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Electronic health records (EHRs) are increasingly moving towards cloud-based web environments. While cloud-based EHRs claim substantial benefits at reduced cost, little cost-benefit research exists for dental schools. The aim of this study was to examine the cost-benefits of a cloud-based EHR compared to an on-premise client-server EHR in the University of Michigan School of Dentistry (U-M Dent). Data were collected in 2016 from the U-M Dent cost-benefit comparison of tangible and intangible factors associated with implementing a new EHR, using the Total Cost of Ownership (TCO) framework from EDUCAUSE. The TCO framework assessed three factors: foundational (overarching aspects: three items), qualitative (intangibles: 56 items), and quantitative (actual costs). Stakeholders performed factor grading, and relative assessment scores were derived for each item as well as the overall factor. The cloud-based EHR solution received higher foundational and qualitative factor summary scores. The overall cost of an on-premise solution over a two-year period was approximately $2,000,000 higher than a cloud-based solution. Cloud solutions did not carry any hidden costs, while such costs accounted for 8% (~$540,000) of the overall costs of the on-premise solution. Across the two-year period, both one-time and ongoing costs were higher for the on-premise solution than the cloud-based solution (by 40.5% and 20.5%, respectively). This study found that a cloud-based EHR system in the U-M Dent offered significant cost savings and unique benefits that were not available with the on-premise EHR solution. Based on cost, the U-M Dent has made a case for cloud-based EHR systems.

The dearth of dental faculty members is a widely known problem that is exacerbated in countries that are attempting to begin dental education programs. This collaboration between Kwame Nkrumah University of Science and Technology and the University of Michigan investigated if dental students who have just started their clinical dental education can learn the knowledge and skills required for identifying and restoring cavitated caries lesions through compact course delivery. There were three instructional blocks: 1) didactic seminar; 2) seminar, simulated hands-on skills instruction, and clinical observation/assisting with treatment of schoolchildren; and 3) seminar, simulated skills training, and application to schoolchildren. Each dental student completed a questionnaire measuring knowledge and perceptions of knowledge, experience, and confidence at five points in time. The dental students’ knowledge increased significantly as well as their perceived knowledge, experience, and confidence (p

This research project was part of a planned initiative at the University of Pittsburgh School of Dental Medicine to incorporate lecture recordings as standard educational support technologies. The goal of an institutional survey was 1) to gather current data about how dental educators across the United States and Canada use lecture recordings; 2) determine dental educators’ perceived value and outcomes of using lecture recordings; and 3) develop recommendations based on #1 and #2 for the dental education community. Of the sixty-six North American dental schools at the time of the study, forty-five schools responded to the survey, for a 68 percent response rate. Of the respondents, twenty-eight schools were found to currently conduct lecture recording; these comprised the study sample. This study focused on the dental schools’ past experiences with lecture recording; thus, those not currently engaged in lecture recording were excluded from further analysis. The survey questions covered a wide range of topics, such as the scope of the lecture recording, logistics, instructional design considerations, outcomes related to student learning, evaluation and reception, barriers to lecture recording, and issues related to copyright and intellectual property. The literature review and results from the survey showed that no common guidelines for best practice were available regarding lecture recordings in dental education. The article concludes with some preliminary recommendations based on this study.

The capabilities of information technology (IT) have advanced precipitously in the last fifty years. Many of these advances have enabled new and beneficial applications of IT in dental education. However, conceptually, IT use in dental schools is only in its infancy. Challenges and opportunities abound for improving how we support clinical care, education, and research with IT. In clinical care, we need to move electronic dental records beyond replicating paper, connect information on oral health to that on systemic health, facilitate collaborative care through teledentistry, and help clinicians apply evidence-based dentistry and preventive management strategies. With respect to education, we should adopt an evidence-based approach to IT use for teaching and learning, share effective educational content and methods, leverage technology-mediated changes in the balance of power between faculty and students, improve technology support for clinical teaching, and build an information infrastructure centered on learners and organizations. In research, opportunities include reusing clinical care data for research studies, helping advance computational methods for research, applying generalizable research tools in dentistry, and reusing research data and scientific workflows. In the process, we transition from a focus on IT-the mere technical aspects of applying computer technology-to one on informatics: the what, how, and why of managing information.

This article describes an Internet-based instructional tool designed to give predoctoral dental students a virtual simulation of clinical pediatric dentistry to develop their pediatric behavior management knowledge. Effectiveness of this tool was evaluated using two consecutive classes of junior dental students. The control group was exposed to the traditional behavior management curriculum (two lectures) in a spring term course. The next class of dental students was exposed to the two lectures and, in addition, completed the behavior management simulation during the following spring term. Both groups completed a two-part examination (objective section=18 questions; open-ended section=responses to a clinical situation) designed to test their behavior management knowledge. The simulation group performed significantly better in both parts of the examination (objective section: p=.028; open-ended section: p=.012). The simulation was evaluated by students and perceived by most to be an effective addition to the curriculum. It was concluded that the experimental behavior management simulation, when added to the traditional lecture curriculum, improved pediatric behavior management knowledge in predoctoral dental students.

The goals of this exploratory study were to determine students’ assessment of portable digital video instruction (using the Apple® iPod®) and to compare examination performance among groups of predoctoral dental students who did and did not utilize portable digital video instruction as a supplement to a conventional pediatric behavior management lecture. Dental students received a one-hour lecture on communication with the parent and child patient as part of their regular sophomore pediatric dentistry curriculum. Digital audio and digital video versions of this lecture were made available to all 113 students in the class. Eleven student volunteers were loaned portable digital video players (the iPod) containing the lecture for a two-week period. Upon completion of the study period, the entire class participated in an anonymous fifteen-minute post-intervention written assessment including a thirteen-item examination covering lecture material. Students who had used the iPod to review the digital video lecture material favored this medium as a pedagogical instrument and as a group performed significantly better on the examination than those who had not reviewed the digital material (p=0.034). In conclusion, portable digital instructional videos may be a useful educational methodology to help predoctoral dental students acquire knowledge in pediatric behavior management.

In spite of efforts by many dental schools to provide information technology resources for students, only a handful of studies have been conducted to determine what dental students think about these initiatives. There are no reports in the literature describing students' perceptions of mandatory laptop programs, which are now being implemented by at least 25 percent of North American dental schools. In schools that have implemented laptop programs, students are required either to enroll with their own laptops that meet specifications or to purchase a laptop from the school at matriculation. In some schools, students are also required to purchase curriculum support software that is bundled with the laptop. This study was conducted to determine students' opinions at U.S. dental schools with mandatory laptop programs about these aspects of this information technology initiative: frequency of use, perceived necessity of use, note-typing during lectures, effectiveness of training, influence on study habits, benefits, implementation problems, added value in relation to added tuition costs, impact on quality of dental education, overall rating of the laptop experience, and impact of the laptop on use of other electronic curriculum resources. Responses of students at schools that purchased packaged curriculum support software from a commercial vendor were compared with students' responses at schools where faculty provided their own educational software. Responses were also compared among freshmen, sophomores, and upperclassmen in a cross-sectional sample. In 2004, approximately 800 dental students at fourteen dental schools responded to eleven questions that requested their impressions and evaluation of mandatory laptop programs and associated educational software. These questions comprised one section of the IREC Students' Questionnaire (IREC=Institutional Readiness for Electronic Curriculum) that assessed students' perceptions of various aspects of information technology at their schools. The majority of students (63 percent) reported that the laptop and associated software were not essential for successful performance in their courses primarily because few instructors had modified their courses to take advantage of laptop capacities. Slightly more than half of the students reported their training was good or excellent, but felt that classroom-based "one size fits all" training was not effective. Less than 15 percent of the students reported that they had made substantial changes in their study habits as a consequence of the laptop program. The benefits perceived by students were primarily related to enhanced email communication with classmates and instructors and convenient access to the Internet and teachers' PowerPoint presentations. Implementation barriers included the inconvenience of carrying laptops to classes, lack of incentive to use the laptop and software because instructors did not require it, and poor quality software. Only 32 percent of students agreed that the value of the laptop and associated software was equal to the added tuition costs. Less than half of the students perceived that the laptop and software had improved the quality of their education, but more than 70 percent rated their overall experiences with laptops as "okay," "good," or "excellent." Freshmen expressed significantly more positive attitudes about the frequency of use, cost-effectiveness, educational value, and overall quality of laptops and bundled software than did upperclassmen. A significantly higher percentage of students at schools affiliated with a software vendor reported that laptops were essential in courses than students at schools with locally produced software, but students at vendor-supplied schools rated the cost-effectiveness significantly lower. Overall, students' assessment of mandatory laptop programs was mixed although freshmen provided significantly more positive responses than did upperclassmen. Incorporation of the e-curriculum into dental schools appears to be following a similar pattern as problem-based learning (PBL) in the 1980s and 1990s. Recommendations for enhancing future e-curricula are proposed based on lessons learned from both information technology and PBL implementation.

Electronic curriculum, or E-curriculum, refers to computer-based learning including educational materials available on CD or DVD, online courses, electronic mechanisms to search the literature, email, and various applications of instructional technology including providing laptops to students, multimedia projection systems, and Internet-compatible classrooms. In spite of enthusiasm about the potential for E-curriculum to enhance dental education, there is minimal guidance in the literature to assist schools with implementation. The study objectives were: 1) identify U.S. and Canadian dental schools that have initiated mandatory laptop programs and assess cost, faculty development issues, extent of curricular use, problems, and qualitative perceptions; 2) determine the extent to which twenty-two other E-curriculum resources were available and used at North American dental schools; and 3) identify factors that influenced E-curriculum implementation. A twenty-six item questionnaire, known as the Electronic Curriculum Implementation Survey (ECIS), was mailed to all sixty-six North American dental schools (ten Canadian and fifty-six U.S. schools) during 2002-03 with a response rate of 100 percent. Twenty-five of the twenty-six ECIS questions employed a menu-driven, forced choice format, but respondents could provide amplifying comments. Fifty-three questionnaires were completed by associate deans for academic affairs, three by deans, and ten by instructional technology (IT) managers, IT committee chairs, or directors of dental informatics departments. The survey found that E-curriculum implementation among North American dental schools is following the classic innovation pattern in which a few early adopting institutions proceed rapidly while the majority of potential adopters make modifications slowly. Fourteen U.S. dental schools have established mandatory laptop programs for students. Ten of these laptop programs were created in the past two years; respondents reported numerous growing pains but were generally pleased with their progress. Other E-curriculum capabilities were incorporated into courses more frequently at laptop schools than the fifty-two non-laptop schools including websites, online course evaluations, and instructor use of email to communicate with students. Few dental schools use online courses, and at most schools, few faculty have received training in online instructional techniques. Virtually all North American dental schools have provided substantial instructional technology resources to their faculty, but use of twenty-two components and capabilities of E-curriculum was limited, especially at schools without laptop programs. Various faculty-related issues were reported as implementation barriers including lack of time, skill, and incentive to develop educational software. We conclude that many North American dental schools, especially those with laptop programs, are functioning at the "learn by doing" phase of initial implementation in a four-stage innovation adoption model. E-curriculum planners should pay close attention to implementation problems that occur at this stage where many innovation efforts break down.

The development of effective educational software requires a systematic process executed by a skilled development team. This article describes the core skills required of the development team members for the six phases of successful educational software development. During analysis, the foundation of product development is laid including defining the audience and program goals, determining hardware and software constraints, identifying content resources, and developing management tools. The design phase creates the specifications that describe the user interface, the sequence of events, and the details of the content to be displayed. During development, the pieces of the educational program are assembled. Graphics and other media are created, video and audio scripts written and recorded, the program code created, and support documentation produced. Extensive testing by the development team (alpha testing) and with students (beta testing) is conducted. Carefully planned implementation is most likely to result in a flawless delivery of the educational software and maintenance ensures up-to-date content and software. Due to the importance of the sixth phase, evaluation, we have written a companion article on it that follows this one. The development of a CD-ROM product is described including the development team, a detailed description of the development phases, and the lessons learned from the project.

Evaluation is an important component of developing educational software. Ideally, such evaluation quantifies and qualifies the effects of a new educational intervention on the learning process and outcomes. Conducting meaningful and rigorous educational evaluation is difficult, however. Challenges include defining and measuring educational outcomes, accounting for media effects, coping with practical problems in designing studies, and asking the right research questions. Practical considerations that make the design of evaluation studies difficult include confounding, potentially small effect sizes, contamination effects, and ethics. Two distinct approaches to evaluation are objectivist and subjectivist. These two complement each other in describing the whole range of effects a new educational program can have. Objectivist demonstration studies should be preceded by measurement studies that assess the reliability and validity of the evaluation instrument(s) used. Many evaluation studies compare the performance of learners who are exposed to either the new program or a more traditional approach. However, this method is problematic because test or exam performance is often a weak indicator of competence and may fail to capture important nuances in outcomes. Subjectivist studies are more qualitative in nature and may provide insights complementary to those gained with objectivist studies. Several published examples are used in this article to illustrate different evaluation methods. Readers are encouraged to contemplate a wide range of evaluation study designs and explore increasingly complex questions when evaluating educational software.

With simulation clinics, dental schools have improved their preclinical laboratories to provide a more realistic clinical teaching environment. However, there is very little data to support the assumption that these facilities actually improve student performance of technical skills. This study compared the scores of two fixed preparations for full cast crowns by third-year dental students. One of the preparations was made in the simulation clinic manikin, and the other was prepared on the bench top. Three prosthodontic faculty members scored the preparations in the areas of occlusal reduction, axial reduction, resistance and retention, and margination. The study also compared the performance of three classes of dental students: one class with no experience in the simulation clinic, one with one year of experience, and one with two years of experience. The amount of time since completing the fixed prosthodontics course among the students was also evaluated. This was done because the third-year students at the University of Iowa rotate through a series often-week clerkships rather than a comprehensive care model. (Therefore, not all students start clinical prosthodontics at the same time.) In addition, all student participants completed a questionnaire that addressed their perception of their clinical readiness prior to treating their first fixed prosthodontic patient. When we compared the classes of years 1, 2, and 3 by average preparation score, we found a significant difference among the scores for teeth prepared on the bench top (p = 0.0001) but not for the teeth prepared in the mannequin (p = 0.1176). For Year 1 (no simulation clinic experience), the amount of elapsed time following completion of the fixed prosthodontic course was not significant for the tooth prepared on the bench top or in the manikin (p = 0.57113 and 0.0661). For Year 2 (one year of simulation clinic experience), the elapsed time following completion of the fixed prosthodontic course was significant for the tooth prepared on the bench top (p = 0.0482), but it was not significant for the tooth prepared in the manikin (p = 0.2968). For Year 3 (two years of simulation clinic experience), the amount of elapsed time following completion of the fixed prosthodontic course was not significant for the tooth prepared on the bench top or in the manikin (p = 0.7275 and 0.6007). The questionnaire revealed that, in general, the majority of the students perceived their clinical readiness as more than adequate. These results are mixed in that students with more bench top experience scored better on the bench top, and students with more manikin experience scored equally in both environments.

The dearth of dental faculty members is a widely known problem that is exacerbated in countries that are attempting to begin dental education programs. This collaboration between Kwame Nkrumah University of Science and Technology and the University of Michigan investigated if dental students who have just started their clinical dental education can learn the knowledge and skills required for identifying and restoring cavitated caries lesions through compact course delivery. There were three instructional blocks: 1) didactic seminar; 2) seminar, simulated hands-on skills instruction, and clinical observation/assisting with treatment of schoolchildren; and 3) seminar, simulated skills training, and application to schoolchildren. Each dental student completed a questionnaire measuring knowledge and perceptions of knowledge, experience, and confidence at five points in time. The dental students' knowledge increased significantly as well as their perceived knowledge, experience, and confidence (p0.0001). In general, the students showed proficiency in delivering simple treatments. The project showed that an integrated compact course delivery model may assist emerging dental schools to cope with the challenging shortage of resident faculty members.

This research project was part of a planned initiative at the University of Pittsburgh School of Dental Medicine to incorporate lecture recordings as standard educational support technologies. The goal of an institutional survey was 1) to gather current data about how dental educators across the United States and Canada use lecture recordings; 2) determine dental educators' perceived value and outcomes of using lecture recordings; and 3) develop recommendations based on #1 and #2 for the dental education community. Of the sixty-six North American dental schools at the time of the study, forty-five schools responded to the survey, for a 68 percent response rate. Of the respondents, twenty-eight schools were found to currently conduct lecture recording; these comprised the study sample. This study focused on the dental schools' past experiences with lecture recording; thus, those not currently engaged in lecture recording were excluded from further analysis. The survey questions covered a wide range of topics, such as the scope of the lecture recording, logistics, instructional design considerations, outcomes related to student learning, evaluation and reception, barriers to lecture recording, and issues related to copyright and intellectual property. The literature review and results from the survey showed that no common guidelines for best practice were available regarding lecture recordings in dental education. The article concludes with some preliminary recommendations based on this study.

The rapidly increasing number of this country9s elderly requires that dental hygiene students practice the clinical problem-solving skills of information gathering, assessment, and treatment applied to geriatric patients. Computer-based simulations are purported to provide this experience, but little research has been completed with simulations in the education of dental hygienists. This paper summarizes the process used to design, develop, and evaluate a series of eighteen computer-based geriatric simulated patients. It contains a brief description of the simulations and a description of the design, validation, authoring, and formative evaluation phases. The paper also describes the summative evaluation, provides implementation suggestions, and summarizes future directions. The summative evaluation, conducted at four institutions, suggests that computer-based simulations are an effective instructional method as measured by pre/post-tests. The results suggest that simulations can provide a standardized set of geriatric patient experiences. These simulations may prove especially valuable at institutions that are unable to provide clinical geriatric experiences or lack the expertise to conduct a didactic course in geriatrics.

The framework presented in this article demonstrates strategies for a global approach to e-curricula in dental education by considering a collection of outcome assessment tools. By combining the outcomes for overall assessment, a global model for a pilot project that applies e-assessment tools to virtual learning environments (VLE), including haptics, is presented. Assessment strategies from two projects, HapTEL (Haptics in Technology Enhanced Learning) and UDENTE (Universal Dental E-learning), act as case-user studies that have helped develop the proposed global framework. They incorporate additional assessment tools and include evaluations from questionnaires and stakeholders' focus groups. These measure each of the factors affecting the classical teaching/learning theory framework as defined by Entwistle in a standardized manner. A mathematical combinatorial approach is proposed to join these results together as a global assessment. With the use of haptic-based simulation learning, exercises for tooth preparation assessing enamel and dentine were compared to plastic teeth in manikins. Equivalence for student performance for haptic versus traditional preparation methods was established, thus establishing the validity of the haptic solution for performing these exercises. Further data collected from HapTEL are still being analyzed, and pilots are being conducted to validate the proposed test measures. Initial results have been encouraging, but clearly the need persists to develop additional e-assessment methods for new learning domains.

This article describes an Internet-based instructional tool designed to give predoctoral dental students a virtual simulation of clinical pediatric dentistry to develop their pediatric behavior management knowledge. Effectiveness of this tool was evaluated using two consecutive classes of junior dental students. The control group was exposed to the traditional behavior management curriculum (two lectures) in a spring term course. The next class of dental students was exposed to the two lectures and, in addition, completed the behavior management simulation during the following spring term. Both groups completed a two-part examination (objective section=18 questions; open-ended section=responses to a clinical situation) designed to test their behavior management knowledge. The simulation group performed significantly better in both parts of the examination (objective section: p=.028; open-ended section: p=.012). The simulation was evaluated by students and perceived by most to be an effective addition to the curriculum. It was concluded that the experimental behavior management simulation, when added to the traditional lecture curriculum, improved pediatric behavior management knowledge in predoctoral dental students.

The goals of this exploratory study were to determine students' assessment of portable digital video instruction (using the Apple iPod) and to compare examination performance among groups of predoctoral dental students who did and did not utilize portable digital video instruction as a supplement to a conventional pediatric behavior management lecture. Dental students received a one-hour lecture on communication with the parent and child patient as part of their regular sophomore pediatric dentistry curriculum. Digital audio and digital video versions of this lecture were made available to all 113 students in the class. Eleven student volunteers were loaned portable digital video players (the iPod) containing the lecture for a two-week period. Upon completion of the study period, the entire class participated in an anonymous fifteen-minute post-intervention written assessment including a thirteen-item examination covering lecture material. Students who had used the iPod to review the digital video lecture material favored this medium as a pedagogical instrument and as a group performed significantly better on the examination than those who had not reviewed the digital material (p=0.034). In conclusion, portable digital instructional videos may be a useful educational methodology to help predoctoral dental students acquire knowledge in pediatric behavior management.

Evaluation is an important component of developing educational software. Ideally, such evaluation quantifies and qualifies the effects of a new educational intervention on the learning process and outcomes. Conducting meaningful and rigorous educational evaluation is difficult, however. Challenges include defining and measuring educational outcomes, accounting for media effects, coping with practical problems in designing studies, and asking the right research questions. Practical considerations that make the design of evaluation studies difficult include confounding, potentially small effect sizes, contamination effects, and ethics. Two distinct approaches to evaluation are objectivist and subjectivist. These two complement each other in describing the whole range of effects a new educational program can have. Objectivist demonstration studies should be preceded by measurement studies that assess the reliability and validity of the evaluation instrument(s) used. Many evaluation studies compare the performance of learners who are exposed to either the new program or a more traditional approach. However, this method is problematic because test or exam performance is often a weak indicator of competence and may fail to capture important nuances in outcomes. Subjectivist studies are more qualitative in nature and may provide insights complementary to those gained with objectivist studies. Several published examples are used in this article to illustrate different evaluation methods. Readers are encouraged to contemplate a wide range of evaluation study designs and explore increasingly complex questions when evaluating educational software.

The development of effective educational software requires a systematic process executed by a skilled development team. This article describes the core skills required of the development team members for the six phases of successful educational software development. During analysis, the foundation of product development is laid including defining the audience and program goals, determining hardware and software constraints, identifying content resources, and developing management tools. The design phase creates the specifications that describe the user interface, the sequence of events, and the details of the content to be displayed. During development, the pieces of the educational program are assembled. Graphics and other media are created, video and audio scripts written and recorded, the program code created, and support documentation produced. Extensive testing by the development team (alpha testing) and with students (beta testing) is conducted. Carefully planned implementation is most likely to result in a flawless delivery of the educational software and maintenance ensures up-to-date content and software. Due to the importance of the sixth phase, evaluation, we have written a companion article on it that follows this one. The development of a CD-ROM product is described including the development team, a detailed description of the development phases, and the lessons learned from the project.

With simulation clinics, dental schools have improved their preclinical laboratories to provide a more realistic clinical teaching environment. However, there is very little data to support the assumption that these facilities actually improve student performance of technical skills. This study compared the scores of two fixed preparations for full cast crowns by third-year dental students. One of the preparations was made in the simulation clinic manikin, and the other was prepared on the bench top. Three prosthodontic faculty members scored the preparations in the areas of occlusal reduction, axial reduction, resistance and retention, and margination. The study also compared the performance of three classes of dental students: one class with no experience in the simulation clinic, one with one year of experience, and one with two years of experience. The amount of time since completing the fixed prosthodontics course among the students was also evaluated. This was done because the third-year students at the University of Iowa rotate through a series often-week clerkships rather than a comprehensive care model. (Therefore, not all students start clinical prosthodontics at the same time.) In addition, all student participants completed a questionnaire that addressed their perception of their clinical readiness prior to treating their first fixed prosthodontic patient. When we compared the classes of years 1, 2, and 3 by average preparation score, we found a significant difference among the scores for teeth prepared on the bench top (p = 0.0001) but not for the teeth prepared in the mannequin (p = 0.1176). For Year 1 (no simulation clinic experience), the amount of elapsed time following completion of the fixed prosthodontic course was not significant for the tooth prepared on the bench top or in the manikin (p = 0.57113 and 0.0661). For Year 2 (one year of simulation clinic experience), the elapsed time following completion of the fixed prosthodontic course was significant for the tooth prepared on the bench top (p = 0.0482), but it was not significant for the tooth prepared in the manikin (p = 0.2968). For Year 3 (two years of simulation clinic experience), the amount of elapsed time following completion of the fixed prosthodontic course was not significant for the tooth prepared on the bench top or in the manikin (p = 0.7275 and 0.6007). The questionnaire revealed that, in general, the majority of the students perceived their clinical readiness as more than adequate. These results are mixed in that students with more bench top experience scored better on the bench top, and students with more manikin experience scored equally in both environments.