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| ORIGINAL RESEARCH ARTICLE |
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| Year : 2017 | Volume
: 30
| Issue : 1 | Page : 31-34 |
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Mobile learning app: A novel method to teach clinical decision making in prosthodontics
Saee Deshpande, Jaishree Chahande, Akhil Rathi
Department of Prosthodontics, VSPMDCRC, Nagpur, Maharashtra, India
| Date of Web Publication | 13-Jul-2017 |
Correspondence Address:
Saee Deshpande
Department of Prosthodontics, VSPMDCRC, Nagpur, Maharashtra
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/1357-6283.210514
Background: Prosthodontics involves replacing lost dentofacial structures using artificial substitutes. Due to availability of many materials and techniques, clinician's clinical decision-making regarding appropriate selection of prosthesis requires critical thinking abilities and is demanding. Especially during graduate training years, learners do not receive the exposure to a variety of cases, thus their clinical reasoning skills are not developed optimally. Therefore, using the trend of incorporating technology in education, we developed a mobile learning app for this purpose. The aim of this study was to evaluate learners' perceptions of this app's utility and impact on their clinical decision-making skills. Methods: After taking informed consent, interns of the Department of Prosthodontics of VSPM Dental College, Nagpur, India, during the academic year May 2015–May 2016 were sent the link for the app to be installed in their Android smartphones. Their perceptions were recorded on a feedback questionnaire using 5-point Likert scale. The script concordance test (SCT) was used to check for changes in clinical reasoning abilities. Results: Out of 120 students who were sent the link, 102 downloaded the link and 92 completed the feedback questionnaire and appeared for the SCT (response rate: 76%). The overall response to the app was positive for more than two-thirds of interns, who reported a greater confidence in their clinical decision-making around prostheses through this app and 94% of the students felt that this app should be regularly used along with conventional teaching techniques. Mean SCT scores were pretest 41.5 (±1.7) and posttest 63 (±2.4) (P < 0.005). Discussion: Clinical decision-making in prosthodontics, a mobile learning app, is an effective way to improve clinical reasoning skills for planning prosthodontic rehabilitation. It is well received by students. Keywords: Clinical decision-making, learning, prosthodontics, smartphone
How to cite this article:
Deshpande S, Chahande J, Rathi A. Mobile learning app: A novel method to teach clinical decision making in prosthodontics. Educ Health 2017;30:31-4 |
| Background | |  |
Information and communication technology has become a critical component of teaching and learning in higher education, including in the education of health-care professionals.
The use of mobile devices by health-care professionals has transformed many aspects of clinical practice.[1] Mobile devices have become commonplace in health-care settings, and numerous apps are now available to assist with many important tasks, from information management to communications and clinical decision-making.[2] For dentistry, in particular, many apps are available mainly for clinical case discussion, postgraduate entrance preparation, and patients' record management. The attitudes of young graduates and professionals regarding the use of mobile devices and apps have been quite positive.[3],[4],[5],[6],[7]
Prosthodontics is a branch of dentistry dealing with the replacement of lost dentofacial structures with artificial substitutes. Any patient with missing teeth can be rehabilitated using removable dentures, a fixed tooth-supported bridge, or an implant-supported bridge. There are a wide variety of materials available, including ceramic, heat-cured acrylic, cold-cured acrylic, and metals. The choice of specific substitute depends on many factors including clinical situation, operators' skill, patients' ability to afford the substitute, and time available to the dentists and patients. A clinician's ability to make the best clinical decision requires experience through exposure to many cases and expert guidance. This may not always be available at undergraduate level, especially in internship when learners are posted in various departments for short periods.[8] Furthermore, not all teaching institutions can provide exposure to a variety of clinical cases. To meet this need, we developed a mobile app for interns that simulates real-life clinical cases to teach clinical decision-making in the subject of prosthodontics.
The aim of the report is to describe this mobile app to teach prosthodontics and to evaluate its effect on intern's measured clinical decision-making capacity as well as their perceptions of its utility.
| Methods | | |
The study was conducted at the VSPM Dental College and Research Centre, Nagpur, India, a private college that follows the curriculum prescribed by Maharashtra University of Health Sciences, Nasik. The participants were B.D.S. students who had completed their 4 years of dental training and were just beginning their 1 year compulsory rotating internship before earning their degree.
Structure of mobile app
The structure of the app was very simple involving interactive screens as described in [Table 1].
A total of 35 real patients' cases requiring prosthodontic rehabilitation with different types of prosthetic treatment modalities were peer validated and programed in the app [Figure 1], [Figure 2], [Figure 3]. Cases included patients' requiring removable complete and partial denture prosthesis, fixed prosthesis, implant-supported prosthesis, maxillofacial prosthesis, and any combination of these treatment options.
A special emphasis was given to selected cases that required preprosthetic treatments by endodontics, periodontal therapy, surgery, and other specialties also. The intent was to train the students to make an interdisciplinary clinical decision and correct sequencing of the treatment.
Apart from this, regular features of app such as reading material, send a query, and recommend to a friend were also made available.
Approval from the Institutional Ethics Committee was obtained. A total of 120 interns were briefed about the nature of the project, its aim and steps involved, and the timeframe. It was made clear to them that participation was voluntary and there were neither any incentive for participation nor negative consequences of nonparticipation. After taking informed written consent, interns of the Department of Prosthodontics during the academic year May 2015–May 2016 were sent the link for the app to be installed in their Android smartphones.
Evaluation
Students' perceptions were recorded using a questionnaire.[9] It included close-ended questions about topics such as students' perceived need for such app, the design of the app, i.e., whether it is user friendly, its understandability and ease of use, and the appropriateness of its content. Responses were provided using a 4-point Likert scale. The 4-point Likert scale response values were combined into three categories to simplify the analysis.
Improvement in interns' clinical decision-making skills was assessed using script concordance test (SCT) administered before and after the intervention. SCT is used to assess clinical reasoning in ambiguous or uncertain situations.[10] It allows testing in real-life situations that are not adequately measured with the current tests. It probes the multiple judgments that are made in the clinical reasoning process. Scoring reflects the degree of concordance of these judgments to those of a panel of reference experts.
An SCT comprised twenty case scenarios with a total of sixty questions formulated, with a maximum attainable score of 100. It was peer validated and administered to the participants before and after they completed the test using all 35 cases in the mobile app. Students' pre- and post-test scores were compared using paired t-test.
| Results | | |
Out of 120 students who were sent the link, 102 downloaded the link and 92 completed the feedback questionnaire and appeared for SCT, with a response rate of 76%.
Most interns felt that planning prosthodontic rehabilitation is important in clinical practice and that conventional textbooks and teaching techniques do not provide adequate training to plan prosthodontic rehabilitation. Most interns found that the app was easy to navigate and many felt that the app enhanced their knowledge and confidence in planning prosthodontic rehabilitation.
Two open-ended questions were posed to the participating interns: in response to “What was the best thing about the app?,” most mentioned its simple design and the wide variety of cases which otherwise they might not have seen during internship. Some mentioned the fact that they can use the app anytime and ask for guidance in an interactive nature. For the question “What can be done to make it even better?,” students provided many suggestions, such as including more cases, procedure videos, and a capacity for live interaction with the faculty.
The groups' mean score on the SCT pretest was 41.5 (±1.7) and posttest was 63 (±2.4) (P< 0.005).
| Discussion | | |
The process of decision-making requires critical thinking abilities and an opportunity to observe and practice a variety of clinical situations. Dental students in their internship get very limited exposure to prosthodontics for many reasons, including a shortage of clinical cases in private institutes that exceed the large number of students.[5] In addition, while posted in a particular department, interns are expected to diagnose and treat for that specialty only. Therefore, there is a fair chance of compartmentalization of knowledge and adversely affecting their ability to treat patients comprehensively. To address this issue, the authors sought to show students the real patients' photographs and provide other case details to train students in the proper diagnosis and selection of appropriate prosthesis for a range of clinical situations.
Computer-assisted, case-based learning has been shown to be effective in this regard, especially with blended learning module.[8] However, desktop-based software cannot be accessed anytime and anywhere, lacking a portability and self-paced structure.
Mobile devices such as smartphones can make a significant contribution to modern health-care education. Apps developed to run on both computer and mobile devices can be used. The mobile app tested here was designed to present a wide range of real-life clinical cases to develop the critical thinking capacity of dental students for planning prosthodontic rehabilitation.
Program evaluation was done at Kirkpatrick's levels 1 (learners' reactions) and 2 (their change in knowledge).[11] As with every technology, understanding the skills of the principal intended users and their attitudes toward the new tool is fundamental in guiding the development of appropriate educational innovation. Therefore, it was important to understand what students think about this intervention.
In the present investigation, we also evaluated the cognitive skills of clinical decision-making among the students before and after the use of the app. SCT was used for this purpose as it probes the multiple judgments that are made in the clinical reasoning process.[10],[12]
In the present study, there was a meaningful and statistically significant improvement in students' test scores after using the app, which reflects improvement in their clinical reasoning.
It was challenging to develop the app as it needed to be both user friendly and attractive. It took considerable effort to validate the cases presented through the app, as there are many possible treatment options available for each case and expert opinion on the best option sometimes varies. Nevertheless, the interns were excited and satisfied with the app; in fact, a few of the faculty from other disciplines as well as general practitioners asked to register for this app. This emphasizes the importance and recognized need for training in clinical decision-making by dentists and the role of technology in education.
Limitations of this study
A bigger sample size including interns from different institutions and regions would give us a better assessment of the broad applicability of this app.
| Conclusions | | |
This mobile learning app is a useful teaching technique to provide training for planning prosthodontic rehabilitation to dental interns. It provides exposure to a wide variety of clinical cases and a chance to improve clinical reasoning in choosing the correct prosthodontic treatment.
Acknowledgment
We thank Dr Usha Radke for supporting this study and Whiz Softwares and Business Solutions, IT Park, Nagpur for providing technical support to this study.
Financial support and sponsorship
This project was funded by VSPM AHE, Nagpur, Maharashtra, India.
Conflicts of interest
There are no conflicts of interest.
| References | | |
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[Figure 1], [Figure 2], [Figure 3]
[Table 1]
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