Dental Anatomy: Its Relevance To Dentistry Download.zip
Malka Crickenberger
Oral histology is perceived by dental students as a challenging subject and often struggle to recognize the long-term relevance of understanding the cells and tissues at the microscopic level. Serious games have been reported to have a positive effect on student cognitive skills and learning motivation. However, there is still a limited amount of research supporting the effectiveness of serious games as a learning method in dentistry. The present study aimed to evaluate the impact of serious game of HistoRM as a complementary learning strategy for oral histology.
The study design was a crossover randomized controlled trial. A total of 74 first year dental students of Universitas Indonesia participated in the study and divided into 2 groups. Study intervention included HistoRM game for 3 days followed by a combination of HistoRM and script-based handouts for another 4 days. The groups represented different intervention sequences. Evaluation was performed using pre-test, post-test on day 3 and 7 and a questionnaire.
Contemporary educational technology is implemented in recent years to scaffold knowledge transfer to the learners in a situated and multimodal approach [9]. Gamification refers to the application of game theory, techniques and mechanics outside the context of traditional game activities [10]. In the past several years, trends in educational research show an increasing interest in incorporating games in learning approaches. Game-based learning refers to a strategy to enhance knowledge and skill acquisition, through game content and game play, where game activities involve problem solving and challenges that provide players/learners with a sense of achievement of the defined learning outcomes [11]. Games are called serious when they have a pedagogical purpose [12]. The introduction of games in education has been demonstrated to stimulate learning and improve learner satisfaction. Previous reviews on serious games in healthcare education indicate the most frequent outcome investigated was the improvement in knowledge acquisition and is perceived as a more engaging learning approach compared to traditional methods [10,11,12,13,14,15,16,17]. Although serious games are not considered mainstream material in medical and dental teaching, it provides tools to enhance interactivity in healthcare education including dental education. Serious games could overcome limitations of asynchronous learning, the learning strategy that became widely used during this frequent pandemic time [15].
The evaluation of undergraduate dental curriculum in the Universitas Indonesia demonstrated a similar phenomenon with others [1,2,3,4,5,6]. Student perception towards their level of understanding of oral histology was still unsatisfactory. In particular, their understanding of the long-term relevance of oral histology, which includes the complexity of functional networks and pathological processes. The implementation of innovative learning strategies such as serious games to enhance knowledge acquisition, motivation and engaging learning environment can therefore be a solution. However, research on the effectiveness and use of serious games as a complementary learning method in dentistry has not been well-studied. The present study was aimed to evaluate the effectiveness of the implementation of a HistoRM serious game specifically designed as a complementary learning of oral histology for undergraduate dental students.
Serious game called HistoRM was developed with Unity game platform and was integrated in the SCORM activity in the Universitas Indonesia moodle-based learning management system (EMAS). This education puzzle-based game consisted of four gameplays: (1) jigsaw puzzle; (2) find the differences; (3) match the pictures; and (4) crosswords (Fig. 3A-D). Two topics of oral histology learning subjects were used in HistoRM game consisted of: (1) Histology of oral mucosa, and (2) histology of tooth and its supporting structure. Each topic was divided into three stage levels, and each stage contained five missions, a total of 15 missions for each topic (Fig. 3E). Mission can be divided into two sessions (puzzle game session and quiz session). Students were required to clear the puzzle game session first before continuing to the quiz session, and were able to repeat the mission multiple times if they wanted to relearn the subject matter. One-to three-star points can be collected in every mission, depending on the winning condition such as the time to complete the mission, the number of mistakes, and the number of hint-feature used. These star points were collected and determined the player ranking in comparison to other players and were monitored in the leaderboard ranking system (Fig. 3F). There was no time limit in playing HistoRM game.
We incorporated the fun elements into the HistoRM game which included the custom-made avatars that represented the players, custom-made background and music. Players can design the avatars (hairstyle, hair color, clothes and other accessories) (Fig. 3G-H). Facial expression of the avatar changes based on the process when they played the games. A character known as Molara, a human-tooth form creature was developed and served to guide the students. In the beginning, Molara gave the explanation of learning outcomes of each stage, and gave instruction on how to play the puzzle-based game. During the puzzle game session, Molara offered the hint-feature when the players had difficulties to complete the mission. At the end of the quiz session, Molara provided immediate feedback and explanation related to the quiz topics (Fig. 3I).
Descriptive statistics were computed and data normality was tested with Shapiro-Wilk. Bivariate analyses were performed using the SPSS 25.0 version. The level of statistical significance was accepted at 0.05.
Initially, there were 100 (73%) out of 137 undergraduate 1st year dental students from regular and international class who filled out the informed consent for their participation in the study. Students were randomly assigned into 2 groups (A and B). During the trial, a total of twenty-six students did not complete a minimum of 10 missions per topic within the designated time frame, and were excluded from the analyses. The reasons for students not being able to complete the required missions were high study load and HistoRM game could be played only on a laptop/desktop. Therefore, seventy-four students (53.6% of all first-year students) were included in the analysis.
Results of student cognitive skill scores. Significant increased of cognitive skills scores were observed pre- and post tests in topic 1 (i) and topic 2 (ii); The order of intervention influenced the scores at day 3 (iii); but no significant different in the two groups tested at day 7 for topic 2 (iv)
In the learning content domain, students responded positively to the content of HistoRM game. Over 95% of participants reported that they gained a better understanding of histology content. More than 90% of students perceived the quiz sessions in HistoRM game helped them to understand the oral histology practicum lessons. They agreed (81%) that the content of HistoRM game has been previously studied. The practicum course is integrated with the theory of oral biology course and serves as the reinforcement of the theory class. In the HistoRM game domains, all of the questions received more than 90% positive responses, although not all students like to play games in their spare time for entertainment purposes. In the learning experience domain, the immediate feedback given after each quiz session helped the students understand the subject matters (98.3%) and agreed that serious games can be implemented as a complementary learning method. They suggested the serious games approach is not only used for learning oral histology but for other learning materials (Table 3).
The main consideration for combining games with education is the ability of games to provide high motivation and potentially make the learning process easier, especially for the learning subjects that students perceive as less interesting. Serious games are different from traditional learning and are considered to provide a more interactive learning environment, support increased motivation, and safe training for students [33,34,35,36]. This occurs because of the different characteristics between conventional learning and games. Conventional learning emphasizes the transmission of information and memory. Meanwhile, games confront players with engaging problems and offer ways to explore the problems [8]. In this way, players have the opportunity to develop a higher level of learning such as analysis and evaluation. Analysis of serious games explains how student competence can be increased with formative feedback until the game is over [14]. In HistoRM, we provided direct feedback, to allow students to identify the results, to recognize mistakes based on previous experiences and reconsider strategies to complete the game. Students can improve their competence from the feedback provided by the game system to complete the games. Immediate feedback on serious games encourages users to learn from experience and is perceived by students as one of the strong features in the HistoRM.
The present study highlights the importance of introducing an innovative learning approach to enhance knowledge acquisition and improve the overall learning environment. However, this study had some limitations. The first limitation of the study was the relatively low response rate of 53.6% of total first year dental students, although students were strongly encouraged to take part in this study, their participation remained voluntary. The number of non-respondents might undermine the power of the study and therefore the potential response bias can not be completely ruled out. The results of the study must be interpreted with caution. Second, the generalizability of the results of the present study was limited by the use of data from a single university with a discrete population of first year dental students. As each dental school may have different conditions that influence the use of serious games in their curriculum [31], the results of the study must therefore be interpreted with caution. Further studies are needed to explore serious games as learning approaches in other settings. Third, future cohort studies evaluating the impact of HistoRM in knowledge retention are also crucial to measure long-term benefit to the learning method. Finally, as social interactions can have an impact on how students could gain knowledge from game-based learning [29], future research should also investigate whether collaborative or competitive approaches could be supportive for the game.
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