Postgraduate student perceptions of face-to-face and distance education in orthodontics: A cross-sectional qualitative study (2024)

Abstract

Introduction

The COVID-19 pandemic caused significant disruption to educational systems worldwide,resulting in closures of schools, colleges and higher education institutions. Due tothe need to control the spread of coronavirus, these institutions had to relyincreasingly and, in some cases, exclusively, on digital tools and remote methods oflearning in a synchronous and asynchronous manner to deliver their educationalprogrammes. With the suspension of face-to-face teaching and resultant changes tothe methods of teaching delivery, it was important that the quality of studenteducation was maintained and impacts on academic learning minimised. There was anonus on educators to adapt rapidly to ensure that they provided the necessaryinformation to students in an online format without compromising their teachingstandards or quality of teaching.

With regard to orthodontics, educators have traditionally relied on face-to-facelectures in a didactic format (Chadwick et al., 2002). Interestingly, Rao and colleagues (2020) conducted asystematic review to investigate the use of e-learning in orthodontic graduateeducation and noted that with newer advances in technology and students who are‘digital natives’, methods of knowledge delivery need to be reassessed inorthodontic training. The COVID-19 pandemic has undoubtably provided a catalyst forthe restructuring of educational systems and, going forward, it is essential thatthis momentum is sustained to ensure that the new educational model is of an optimalstandard for students.

There have been limited studies that have investigated student perspectives ofdistance education in postgraduate dentistry compared with face-to-face education(Kunin et al., 2014;Rosenbaum et al.,2012). At present, most of the research in this emerging area isquantitative and questionnaire-based and does not provide a full understanding ofthe reasons behind the perceptions about different modes of teaching (Dost et al., 2020).

It is therefore imperative to investigate this area to aid understanding and improvethe delivery of orthodontic programmes for students. In addition, research in thisarea will help aid the understanding of how educational tools and digital technologycan be used to enrich the student experience and will provide invaluable informationto educational institutions, to help shape the future development of orthodonticpostgraduate education both nationally and internationally.

The aim of this study was to investigate postgraduate student perceptions offace-to-face and distance education in orthodontics and to determine the mosteffective and engaging methods of teaching to provide students with an optimaleducation experience.

Material and methods

This qualitative study investigated postgraduate student perceptions of face-to-faceand distance education in orthodontics at one UK dental school. Ethical approval wasgranted by University College London (UCL) Research Ethics Committee (18239/001) andthe project was registered with the UCL Data Protection Office. A Data SharingAgreement was signed with a professional transcription company to meet GDPRrequirements.

Participants were recruited from the Orthodontic Department in a large postgraduateteaching hospital in the United Kingdom. Before commencing recruitment, the studywas introduced during departmental staff meetings and it was explained thatpotential participants would be contacted individually by the research team to askif they would be happy to consider participating in the study; however, it wasstressed that participation was voluntary and they did not have to take part if theydid not feel comfortable doing so. Anyone who did not wish to be contacted in thisway was asked to let the lead investigator know. Individual invitation emails weresubsequently sent to all postgraduate orthodontic students (n=30) on the three-yearprogramme of study who had received both face-to-face and distance education betweenMarch 2020 and January 2021; email addresses were available from the existingdepartmental staff/postgraduate lists. The aim was to include students from allthree year groups, representing different genders and national/internationaleducational backgrounds. All potential participants were asked to respond to theemail to confirm whether they were happy to take part in the study. In total, 25students agreed to participate in the focus groups; there were five students whowere unable to participate due to illness scheduling conflicts or time zonedifferences. After confirmation of their wish to participate, participants wereasked to complete and return a signed consent form.

Postgraduate student perceptions were investigated through online focus groups onZoom Video Communications, Inc. (Zoom) and facilitated by the researcher (OJK) whounderwent focus group facilitation training and undertook practice interviews withthe senior researchers. The researchers felt that there were potential benefits tousing an ‘insider’ facilitator for the focus groups; the facilitator had thoroughknowledge of the academic programme, an ability to draw on experience when probingduring the focus groups, and there was a willingness and openness of participants todiscuss issues with a familiar facilitator, which optimised the data yield.

A topic guide was developed by the project investigators to guide the discussions inthe focus groups, explore perceptions of face-to-face and distance education, and toensure adequate coverage of key topics. An initial draft of the topic guide wasdeveloped based on a thorough review of the literature in this area as well as basedon the aims of the study and the aspects of orthodontic education, which theresearchers intended to explore. The topic guide commenced with an introduction toset the context for the focus group discussion and consisted of four sections withquestions about traditional face-to-face education, distance education, a comparisonof the two teaching methods and assessments. Following the practice interviews, thetopic guide was amended and during the focus group interview process the guide wasmodified if previously unidentified, but pertinent, topics emerged. The topic guidewas not rigidly followed in this order, but all aspects were covered, and the orderadapted according to the flow of the focus groups.

Participants were grouped according to their year of training to ensure they feltcomfortable in the focus group environment. The focus groups were recorded locallyon Zoom and the audio recordings were transcribed by a professional transcriptioncompany with any identifiers removed. There were seven focus groups and the groupsizes were in the range of 3–5 participants, as the researchers felt this was areasonable number of participants to manage in an online focus group.

A content thematic analysis using the Framework method was used to analyse the data,based on the methodology developed by the National Centre for Social Research (Ritchie and Spencer,1994). The identification of themes and subthemes was conducted by threeresearchers (OJK, FR, SJC) independently; all three researchers read and reread thetranscripts and agreed on the themes and subthemes. Each of the themes werecolour-coded and grouped to allow for comparison and checking. Quotes from thetranscripts were inserted into Microsoft Excel; each theme was allocated a separateworksheet and the column represented the subthemes. Each student was allocated a rowand the relevant quote from the transcripts was entered in the relevant cell inExcel; this method allows researchers to track findings, helping ensure that linksbetween the original data and findings are maintained and transparent.

Results

In total, 25 postgraduate students were recruited, including 15 UK and 10international trainees, representing 83% of trainees on the programme (Table 1). The timing ofthe focus groups was such that it was possible to include two cohorts of third-yearstudents: those who finished their orthodontic training in summer 2020 and thosecompleting training in summer 2021. The focus group interviews lasted 51–81minutes.

From the analysis, six themes were identified and within each theme there wereseveral subthemes (Table2). The results are presented using direct verbatim quotes fromparticipants (e.g. P1 = participant 1) to support the identified themes andsubthemes.

Preferred teaching methods

At the end of each focus group, each participant was asked which teaching method theypreferred: face-to-face, blended or distance learning; the majority of studentsexpressed a preference for a blended approach and wanted this method to be used forthe orthodontic programme going forwards. Participants commented that they founddistance teaching more time efficient and it allowed them more time to prepare forteaching sessions as they did not need to travel to access that teaching. Themajority of students expressed that they wanted the online format of teaching tocontinue for theoretical orthodontic topics; however, they felt strongly thatpractical skills needed to be taught using a face-to-face approach. These findingshighlighted the benefits of a blended approach and a hybrid teaching model,utilising the benefits of both modes of teaching delivery to provide an optimallearning experience for students.

Discussion

The COVID-19 pandemic has been a catalyst for the inevitable cultural transformationof the educational system and the circumstances have given rise to an enhancedhybrid model of education involving face-to-face and distance education. As thismodel of education has developed, going forward it is crucial to determine the bestteaching methods to improve curricula and to maximise the benefits of bothface-to-face and distance education. Thus far, there has been limited research toassess student perceptions of distance and face-to-face teaching in orthodontics andthere is a clear need to conduct research in this area. This study therefore adds tothe evidence base in this area.

Six themes were identified from the analysis of the focus groups. With regard to thefirst theme, social support network, students explained that the distance educationformat made it more difficult for them to bond with their peers and they could notget to know each other as well. Harasim and colleagues (1995) found that the establishment of socialbonds has important cognitive and socio-effective benefits for learning.Interestingly, Alqurashi(2019) found that socialising and interactions between students had apositive impact on student satisfaction and the perceived effectiveness of onlinelearning. The present study supports previous findings that social interaction is animportant aspect in the delivery of education and is easier to achieve in aface-to-face format.

Technology was the second theme and, within this, students reported that technologymay be unreliable which could negatively impact on their education where distanceteaching was being provided. This was also experienced by undergraduate dentalstudents in Indonesia in a study by Amir et al. (2020). In addition, researchfound that an unstable Internet connection was a barrier to distance learning for21.53% of UK medical students (Dost et al., 2020). In the present study, students across all three yeargroups discussed the benefits of being able to access pre-recorded lectures onlineas it allowed them to review educational material at the time of their choosing.Recording lectures and maintaining their availability online may therefore helpcounteract any technological difficulties faced by students during onlinesynchronous sessions; however, this issue clearly remains one of the reallimitations of distance learning.

The educational experience was discussed in relation to accessibility of educationalresources, the convenience of accessing education without commuting, diversity ofthe educator pool and time efficiency. A reported benefit of distance education wasstudents being able to access and review educational material at a time of theirchoosing. A reported strength of the virtual learning environment for orthodonticpostgraduate students in a previous study also included the improved access toresources and ability to interact with the programme regardless of distance (Shah and Cunningham,2009). These findings were also supported by Rad and co-workers (2021) whoreported that online education made resources more accessible for dentalstudents.

In the ‘education environment’ theme, there was no clear consensus about the besteducation setting. For some students, working from home in a distance format wasbeneficial for their concentration and for others face-to-face teaching in atraditional lecture setting improved their concentration. In the literature, thereis also no clear consensus as individual circumstances and preferences clearly playa key role (Grimes, 2002;Rad et al., 2021);and it is likely that the education setting will always pose a challenge foreducators, and this could be the reason why blended courses where there is acombination of face-to-face and distance education are viewed favourably bystudents.

In the ‘effective teaching and learning’ theme, students discussed peer learning,practical skills teaching and theoretical teaching. In general, students felt thatpeer learning was facilitated in a face-to-face setting. The consensus from studentswith regard to practical skills was that these could only be taught effectivelyface-to-face. This is supported by other studies investigating medical and dentalstudent perspectives on distance and face-to-face learning (Dost et al., 2020; Wang et al., 2021). In the present study,the majority of students expressed that they would like the online format ofteaching to continue for theoretical orthodontic topics and replace face-to-faceteaching in these areas; this finding was also similar to the study by Schlenz et al. (2020) whofound that dental students wanted approximately half of their theoretical teachingto be online in the future.

In the final theme, interactions, several students expressed that online teachingcould make them feel exposed and vulnerable, which prevented some from askingquestions during the teaching session. Some students found they were lessinteractive online, and this format made them feel disconnected; this highlights theimportance of ensuring educators are aware of this and are able to manage theseaspects of teaching with sensitivity. Grimes (2002) also reported that theface-to-face classroom allowed the discussion of specific student questions, butthis was not as easy in a distance format. In addition, Grimes found that 69% ofdental assistants and dental hygiene students reported feeling detached from thefaculty and other students with distance education. Varvara and co-workers (2021) noted thatdental students found interactivity challenging with distance education as there waslittle possibility for discussion. Students in the present study found thatface-to-face teaching was beneficial to nurture a relationship between students andeducators. McCann et al.(2010) concluded that although students found that electronic materialscan enhance learning, they wanted face-to-face contact with faculty and expressedthat electronic resources should not replace faculty interaction.

The present study has the advantage of having included both UK-based andinternational orthodontic trainees in order to ensure a breadth of opinions, whichenhanced generalisability and wider transferability of results. In addition,students were recruited from all three year groups in order to obtain opinions fromthose at different stages of training. The authors acknowledged that students fromthe different year groups had varying levels of experience with asynchronous andsynchronous teaching methods on the programme. Despite these differences, theauthors believe that obtaining opinions from students at various stages of trainingprovided a greater diversity of opinions and optimised the data yielded.

As this study was carried out at one postgraduate dental school, the authors areaware that the results may not be applicable to all orthodontic students nationallyand internationally. Future research could therefore be conducted at other dentalinstitutions, including larger cohorts of students, to obtain a broadercross-section of views and make results more generalisable.

The researchers made a decision to use focus groups rather than one-to-one interviewsfor this study; prior research has found that focus groups allow for a greater rangeof discussion between the participants (Schneider et al., 2012). In addition, theinteraction between participants in focus groups generates accounts which may bemore fully articulated and detailed than one-to-one interviews (Wilkinson, 1998). Thereported optimal number of participants for a focus group varies; however, Krueger and Casey (2000)suggested that smaller groups of 6–8 participants have greater potential. For thisstudy, the focus group sizes were in the range of 3–5 participants as theresearchers felt this would be a reasonable number of participants to manage in anonline focus group. As each year group contained 6–9 students, year groups weresubdivided into smaller focus groups for participation in the study. These smallergroups also allowed the researcher (OJK) to accommodate variations in individualstudent timetables. The focus groups took place at a time when students were onlyreceiving distance education due to the national restrictions on face-to-faceeducation with the COVID-19 pandemic. It is important to note that the timing ofthese focus groups may have impacted on the data collected as the students were notable to have simultaneous face-to-face and distance teaching and therefore it wasnot possible to have a concurrent comparison of the two teaching methods. However,all participants had wide prior experience of face-to-face teaching with which tomake comparisons.

The researchers considered whether to utilise an ‘outsider’ or an ‘insider’ as afacilitator of the focus groups. Insider research studies have been criticised forthe research being ‘too close’ for objectivity (Brannick and Coghlan, 2007). However, thistype of research also has multiple benefits, including having perspective of theculture of the academic programme, ability to draw on understanding and experiencewhen probing during the focus groups, and the willingness of participants to discussissues with someone who understands them (Fleming, 2018). The challenges of insiderresearch include inherent subjectivity, the potential for implicit coercion ofparticipants, potential of professional conflicts and researcher bias (Fleming, 2018). Afterconsidering the advantages and disadvantages, the researchers felt that the benefitsof ‘insider’ facilitator knowledge of the programme structure and participantsoutweighed the perceived disadvantages. To minimise any disadvantages of insiderresearch, the researcher OJK underwent focus group interview training during whichemphasis was put upon remaining neutral and impartial and avoiding the temptation toshare experiences and introduce bias.

The COVID-19 pandemic has provided an opportunity for cultural transformation of theeducational system and the present circumstances are likely to give rise to furtherdevelopments of the hybrid model of education to maximise the benefits of bothface-to-face and distance education. In light of the findings in this study, theauthors would recommend the following:

• Educators should ensure a blended learning approach for orthodonticprogrammes; with practical components/skills being taught in a face-to-facesetting but with some of the more theoretical aspects of teaching deliveredremotely.

• Online libraries of pre-recorded lectures and practical skills videos shouldbe expanded and made available for all students (e.g. via local virtuallearning environments or potentially through the British Orthodontic SocietyVirtual Learning Environment).

Conclusion

This research aids the understanding of how students perceive face-to-face anddistance education in orthodontics and the results provide valuable information forthe future development of orthodontic education.

Although there were challenges noted with distance education, the majority ofstudents felt that blended learning would be their preferred way to engage with theorthodontic curriculum. Several students felt that some of the theoreticalorthodontic subjects could be delivered effectively in a distance format and wouldlike this format to be used going forward but more practical elements of thecurriculum should continue to be delivered in a face-to-face format.

Supplemental Material

Acknowledgments

The authors thank all the postgraduate students who participated in this study.

Footnotes

References

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