Hope Saltmarsh RDH, BA, MEd
Computer-assisted learning (CAL) of orthodontic topics is at least as effective as conventional learning modes, and adds 4 to 10 percent knowledge gain.
There is insufficient evidence comparing the effectiveness of CAL and traditional methods for orthodontic topics.
Do computer-assisted learning methods compared to traditional learning methods increase the quantity and quality of knowledge gain as well as improve knowledge retention in orthodontics?
The authors searched 13 electronic databases and Internet to November 2008 for randomized controlled trials (RCTs) and prospective studies published in English. They also performed an extensive manual search. They included studies on undergraduate dental students, postgraduate orthodontic residents or orthodontic educators. Computer-assisted learning interventions included interactive multimedia course packages, web-based cases, hypertext tutorials, other computer-based tutorials, and CDs. Traditional learning methods included lectures, seminars, tutorials, and live demonstrations. The primary outcomes were quantity and/or quality of knowledge gained by the students as measured by pre- and postintervention survey or postintervention only, and knowledge retention at three or more months later. The authors used a checklist for evidence appraisal with a maximum score of 17. The minimum score for inclusion was 11.
The authors identified nine studies that met the inclusion criteria (seven RCTs and two prospective controlled trials). In all nine studies the participants were undergraduate dental students. The authors performed a meta-analysis of the three studies that used pre- and post-intervention tests. Their results indicated a statistically significant gain in knowledge favoring CAL with a weighted mean difference (WMD) of 9.78 percent (95 percent confidence interval [CI], 2.89 percent to 16.67 percent). Authors did a meta-analysis of five studies which used only a post-intervention test. The results were statistically in favor of CAL with a WMD of 3.79 percent (95 percent CI, 0.31 percent to 7.28 percent).
Computer-assisted learning, for teaching orthodontic topics related to diagnosis and treatment planning, is at least as effective as conventional methods, and adds an additional small (4-10 percent) but significant gain in student knowledge.
Source of Funding:
Importance and Context:
Computer technology can support learning in different ways, including self-directed, distance and asynchronous learning. However, studies of CAL in orthodontics have reported mixed results. There is no reported previous meta-analysis of the effectiveness of CAL and other learning methods in orthodontics.
Strengths and Weaknesses of the Systematic Review:
The authors used a comprehensive search strategy, but limited it to English-only publications. They stated a November 2008 search end date but reported no start date. Based on AMSTAR (assessment of multiple systematic reviews), the methodology of this systematic review is sound. In their statistical effect size calculation, the authors used weighted mean difference (WMD). Because of the heterogeneity in the studies, they used a random effects model for analysis and quantified heterogeneity. The authors did not include one RCT from 1998 in the meta-analysis of studies with pre- and posttests because standard deviations for the posttests were not available. The scope of this review appears too broad for an investigation of CAL in dental education limited to orthodontics. The authors sought two primary outcomes and nine secondary outcomes. The results for all but one primary outcome were either not investigated in any studies, inconclusive, or inadequate for meta-analysis. A meta-analysis was possible only for quantity and/or quality of knowledge gained. The authors chose to include studies that did not have a pretest. Without a pretest, knowledge gained cannot be measured.
Strengths and Weaknesses of the Evidence:
In the meta-analysis of the three studies which included pre- and posttests, one was a prospective study that the authors judged of lesser quality than the others because the control and experimental groups of students were not similar at the start of the study, and the posttest they administered covered more than just the CAL material. That study carried a weight of 67 percent which may have exaggerated the effectiveness of CAL. The two remaining RCTs in the meta-analysis showed no difference in the effectiveness of CAL versus traditional methods. At best, test scores are surrogate measures of knowledge gain. Although the included studies assessed the reliability of their test instruments, none presented their tests. Knowledge gained by the students is unclear.
Implications for Dental Practice:
Computer-assisted learning in orthodontics can be used as an adjunct to traditional learning methods in training and dental education with respect to assessment, diagnosis and treatment planning. Its use for orthodontic continuing education could make it more readily available and convenient for a broader group of potential learners.