by Robert W. Hasel, D.D.S., Associate Dean, College of Dental Medicine.
The need for change in education has been an ongoing discussion for many years. For more than three centuries the pedagogical model of delivering education has been the traditional lecture based approach, placing large groups of students in a room and reciting lectures to them. This passive learning environment requires students to memorize lectures without internalizing the complexity of scientific inquiry. In the 21st century, the ever-changing society we live in has placed different demands on the way learners learn and health practitioners practice their professions.
Western University College of Dental Medicine is taking a new approach to the need for change by designing a curriculum that will prepare graduates for the society they will face when they enter the 21st Century workplace. The integration of basic sciences and clinical sciences in a multidisciplinary evidence-based curriculum, problem-based learning, and addressing individual learning styles is a priority for the next generation of graduates.
To help achieve this goal, the traditional approach to delivering content for memorization is being changed with blended learning environments and flipped classrooms. Instead of listening passively to lecturers, students are actively immersed in the online adaptive learning environment which delivers the learning content to the student outside of the classroom on their own time. Classroom time is used for face-to-face group interaction where students are engaged in course-related activities rather than watching and listening to the instructor. Instead, students answer questions, solve problems, explain concepts, interpret observations, brainstorm a list, predict outcomes of a case and discuss and apply the information learned online to develop understanding and critical thinking skills.
The online delivery of the course content is much more than downloading a PowerPoint or a video of the classroom lecture. The curriculum design of online content placed in the adaptive learning platform requires students to engage the information through activities, challenges, and gaming with the use of multimedia and interactive models of human anatomy. Learning activities are embedded in each lesson that require the student to go outside the online environment to perform activities such as research and reference of information, building models, mapping pathways of neural vasculature anatomy, and solving case based problems.
The Realize-It Adaptive Intelligence Engine platform delivers the learning content to the student outside of the classroom in their own personal environment. Students interact with the didactic content by completing various requisite nodes that branch to other nodes in an intricate manner pre-determined by the course instructor. The instructor designs the learning map to reflect the inherent prerequisite relationships that exist between the nodes, and the students can make choices as to the pathways they will follow within this structure. Each node contains learning objectives, didactic content, interactive 3D models, supportive diagrams and media files, learning activities, and assessments. Algorithms in the adaptive learning platform guide the student in a learning path according to the student’s demonstrated level of ability, preferences, and proficiency. When students achieve a threshold level of proficiency of knowledge in that requisite node, they can then progress to the next open node. If a student is struggling with a particular topic or node, the algorithm driven engine redirects them to the precise remedial material that will strengthen that particular area of weakness.
Realize-It accumulates evidence from every interaction that a student has with the system. This allows it to continuously refine its knowledge of the student’s profile as a learner in order to provide improved personalization for the individual.
After completing prescribed online lesson plans, students attend classroom sessions that provide an active learning environment. In these sessions, they participate in multiple activities that reinforce and synthesize the requisite knowledge covered in the online environment. There, the students apply what they are learning to develop understanding through interaction with peers, facilitators and faculty, receive valuable mentoring experience, participate in large group and small group activities rotating through stations with designed learning activities, work with peer-to-peer learning, and competitive gaming.
Further development of understanding to higher levels of critical thinking is accomplished with problem solving activities, case studies, and presentations. Through these activities, students learn by doing and teaching, and they refine their proficiency and competency to much higher levels.
Pre-dissection lab sessions preview and focus on the topics of the anatomical dissections that are occurring that day. In addition, these special classroom sessions emphasize and focus on appropriate dental related topics such as the oral cavity, temporal mandibular joint, muscles of mastication, occlusion, and head and neck examination.
For the administration of the course, the Realize-It platform allows the faculty to monitor the status of each individual student in real time. Faculty can track the progress the student is making in each node they are studying, observe every assessment and every question, how many times the student has attempted each question, how much time the student has spent on the question, and the results achieved. When a student is lagging behind or struggling with certain topics, faculty can send notifications, advise remediation, and give additional help. Not only can a faculty tell that a student is struggling with a course, and not only with a particular chapter, and not only with a particular topic, but in which specific questions the student is weak.
Access to all of the data of activity and results give the faculty valuable feedback in the quality of the material from the learning objectives to the content to the assessments. All of these areas can be continually updated and revised, bringing about an improved course and outcomes.
The literature provides many articles showing improved performance on exam questions in measurement of immediate results using blended learning environments. Day and Foley  and Moravec  have shown a performance increase of 20%. Missouri State showed early improvement of learning outcomes of 30%. . San Jose State U data shows marked improvement in median scores at 10 to 11 points higher and in some programs changes from 33 to 40 points higher, , but it is in long term retention of learning where blended learning environments show differences. Some authors show long term retention rates in higher levels of learning, engagement, discussion groups, showing and teaching, as ranging from 30% to 50% higher .
The comparison of results at Western University of Health Sciences College of Dental Medicine over the past 4 years shows a marked increase in test scores in both the written exam and the dissection lab practical after migrating to a blended learning environment. Fall 2013 was the first year of delivering the Head & Neck Anatomy course to the dental students in a basic blended learning environment. All of the didactic content was delivered online in the form of PowerPoint presentations and videos. The classroom sessions involved mixed group learning activities. Fall 2014 was the second year of the flipped classroom and the first year with the RealizeIT Adaptive Learning Platform delivering all the online learning content. Most of the content ingested into the platform was still in basic PowerPoint form and set as placeholders for future revision. Supplemental materials such as movies, interactive anatomical models and improved diagrams were added to enhance the existing material. The flexibility of the platform also allows for the creation of interactive and variable type questions, providing multiple question types which adapted to each student’s personal response. This greatly enriched the whole question and response capability.
The entire 2014 curriculum was designed for future versions of the Head & Neck course. The results of the test scores show marked improvement in the last two years, especially in the dissection laboratory test results. Although it is hard to measure in this iteration of the course, the area of application and critical thinking performance also improved. The evidence for this is anecdotal and reflected overall student performance and in the comments by several of the student evaluations.
Combined with the results of the student outcomes, evaluations of the faculty, facilitators, and students, and the overall experience of the course, the Administration has begun working with all the suggestions and ideas to develop the new 2015 version of the course. In 2014, the content was delivered in specific silos of content such as osteology, musculature, neural vasculature, etc. The new 2015 course will be constructed in a more systems based approach. The first chapter will cover all five regions of head and neck anatomy in a very basic approach. Each succeeding chapter will become more advanced, allowing the student a more holistic approach to the overall concept of head and neck anatomy. Also, a prerequisite structure will be designed in the background to allow each individual student more freedom to approach the overall content in their specific learning style. More media assets such as audio, video, interactive and immersive models will be added to enhance the content.
The overall result of the Head & Neck Anatomy course for the Western University College of Dental Medicine first year students was a resounding success. The Realize-It adaptive learning platform and blended learning environment generated enthusiasm, excitement, fun and great outcomes. Students were actively engaged in their learning and achieved higher levels of applied, critical thinking, and problem solving knowledge.
 J. A. Day and J. D. Foley. Evaluating a web lecture intervention in a human–computer interaction course. IEEE Transactions on Education, 49(4):420–431, 2006
 M. Moravec, A. Williams, N. Aguilar-Roca, and D.K. O’Dowd. Learn before lecture: a strategy that improves learning outcomes in a large introductory biology class.CBE-Life Sciences Education, 9(4):473–481, 2010
 D. Dotlich, J. Noel, N Walker. Leadership Passages. Jossey-Bass
For more information, contact: