Benefits from peer teaching in the dental gross anatomy laboratory

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  • Benefits from peer teaching in the dental gross

    anatomy laboratory

    Jennifer K. Brueckner and Brian R. MacPhersonUniversity of Kentucky Medical Center, Department of Anatomy and Neurobiology, Educational Technology Group, Lexington, KY 40536-0298, USA

    This study examined the impact of implementing a rotatingdissection schedule on the attitudes and performance of first-

    year dental students in the gross anatomy laboratory at theUniversity of Kentucky. In 20022003, half of the students

    assigned to each cadaver dissected the assigned objectivesduring the first 90 min of the laboratory session. During the last

    30 min, the non-dissecting group members came into the labor-atory and had the days dissection demonstrated and explained

    to them via peer instruction. Dissection responsibilities rotatedwith each laboratory session. Eighty-eight percent of student

    participants were satisfied with the rotating dissection approachaccording to a mid-term survey, and this satisfaction level

    remained unchanged at the end of the semester for most

    students. Students perceptions of the quality of peer laboratory

    presentations varied, with only 44% rating them as good orbetter. Eighty percent of students perceived that rotating dissec-

    tion did not impede their performance, and this was confirmed byanalysis of grade data. Student satisfaction and the ability to

    devote additional weekly curriculum time to studying anatomy ina very compressed curriculum were the main student-described

    benefits.

    Key words: peer instruction; gross anatomy; laboratory; basic

    science instruction.

    Blackwell Munksgaard, 2004Accepted for publication 10 November 2003

    I n teaching others, we teach ourselves (proverb).For educators at all academic levels, the learningpyramid has been a longstanding advocate for peer

    training, demonstrating that the process of teaching

    others results in a 90% retention rate of material, as

    compared to the 5% for lecture, 10% for reading, and

    50% for discussion (1). In addition to its intellectual

    benefits, peer teaching also heightens students sense

    of responsibility, increases self-confidence, and allows

    for growth in interpersonal and collaborative relation-

    ships while improving organizational and problem-

    solving skills (25). Peer teachers are often better at

    understanding students learning problems, more

    interested in their lives and personalities, less autho-

    ritarian and yet are still focused on assessment (6).

    In the realm of health science education, peer

    instruction is a cooperative learning technique used

    widely during both basic science (7) and clinical

    training (8, 9) in a variety of contexts, including

    lecture (10, 11) and laboratory (5, 12). For more than

    30 years, the medical education literature has docu-

    mented different forms of peer instruction in gross

    anatomy in order to save time and facilitate learning

    (1319). As curricular demands increase and qualified

    anatomists become scarce (20), medical schools are

    seeking more cost- and time-efficient ways to teach the

    laboratory component of gross anatomy. A number of

    medical schools have replaced the traditional dissec-

    tion method (where all students attend laboratory and

    participate in dissection) with alternative strategies,

    such as the rotating dissection approach. In this

    instructional technique, only a fraction of the students

    at each laboratory station dissect on any given day; at

    the end of the laboratory, they teach the days

    dissection to their peers. To date, the effectiveness of

    this peer teaching method has been evaluated primar-

    ily for medical students; the present study focuses on

    the implementation of rotating dissection in a dental

    anatomy curriculum.

    In the 2002 academic year, the authors restructured

    the laboratory component of the first-year dental gross

    anatomy course at the University of Kentucky in order

    to correct some serious instructional trends. While

    dental gross anatomy had always been a dissection-

    based course, the dedication to the dissection effort by

    the students was highly variable. Some students

    preferred to spend little time in the laboratory during

    the scheduled course dissection, returning to the

    laboratory in the evening to learn the material largely

    by prosection. Other students preferred to monopolize

    72

    Eur J Dent Educ 2004; 8: 7277All rights reserved

    CopyrightBlackwell Munksgaard 2004euro pean journal of

    Dental Education

  • the dissection, theoretically readying themselves for a

    future in oral surgery. In addition, a concern for the

    faculty was a reduction in the number of trained

    laboratory instructors and their potential monopoliza-

    tion by the full class of 52 students in the laboratory.

    Laboratory instructors needed to be able to move

    between dissection tables quickly to ensure that each

    student group received appropriate assistance.

    The purpose of this curricular shift in dental

    anatomy was to ensure all students participated in

    the dissection experience as well as to make more

    effective use of their dissection time/experience. The

    authors took the opportunity to assess the impact of

    rotating dissection on student attitudes and laboratory

    performance.

    Methods

    The rotating dissection approach was tested with the

    first-year dental class during the spring semesters of

    2002 and 2003 (52 students each semester). On the first

    day of class, the rationale for and structure of the

    rotating dissection approach was presented to the

    class. Dissection teams of six to eight dental students

    were assigned alphabetically and divided into two

    groups. During each laboratory period, only one group

    at each table attended the first 90 min of laboratory and

    dissected the days objectives. The non-dissectors used

    most of the laboratory time to study anatomy in groups

    or independently. During the last 30 min of laboratory,

    the non-dissecting members of each group came into

    the laboratory and had the days dissection demon-

    strated and explained to them by the dissectors. Each

    student present for the dissection played a specific role

    in the laboratory demonstration, as described below.

    Faculty members were present throughout the labor-

    atory period to answer questions and monitor the

    quality of student presentations.

    Each member of individual dissecting groups

    assumed one of three team roles each day. The reader

    was responsible for leading the dissection by reading

    the dissection instructions to the others and locating

    appropriate atlas images to assist in the dissection.

    The reader was also responsible for narrating the

    laboratory demonstration for the students who did not

    participate in the days dissection. The head dissector

    took a lead role in the dissection process and also

    identified key structures during the laboratory demon-

    stration. One or more assistant dissectors assisted the

    head dissector by retracting structures or dissecting

    the opposite side of the cadaver, when appropriate.

    These roles rotated with each laboratory period so that

    all students had the opportunity to act in each role on

    six different occasions during the semester.

    To evaluate student satisfaction with the rotating

    dissection approach, surveys were conducted at mid-

    term and end of semester time points. The surveys

    were designed to collect quantitative data as well as

    qualitative written comments on many aspects of the

    new dissection experience from the first-year class. In

    addition, the teaching faculty recorded their impres-

    sions on the pros and cons of the rotating dissection

    experience.

    To ensure that the rotating dissection approach did

    not impact on student laboratory performance negat-

    ively, laboratory examination scores from 2002 to 2003

    (rotating dissection implemented) were compared to

    the performance in 2001, when a traditional laboratory

    schedule was used (in which all students are expected

    to dissect during each laboratory period). spss statis-

    tical software was used to perform statistical analyses

    on the grade data.

    An exemption certification for this study (Protocol

    03-0375-X2Q) was granted for this study from the

    University of Kentuckys Institutional Review Board.

    Results

    One hundred and four dental students from the first-

    year classes of 2002 and 2003 participated in the study.

    The overall response rate for the surveys (20022003)

    was 87.5% (91 respondents out of a total of 104

    students). Forty-six of the respondents were male

    students (50.5%), and 45 were female (49.5%).

    Eighty-eight percent of student participants indi-

    cated some level of satisfaction with the rotating

    dissection approach (Fig. 1), according to the mid-

    term survey. This satisfaction level remained

    unchanged at the end of the semester for most

    students (79%), while 17.5% indicated a higher level

    and 3% reported a reduced level of satisfaction.

    With regard to student perceptions of the schedules

    impact on learning, 45.6% felt it enhanced their

    learning, while 34.4% perceived that it had no effect

    and 20% thought that it impeded learning (Fig. 2). In

    order to ensure that rotating dissection did not

    impact on performance negatively, laboratory exam-

    ination performance in 2001 (prior to rotating

    dissection schedule implementation) was compared

    to that in 2002 and 2003 (after rotating dissection

    implementation) using anova analysis. Overall per-

    formance on laboratory examinations was not com-

    promised as a result of implementing the rotating

    dissection method.

    Peer instruction in anatomy

    73

  • Students perceptions of the quality of laboratory

    presentations was varied: 15.4% rated them as excel-

    lent, 44% as good, 23.1% as satisfactory, and 17.6% as

    needing improvement (Fig. 3). Most students views

    of presentation quality did not change as measured by

    the end of semester survey (69.1%); 15.5% felt that the

    demonstrations improved over time, while 15.4%

    perceived a reduction in presentation quality. Figure 4

    demonstrates that most students enjoyed teaching

    their peers (88.9%) while fewer reported that they

    enjoyed learning from their peers (64%). 83.8% felt that

    the division of labor among their group was equitable.

    When queried about the schedules influence on

    laboratory preparation, 43.2% indicated that the

    schedule encouraged them to prepare more diligently,

    while the rest indicated that the schedule had no

    impact on their preparation (Fig. 5).

    Each survey provided space for subjective student

    comments. Student-derived benefits of the approach

    were listed as: (i) more time-efficient laboratory

    schedule, allowing extra study time on non-dissecting

    days; (ii) less crowded laboratory environment; and

    (iii) a lower studentfaculty ratio. Students expressed

    concerns about three aspects of the rotating dissection

    approach: (i) 22% of the class wanted to dissect during

    every laboratory and were displeased on days when

    they failed to view the dissection in progress; (ii) 36%

    Enhanced Impeded0

    5

    10

    15

    20

    25

    30

    35

    40

    45

    50

    Per

    cen

    tag

    e o

    f st

    ud

    ents

    No effect

    Fig. 2. Students perceptions of rotating dissection on theirlearning at end of semester. An exit survey indicated that 80%of students felt that the rotating approach did not impede theirlearning. As with the mid-term survey, those students who feltthat rotating dissection compromised their learning cited theinability to participate in all dissections and distrust of the peerinstructors as the primary issues.

    Excellent Good Satisfactory Needs improv.0

    5

    10

    15

    20

    25

    30

    35

    40

    45

    50

    Per

    cen

    tag

    e o

    f stu

    den

    ts

    Fig. 3. Students perceptions of the quality of peer laboratorydemonstrations, as evaluated by mid-term survey. Eighty-two percent of the class rated the student presentations as satisfactory orbetter at mid-term. Only a minority of the class (15.4%) consideredthe presentations to be excellent, however, because of manystudents distrust of the information conveyed by their peerinstructors.

    Yes

    No

    0

    10

    20

    30

    40

    50

    60

    70

    80

    90

    100

    Per

    cen

    tag

    e o

    f st

    ud

    ents

    Enjoyed learning from peers

    Enjoyed teaching peers

    Fig. 4. Students attitudes about peer learning and teaching. Mid-semester evaluation revealed that students enjoyed both teachingtheir peers and learning from them. More students howeverindicated a preference for teaching their classmates (88.9%) overlearning from them (64%).

    Very satisfied Satisfied Dissatisfied Very dissat.0

    5

    10

    15

    20

    25

    30

    35

    40

    45

    50P

    erce

    nta

    ge

    of

    stu

    den

    ts

    Fig. 1. Students satisfaction with rotating dissection at mid-term.A mid-term survey indicated that 88% of students were satisfiedwith the rotating dissection approach. Of those 12% of studentswho indicated some level of dissatisfaction, most cited the under-lying reasons as either a desire to participate in all dissections or aninherent distrust of their peers as teachers.

    Brueckner & MacPherson

    74

  • of the class cited structure misidentification during

    student presentations as a problem; and (iii) 20% of

    the class perceived that they had less effective labor-

    atory learning on non-dissection days.

    In addition, the faculty recorded their impressions

    of the rotating dissection experience and noted the

    following benefits: (i) laboratory attendance was 99%

    or better; (ii) students more effectively divided the

    responsibilities of the dissections at their tables so that

    everyone participated; and (iii) a less crowded labor-

    atory environment facilitated faculty circulation to all

    tables more quickly (fewer faculty can be effective in

    the laboratory); (iv) a better quality of dissection and

    more accomplished per interval as students feel an

    onus to be able to demonstrate the structures to those

    arriving later; (v) faculty can better determine the level

    of knowledge of individual students as they get to

    interact one-on-one with the reduced number of

    students in the laboratory; and (vi) students have the

    opportunity to refine their presentation skills in an

    informal setting through their demonstrations.

    Discussion

    In the literature to date, most of the innovative

    approaches in teaching and learning gross anatomy

    have focused on medical students (2123). Given some

    of the documented differences in the medical and

    dental student populations (2426), it is surprising

    how few studies have addressed dental students

    attitudes toward and performance in the gross anatomy

    laboratory (26, 27). The present study investigated the

    impact of implementing a rotating dissection schedule

    on students attitudes and performance in a first-year

    dental anatomy course at the University of Kentucky

    during the 20022003 academic years.

    Overall, the new approach to laboratory instruc-

    tion was well received by our students. They

    reported the primary benefits of the approach to be

    a low faculty to student ratio as well as extra study

    time for lecture material on their non-dissecting

    days. While most students enjoyed serving in the

    role of teacher, a substantially lesser number of

    students liked being in the role of student. Their

    ratings of the quality of student presentations gen-

    erally expressed uncertainty and mistrust regarding

    the accuracy of information presented by their peers

    dur...

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