementary Material 3
Supplementary Material 5
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