Inside Dentistry
September 2020
Volume 16, Issue 9

For Your Information

The changing landscape of knowledge intake in dentistry is increasingly virtual

In a profession that is historically isolating, it is a critical necessity for dentists to be able to obtain new information from outside of their practices-whether it involves taking continuing education courses, staying up-to-date on new products, or networking with colleagues-and the methods for doing so are evolving. The restrictions associated with the coronavirus pandemic have profoundly impacted the way that dentistry is practiced as well as how it is taught. In particular, the COVID-19 shutdown accelerated a trend toward remote and virtual models of instruction, and emerging technologies are making these models even more promising for the future. Although virtual learning has become more of a necessity, moving forward, acquiring an understanding of its strengths and limitations is important both for educators, in order to design the most effective and appropriate remote educational experiences, and for students, in order to maximize their learning potential.

Adjusting to a New Normal

A variety of experiences, including continuing education programs, conferences, trade shows, study clubs, webinars, and more, combine to make dentistry's environment of information intake substantial, varied, and comprehensive. Each of these experiences are key tools for the dissemination of knowledge and best practices within dentistry, and they also provide resources for networking and platforms for industry experts, senior leaders, and businesses to engage with the dental community in meaningful ways that improve the delivery of oral healthcare.

Traditionally, many of these educational opportunities and events expect the participants to appear in person. In addition to the education offered during the scheduled sessions, conferences also provide social and informal learning experiences as well as opportunities for the formation of enduring and productive practice communities and social networks.1-4 Therefore, the attendance of conferences is considered by many professionals to be a critical part of "academic citizenship."5

Unfortunately, the situation surrounding the ongoing COVID-19 pandemic has disrupted the status quo. Although some have attempted to go virtual, a plethora of industry-wide events have already been postponed or outright cancelled, including many annual meetings, large conferences, and educational programs, such as those hosted by the American Dental Association (ADA), the American Academy of Cosmetic Dentistry (AACD), the American Academy of Esthetic Dentistry (AAED), the International Association for Dental Research (IADR), the International Team for Implantology, and the Thomas P. Hinman Dental Society. In addition, exocad's Insights meeting, Ivoclar Vivadent's International Expert Symposium, and a growing list of other sponsored regional meetings have also been impacted by the effects of the global shutdown, travel bans, and social restrictions imposed to combat coronavirus disease.

"The cancellation of the AACD meeting in Orlando was a major blow because it was a meeting that I, the other members of AACD's Professional Education Committee, and the AACD staff had been involved in planning for 3 years," explains Betsy Bakeman, DDS, a past president of the AACD, a faculty member of the Kois Center in Seattle, Washington, and a private practitioner in Grand Rapids, Michigan. "We had a fantastic group of educators from all over the world scheduled to share their vast knowledge, but cancelling the meeting was the right thing to do."

Despite the onslaught of cancelations of in-person experiences, the field of dental education continues to evolve, and remote experiences are becoming more robust to compensate. There are a growing variety of continuing education and professional development options available that range in scope from passive to more active experiences.6,7 "Different formats serve different purposes," explains Dean Kois, DMD, MSD, an instructor at the Kois Center and a prosthodontist in Seattle, Washington. "For example, a webinar has low buy-in, is concise, and can be done during one's free time. Furthermore, participation can be anonymous, and webinars can provide exposure to new educators." Although many dentists participated in various remote and virtual learning experiences before COVID-19, the shutdown and restrictions have accelerated the proliferation of online education options and participation within dentistry as well as throughout other industries and educational settings.8

A Shift to Embrace Virtual Learning

With conferences and hands-on training programs being rescheduled, webinars, as well as lectures and courses that have transitioned to some sort of virtual experience, have generally been well-received by dental healthcare professionals. In a recent survey conducted by Inside Dentistry, nearly all of the responding dentists (93.08%) reported that they had completed an online course during the COVID-19 shutdown, and 43.6% reported that they had taken more than 10 online courses during the shutdown. Interestingly, just over 50% of the respondents indicated that they believed that virtual learning modules were just as effective as live events, with 19.1% indicating that some learning modules were even more effective when presented virtually than in person. The effectiveness of this education may be a good indicator of how strongly the trend toward virtual platforms will to continue in a post-COVID-19 world. Just over 33% of those surveyed reported that they plan to do "much more" virtually in the future, and 49.48% said they would do at least "some more" virtually in the future. During the short-term, the impact of this pandemic may be even more drastic; only 32.3% of the survey's respondents indicated that they were interested in attending live events during the second half of 2020.

The trend toward virtual participation in educational offerings is not unique to dentistry. Indeed, even before the pandemic, but especially since, there has been a clearly observable shift away from in-person learning across the educational landscape. Before the pandemic, the online education market was forecasted to reach $350 billion by 2025,9 and since COVID-19, there has been a significant surge in the usage of language learning applications, virtual tutoring, video conferencing tools, and online learning software.10

The Intersection of Education and Technology

Regarding the pursuit of dental education, students and professionals seeking to advance their knowledge should be engaged and take a personal and active role in all aspects of their learning and problem-solving.11 The goal of continuing dental education involves the acquirement and progression of knowledge, competencies, performances, and skills that will lead to clinical application.12,13Proactive, solution-driven thinking is critical because all patients present with unique challenges and require solutions that meet their individual situations, limitations, and preferences.14

Increased participation in online education is being driven by advances in sophisticated communication technologies and the media-rich extensions of the internet.15 These technologies include virtual reality, artificial intelligence, and holograms-all of which are being incorporated into events and learning spaces.16-18 These advances in technology offer exciting opportunities to improve the way that dentistry is taught, and new teaching methodologies are being incorporated to suit an evolving population of learners.

In addition to the exciting advancements in technology that are often seamlessly incorporated into virtual experiences, virtual learning models can provide opportunities for community building without a large investment of time or energy. The ability to communicate directly with colleagues and industry experts via chat rooms, video conferencing, and other virtual formats may help a practitioner to feel less isolated without causing too much disruption to his or her day-to-day practice.

However, Bakeman warns that "although technical skill sets may be able to be mastered in isolation, it is the ability to think, perform the learned skill, and do so in an environment with dozens of other variables that must be successfully cultivated. This is best achieved by performing hundreds of hours of actual treatment and having the opportunity to receive feedback from a trusted mentor."

Peter Pizzi, MDT, CDT, editor-in-chief of Inside Dental Technology, agrees. "The concept of ‘virtual' learning is a necessary part of the education model, but it is not a replacement for hands-on programs," he says.

The solution may be a hybrid approach to education that incorporates the best of both worlds. "Both in-person and virtual experiences have advantages and disadvantages. Which one you choose depends on the subject matter being presented, the logistics, and the level of engagement that the presenter is hoping to achieve," explains John Kois Jr, CEO of the Kois Center.

David Hornbrook, DDS, the director of education at Utah Valley Dental Lab and a private practitioner in San Diego, California, believes that hybrid events will play a significant role in the future. "The ease of doing a Zoom-like virtual presentation allows more diversity with reduced costs, but doctors still like to interact with the presenter in person," he says. "I call it ‘edu-tainment'-great educational material combined with a little bit of theatrics and stage persona."

The type of educational experience that one is drawn to may also depend on individual traits. For example, a generational distinction can be made between digital natives and digital immigrants.19 Digital natives (ie, millennials, Generation Z) grew up with technology, whereas digital immigrants (ie, baby boomers, Generation X) grew up in an analog world and may be more likely to view technology as a recent innovation. "Older doctors like to go hear a speaker live," notes Hornbrook. "Younger doctors have always leaned on YouTube and Google for their knowledge, even outside of dentistry, so the transition toward more virtual education will be easy for them." A familiarity with technology is critical to the success of distance education, and concerns related to both students' ability to learn and satisfaction are abundant.20,21

Looking forward, traditional educational formats that may prove less effective with today's learners will be replaced, where appropriate, with online education, augmented reality, virtual reality, and other exciting modalities that leverage digital technology. If the dental industry as a whole can institutionalize the new knowledge being acquired during this pandemic, it can incorporate this knowledge into its various organizational memories for future use. An organization that learns is better equipped to identify new trends and understand new challenges and, therefore, is more capable of coming up with faster responses and taking the most appropriate actions in a rapidly changing learning environment.22

Leaving a Lasting Legacy

COVID-19 will likely have a lasting impact on the way that dentistry is practiced as well as the way that education is transmitted in the dental industry. The Kois Center, for example, received many requests for information about how dentists can safely return to practice. To respond, the center presented a webinar called Navigating the Delivery of Dental Care in the Midst of the COVID-19 Pandemic. "All of the documents that we created for the webinar are available online for free to anyone," says Kois, "Since we presented the webinar in May, the documents have been downloaded more than 100,000 times." The lingering risk of infection makes these procedures the new normal for dental practices.

Regarding education, the application of online courses has both technological and pedagogical implications.23 A successful virtual transition is not determined by the technology, but by how the technology enables teaching and learning.24 To this end, the very first massive online open courses precipitated new discussions of pedagogy and didactics and challenged the established ways of organizing education and competency development.25 Today, these courses are part of the emerging landscape of e-learning and the increased use of video and visual resources in relation to learning and the development of competencies.

The Benefits of Virtual Platforms

Online conferencing is increasingly popular, as are the dynamic, user-friendly tools and software applications enabling this trend.26 Although there will always be glitches, thanks to recent advancements, the reliability of the technology is no longer much of an issue. Virtual events are democratizing information by reducing the barriers to entry for everyone around the world. Even if the event itself maintains the same price of admission, the indirect costs involved in attending, such as those for plane tickets and accommodations, are minimized if not completely eliminated.27 Furthermore, especially in academic environments, the emissions resulting from travel to conferences and meetings are being recognized as a problem potentially contributing to climate change.28 The continued improvement of virtual curricula and instruction can strengthen the quality of virtual events.

For those who are accustomed to in-person educational experiences, both students and educators, adjusting to an online learning model can be challenging at first. However, once that adjustment occurs, there are numerous benefits to be realized. Online classes and prerecorded lectures are often praised for their provision of flexibility and self-paced learning.29,30 Research has indicated that augmented reality promotes enhanced learning performance,31 and many studies in the medical field have demonstrated the positive effect of video tools in education, as well.32,33 When properly designed to accomplish their educational objectives, the ultimate benefits of virtual events, meetings, and other such learning experiences are the savings in time, energy, and money for the participants and educators. Virtual learning also expands the reach of educational information. These virtual platforms for scholarly discussion have caused a pedagogical shift in education and connectivity; experiences are reflected, but not only in traditional academic formats such as scientific journals.25

Not Without Disadvantages

One cannot neglect to address the limitations of virtual events. They can require even more organization, including precise program planning, when compared with live events. Online teaching often takes more time to accomplish than face-to-face teaching.34 In addition, online formats demand a greater level of discipline from the participants, and this leaves little space for the kind of unplanned spontaneous social interactions that are more likely to occur in face-to-face settings. For many, networking is still easier when talking to people in person.

Virtual experiences can pose significant challenges for educators. As Parag R. Kachalia, DDS, a private practitioner in San Ramon, California, notes, content that was designed to be delivered in a live atmosphere does not always translate seamlessly into an online format. "The learner and the educator need to evolve," he explains. "As a speaker, I have had to rethink my own lectures and reimagine them to work in an online medium because we do not have the same level of interpersonal interaction that is facilitated by an in-person format. The downside, at least as it stands today, is that most online education is delivered in a passive format where participants are simply watching a screen. Personally, I prefer courses that have a small group or study club feel, so there is actual interaction between the presenter and learners. This allows me to achieve a higher level of thinking."

The comparison of online and traditional learning experiences goes beyond the anecdotal and is not unique to dentistry. According to the results of a recent analysis of data from the National Survey of Student Engagement, although students enrolled in a greater numbers of online courses were more likely to engage in quantitative reasoning, they were less likely to engage in collaborative learning, student-faculty interactions, and discussions with diverse others, when compared with their more traditional classroom counterparts.35

Faculty must rethink their assumptions about teaching and learning as well as the roles that they play in online courses.36,37 "It is easy to become distracted when the flow of information is only in one direction," Bakeman notes. "I find that virtual formats that are interactive and require the attendee to do something, whether it is to answer a question or perform a task, are more engaging and provide greater learning value." A direct transition from an in-person format to a virtual one often requires adjustments and the incorporation of new forms of engagement for the virtual educational experience to be successful.

Back to Reality

The coronavirus crisis has been a catalyst, amplifying a preexisting trend toward virtual educational content. The immediate goal is to prioritize the health of students and educators in the field while ensuring the continuity and quality of dental education. At the same time, event organizers, education providers, and companies across the industry have had to reconsider how to stay connected with colleagues and customers. Technological advances offer many options and opportunities for education and communication, but a full virtualization of the industry would forfeit the many advantages that hands-on training and in-person networking provide. As the pandemic rages on indefinitely, the dental education industry will continue to adjust to provide safe learning experiences; however, the disadvantages associated with an exclusively virtual learning experience make it clear that live events won't forever be a thing of the past.


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