Category Archives: Community Oral Health

This tag is for all blog posts which discuss topics related to the master or certificate program in Community Oral Health.

A Homeless Person Puts on a Face Mask During the COVID-19 Pandemic

COVID-19’s Impact on Homeless Populations in Los Angeles


As COVID-19 continues to threaten communities across the world, the homeless population is facing a “crisis in a crisis.”  Below is a presentation I’ve put together on the state of homelessness in Los Angeles, the impact COVID-19 has had on this population, and a few resources where you can find additional information.

Don’t have time to read the full article?  Download the Healthcare Provider’s Guide to Caring for Vulnerable Populations During COVID-19.


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What is homelessness?

The Department of Housing and Urban Development defines homeless as, “an individual or family who lacks a fixed, regular, and adequate nighttime residence.”

Emergency shelters, rapid rehousing programs, and transitional housing may fit the “adequate nighttime residence” definition, but these are not “places meant for human habitation,” and people are still considered literally homeless in these housing arrangements.

Additionally, stays in institutions such as jails, hospitals, and inpatient treatment facilities for less than 90 days do not constitute as a break in homelessness, and individuals are still considered literally homeless.


Homelessness in Los Angeles Before COVID-19

Before COVID-19 happened across the globe, homelessness in Greater Los Angeles was increasing.  The Los Angeles Homeless Services Authority’s (LAHSA) point-in-time count showed a 12.7% increase year-over-year, and reported those experiencing chronic homelessness increased 17%, youth homelessness increased 24%, and black people being 4 times more likely to experience homelessness in LA.

With widespread job loss, increased risk for medical expenses, 8.3 million Americans being behind on rent, and the unemployment rate at 7.9% as of August 2020, it’s difficult to imagine the number of homeless people doing anything but increase with likely thousands of individuals and families undoubtedly living on the edge of homelessness.

Further Reading: State of Homelessness (2020 Edition)


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Shelter in Place Guidelines for Homeless People

A Homeless Person Puts on a Face Mask During the COVID-19 Pandemic

Organizations like the National Alliance to End Homelessness acted quickly to identify and implement protocols to safeguard homeless populations.  In March 2020, The Homelessness Research Institute concluded that $11.5 billion dollars was necessary for 400,000 new shelter beds to accommodate unsheltered homeless people while maintaining social distancing and quarantine protocols.

The Center for Disease Control (CDC) also put together a comprehensive document detailing how homeless service providers, community organizers, and local officials can support homeless people during COVID-19.

For more information about how you can support homeless populations, consider these resources:

  1. Homelessness and COVID-19 FAQs – CDC
  2. US Department of Housing and Urban Development (HUD) Resources
  3. US Interagency Council on Ending Homelessness (USICH) Coronavirus (COVID-19) Resources


An Aging Homeless Population

LAHSA, in their 2019 report, found that senior homelessness increased 8% since the previous year. Because many people who are homeless are older adults or have pre-existing medical conditions and comorbidities they face an increased risk for severe illness.

For evidence, the Coalition for the Homeless, charted the age-adjusted mortality rate for sheltered homeless New Yorkers.  As of September 15, the overall New York City mortality rate due to COVID-19 was 227 deaths per 100,000 people.  For sheltered homeless New Yorkers, it was 377 deaths per 100,000 people – or 66 percent higher than the New York City rate.

Older adults experiencing homelessness age faster than everyone else.  In fact, homeless people in their 50s have been experiencing geriatric conditions (e.g. memory loss and dementia, falls, functional impairments) at rates similar to members of the general population in their 70s.  Now, medically vulnerable older adults include people as young as 45-50.


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Self Reported Health Challenges of Sheltered vs. Unsheltered Homeless People

Physical Health Problems19%84%
Mental Health Problems50%78%
Substance Abuse Conditions13%75%
Trimbordity (Physical, Mental, Substance)2%50%

Source: Population At-Risk: Homelessness and the COVID-19 Crisis Fact Sheet


Challenges Facing Homeless Individuals & Families

Encampments, sleeping outdoors, and housing instability make it difficult to engage in activities that can help ward off COVID-19 illnesses and complications.  Here is a short list of challenges that homeless people are facing during the pandemic:

  • Getting sufficient rest
  • Loss of property
  • Food insecurity
  • Social distancing in encampments and shelters
  • Access to running water
  • Access to hygienic supplies

Los Angeles County is committed to its unprecedented efforts to address the crisis of homelessness.  Through the COVID-19 pandemic, the County is urgently mobilized many volunteers to prevent the spread of COVID-19.


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Woman Practicing Oral Healthcare Best Practices at Home - Brushing Her Teeth for Two Minutes Twice a Day

Dental Hygiene Tips During the COVID-19 Pandemic


Keeping good oral health during the pandemic is not only important, but a critical message that must be adopted in every community.  Read on to discover dental hygiene tips to stay healthy during the pandemic, and for caring for a COVID-19 positive patient.

Don’t have time to read the full article? Download the Healthcare Provider’s Guide to Caring for Vulnerable Populations During COVID-19.


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Relationship Between Oral Health and COVID-19

Community oral health messages during the COVID-19 pandemic are important to help the public understand the possible emerging relationships of oral health and the novel Coronavirus.  When oral health services were abruptly curtailed, community health messages were supposed to ensure that all patients requiring emergency dental care can access appropriate care if their usual dental practice was not able to provide care owing to pandemic influenza-related illness or absence.


Oral Health is Essential

Oral health became emergency treatment only and not viewed as an essential part of health.  Elective procedures were halted even though they are important to mitigate problems that potentially evolve into emergencies.  Public health, community health, and private health were initially unprepared with coordinated messages to guide oral health practices.

Before the pandemic, multiple public and professional information outlets had studies that showed regular dental care keeps those who are working on the job.  Neglected oral health practices can keep even essential workers from working.

65.5% of adults who visited a dentist lost time from work or school from unplanned emergency dental care.  Many who lacked regular preventive dental care delayed the diagnosis of oral health problems that became emergencies such as gum problems, tooth decay, tooth loss, and dental abscesses. [1]

Additionally, 45% of the nation’s working parents missed some work due to their kid’s oral health issues, many of which arose from skipped visits to the dentist’s office resulting in complications that required emergency dental appointments to fix.  Keeping our essential workers’ mouths healthy is not to be overlooked. [2]

What happens when closures delay dental treatments?

The pandemic delayed oral health care for many, potentially transitioning minor cases into more urgent situations. [3]

  • Teeth with cavities that could have been filled are now going to need root canals
  • Teeth that could have been treated with root canals are now going to require extractions
  • Mouths with oral cancers may have not been discovered and could not receive proper treatment
  • Preventive and therapeutic scalings that they need before beginning  dental and medical treatments have been delayed


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A Clean Mouth is Important Too

Much emphasis has been on having clean hands, however maintaining a clean mouth can be significant during this pandemic too.

Current evidence suggests the novel Coronavirus can be transmitted directly through airborne transmission of droplet and aerosols from the mouth. [4]  Contaminated surfaces can then indirectly transmit the virus as studies have shown that they may remain viable for hours to days on certain surfaces. [5]

The mouth is the most common entrance and outlet of droplets and aerosols that contain the virus.  It can be spread while sneezing and coughing, however evidence has shown it can be transmitted even when just speaking, shouting, or singing.

Saliva contains discharges from the nasopharynx and the lungs where the Coronavirus is known to be present. [6]  Keeping a clean mouth may help in efforts to prevent the spread of the disease.


Oral Healthcare Tips During COVID-19

Woman Practicing Oral Healthcare Best Practices at Home - Brushing Her Teeth for Two Minutes Twice a Day

Since the SARS-CoV-2 virus appears to colonize in the mouth, maintaining good oral hygiene at home is more than just trying to prevent cavities, gum disease, and other conditions.

  • Brush your teeth two times for two minutes and use a fluoridated toothpaste*
  • Floss and use an antiseptic mouth rinse daily with 1.5% hydrogen peroxide-based rinses (e.g. Colgate Peroxyl, Oragel, etc)

* Many toothpastes contain sodium lauryl sulfate which can be irritating to some, however it has shown to reduce the Coronavirus. [6]

How to Keep a Healthy Mouth

Many of us are overdue for our regular check up during this pandemic.  Daily oral care is now ever so important!

  • Use fluoridated toothpaste and water to help prevent tooth decay
  • Prevent oral conditions by decreasing or eliminating alcohol, tobacco and drug use
  • Practice sensible healthy nutrition with less hard and sticky food to help protect teeth
  • Don’t overlook any oral problem symptoms and seek care when and where possible as many dental services are now available
  • Take advantage of teledentistry consultations which are available from many dental providers

Clean & Disinfect Your Toothbrush

Many people do not realize their toothbrush can harbor bacteria, blood, and saliva.  Not only does improper toothbrush care result in poor oral hygiene over time, but it can also spread contagious diseases, such as COVID-19.

The coronavirus can stay on surfaces for up to three days, and this may include toothbrushes.  To disinfect your toothbrush daily, rinse it in 0.5 percent hydrogen peroxide [7] for up to 15 minutes. [5]  This solution can kill COVID-19 in about one minute.  Make sure you rinse off your toothbrush before brushing.

Lastly, don’t forget to replace your toothbrush regularly.  Everyone is supposed to replace their electric toothbrush head or disposable toothbrush every 3 to 4 months.


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Dental Hygiene Tips for COVID-19 Positive Patients

Oral hygiene should not be neglected during the COVID-19 condition.  Here are some tips to stay safe:

  • Try to store oral health products separately during illness
  • Disinfect all oral health tools and products daily
  • Discard and replace the toothbrush and toothpaste after recovery [4]
  • Clean your hands before oral care
  • Disinfect with hydrogen peroxide or rinse your toothbrush under hot water for a few minutes
  • Always dry in an upright position with fresh air
  • Never share your toothbrush
  • Avoid powered toothbrushes and Water Piks which may produce more aerosols than manual toothbrushes

It has been a big message that washing the hands help prevent contracting COVID-19.  Avoid touching the face, lips, mouth, eyes, and ears with potentially contaminated hands.  Studies show that people touch their face approximately 23 times in an hour and this can pose a virus threat through mouth, nose, or eyes. [7]  When a person’s hands touches their own mouth and have the virus in their saliva, they can potentially transfer it to others.  It is this cycle of clean hands and mouth that is important to curb the pandemic.


Does poor oral health have an association with COVID-19?

Surgical Mask to Prevent COVID-19 - How to Treat Mask Mouth - Dental Hygiene Tips for Good Oral Health

Four essential risk factors for severe COVID-19 have been identified: diabetes, high blood pressure, heart disease, and obesity. [8]  All these have also been associated with poor oral health.  If an individual has periodontal disease, the increased risk association for heart disease is 25%, high blood pressure is 20% and 3 times the risk for diabetes. [8]

Evidence also exists on poor oral health and associations with severe respiratory complications. [7]  52% of the deaths occurred in healthy individuals and 20% of those had high oral bacterial levels that may have affected the progress of COVID-19 disease.

Improving oral hygiene and oral health may prevent the potential risk of the airway superinfections of those infected with COVID-19.


How to Treat “Mask Mouth”

Wearing a mask helps limit droplets and aerosols from our nose and mouth from transferring to one another.  Some have become aware of mouth odors when wearing a face mask.  More than 50% of the general population have halitosis or bad breath. [9]

Wearing a mask can cause the saliva and moist air to cling and dry onto masks to cause a bad smell.  Many people breath through their mouths when wearing a mask which can cause dryness, produce mouth odors, and increase risk for cavities.

Related Reading: How to Treat Dry Mouth in Older Patients

Remember to focus on good oral hygiene at home, to have a healthy mouth and reduce odors from mask mouth. [10]

  • Brush your tongue and rinse with a good mouthwash
  • Watch what you eat as that can contribute to a smelly mouth
  • Check your medications which can cause a dry mouth and add to bad breath
  • Keep hydrated and find dry mouth products to use
  • Quit smoking if you’re thinking about that right now as that can give you lingering odors and increase your risk for oral problems
  • Keep your mask clean and fresh
  • Contact a dental professional for guidance if you have gum problems that cause odors

Oral health is critical to people’s mental health, physical health, and their well-being.


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[1] Kelekar U, Naavaal S. Hours Lost to Planned and Unplanned Dental Visits Among US Adults. Prev Chronic Dis 2018;15:170225.

[2] Delta Dental Children’s Oral Health Survey (2017, September 18)

[3]. Dentists say patients are suffering because routine care can’t resume due to coronavirus, COVID-19 pandemic. (2020, May 12)

[4] Kai-Wang To, Kelvin. et al. Consistent Detection of 2019 Novel Coronavirus in Saliva, Clinical Infectious Diseases, Volume 71, Issue 15, 1 August 2020, Pages 841–843

[5] Cai, J., Sun, W., Huang, J., Gamber, M., Wu, J., & He, G. (2020). Indirect Virus Transmission in Cluster of COVID-19 Cases, Wenzhou, China, 2020. Emerging Infectious Diseases, 26(6), 1343-1345.

[6] Bains, Vivek Kumar, and Rhythm Bains. “Is oral hygiene as important as hand hygiene during COVID-19 pandemic?.” Asian Journal of Oral Health and Allied Sciences 10 (2020).

[7] Oral Hygiene & Coronavirus. Retrieved from on July 6, 2020

[8] Sampson, V., Kamona, N. & Sampson, A. Could there be a link between oral hygiene and the severity of SARS-CoV-2 infections?. Br Dent J 228, 971–975 (2020)

[9] Aylıkcı BU, Colak H. Halitosis: From diagnosis to management. J Nat Sci Biol Med. 2013;4(1):14-23. doi:10.4103/0976-9668.107255

[10] Mask Mouth during COVID-19. Retrieved from on July 10, 2020.

Health care professional and young girl at a public health clinic exchanging a high five.

How to Plan and Implement a Community Health Program

Health care professional and young girl at a public health clinic exchanging a high five.

This is an adapted presentation by Professor Linda Brookman, RDHAP, BSDH, MS for the Community Health Program Planning and Implementation course as part of USC Ostrow’s Community Oral Health program.

What is the public health pyramid?

The public health pyramid is a framework to improve health, with the base of the pyramid including the interventions with the ability to impact the most people (infrastructure services) moving up to direct healthcare services, which offer the most immediate affects, yet not as accessible.  Public health interventions are listed below, starting from the top and moving to the base of the pyramid.

Direct Healthcare Services

Direct healthcare services is the smallest section of the pyramid.  They have the most immediate affect, yet impact the smallest number of people.  Services include:

  • Direct medical care from MDs, PAs, NPs
  • Pharmacy services
  • Psych counseling
  • Hospital care

Enabling Services

Aggregates are a population who share common needs (e.g. mental illness, need for dental care, people with diabetes).  Enabling services provide aggregates with medical care and social services.  Enabling services may directly or indirectly affect the individuals, families, or communities, and address some of the social determinants of health.  Some examples of enabling services include:

  • Mental health drop-in centers
  • School-based sealant programs
  • Diabetic counseling centers

Population-Based Services

Population-based services are delivered to an entire population (e.g. city, county, state, country), and can improve the health status of a the population.  These programs are directed at changing one or more social determinants of health. Examples include:

  • Immunization program for all children entering kindergarten in a county
  • Newborn screenings for all infants in a state
  • Nutritional labeling on all foods sold in the country

Infrastructure Services

Infrastructure services are supported by laws and regulations pertinent to health care.  Examples may include:

  • The FDA over-seeing all prescription medications
  • Seat belts required in all automotive vehicles

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6 Stages of Community Health Program Planning

Activities for the planning and evaluation of a community health program occur in stages.  These stages are cyclical; when one finishes, an evaluation is done to improve the former stage, and then proceed to the next stage.  Below are the six program planning stages and supporting  steps to accomplish each stage.

Stage 1:  Mobilize Community Support

  • Getting started
  • Finding partners and champions

Stage 2:  Assess Needs and Resources

  • Organize the assessment
  • Conduct the assessment

Stage 3:  Determine Priorities & Plan the Program

Priorities are based on data collection of needs.

  • Prioritize needs
  • Plan for integration of cultural competency
  • Design the program

Stage 4:  Implementing the Program

  • Identify program components
  • Create an implementation plan

Once resources are secured, implementation can begin.  Implementation can include:

  • Marketing to target audience
  • Training and managing personnel
  • Delivering the intervention
  • Conduct a process evaluation

Once the process evaluation is completed, this can lead to necessary revisions in program delivery.

Stage 5:  Evaluate the Program

  • Determine how the evaluation will be used
  • Determine evaluation questions
  • Develop evaluation measures

At end of cycle, an outcome evaluation is required.  The cycle is then repeated with improvements.

Stage 6:  Participate in Policy Development & Research

  • Community Oral Health Policy
  • Community Oral Health Research


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Young Black Girl Receives Oral Health Care at a Community Oral Health Clinic

Health Equity and Social Determinants of Health

Young Black Girl Receives Oral Health Care at a Community Oral Health Clinic

This is an adapted presentation by Professor Linda Brookman, RDHAP, BSDH, MS for the Community Health Program Planning and Implementation course as part of USC Ostrow’s Community Oral Health program.


What is health equity?

According to the World Health Organization (WHO), equity is “the absence of avoidable or remediable differences among groups of people, whether those groups are defined socially, economically, demographically or geographically.”  As such, equity is a process and equality is an outcome of that process.  Health equity is the attainment of the highest level of health for all people.

Health inequities are “avoidable inequalities in health between groups of people within countries and between counties…Social and economic conditions and their effects on people’s lives determine their risk of illness and the actions taken to prevent them becoming ill or treat illness when it occurs.”

Inequities result from circumstances stemming from socioeconomic status, living conditions and other social, geographical, and environmental determinants that can be improved upon by human actions.

In other words, they are neither naturally predetermined nor inevitable.

According to the NIH’s National Institute on Minority Health and Health Disparities, “Health disparities refer to differences in the health status of different groups of people. Some groups of people have higher rates of certain diseases, and more deaths and suffering from them, compared to others. These groups may be based on…”

  • Race
  • Ethnicity
  • Immigrant status
  • Disability
  • Sex or gender
  • Sexual orientation
  • Geography
  • Income


Social Determinants of Health

The social determinants of health are the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels.

Disparities in Health Care

Unfortunately, disparities in health care still exist:

  • African Americans received substandard care relative to Whites for 41% of quality measures
  • Asians and American Indians and Alaska Natives received substandard care relative to Whites for about 30% of quality measures
  • Hispanics received substandard care relative to non-Hispanic Whites for 39% of measures

In short, when creating health programs, planners must be careful in their assessments. Look at the communities social determinants of health.  Are you addressing the inequities?


Postgraduate Degree in Community Oral Health

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Dentist Taking an Online Distance Education Course in Postgraduate Dentistry from the Comfort of Their Home

Distance Education vs. Correspondence Courses

Dentist Taking an Online Distance Education Course in Postgraduate Dentistry from the Comfort of Their Home

Not all online programs are the same. Let’s look at the definition of a correspondence course versus an eLearning experience.


Why is the distinction important?

While there has been no payment made by St. Mary-of-the-Woods College, the U.S. Department of Education’s Office of the Inspector General categorized courses given at this college as “correspondence courses” not as distance education courses.

This is critical as students qualify for financial aid dollars when they take distance education courses, not correspondence courses. The Inspector General suggested that St-Mary-of-the-Woods college should refund $42 million in federal financial aid dollars that it disbursed to students over a five-year period.

At any time in the future a college can be inspected and if instructors are found to be offering correspondence course, this finding can be very financially damaging to the University.


Correspondence Courses vs. Distance Education

To understand the difference, let’s look at the Higher Education Act of 1965 and it’s subsequent amendments. In part 600, Institutional Eligibility, the HEA-1965 defines a “Correspondence” course as one that has the following elements:

  • Course materials given by mail or digitally.
  • Exams are all non-proctored (open book).
  • Limited, irregular faculty-to-student (F2S) interactions.
  • Almost all interaction initiated by student.
  • Courses are typically self-paced.
  • Emails to instructor gets no response.
  • Help requests responses only staff, not faculty.
  • There are no office hours.
  • Student must trouble shoot own problems.
  • Course have no chatroom for students.
  • If discussion forum exists, no faculty input.
  • All course work is automatically graded.

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Other Styles of Education

Here are five other popular styles of education:


1. Tutorials at Oxford and Supervisions at Cambridge

The two oldest and quite highly ranked universities in the world are Oxford and Cambridge. At these institutions they have used small group interactions between faculty and students which they call either tutorial or supervision sessions.

Oxford’s student tutorials may be more academically challenging and rigorous than a standard lecture. At each session students must orally communicate, defend, analyze, and critique the ideas of others as well as their own.


2. Large Lecture Hall Lectures

Some colleges and universities use large lecture halls to provide content to a very large group of students (usually taken 1st-year core courses). As we mentioned in the first lecture in this course, these lectures are usually not effective as there is not interactivity and even if you wanted to ask your students questions, the group is too big.

Related Reading: How to Use Guided Discovery Questions to Deepen Learning


3. Project-Based Learning Group Sessions

A style of education similar to Oxford or Cambridge tutorials is Project-Based Learning (PBL). In a PBL class the instructor gives the students a problem, the students identify their learning needs, they are assigned, and students go off and research these LNs. At the next session the students review what they have learned and then the instructor gives them another piece of the problem to work on. Like the Oxford and Cambridge tutorials, PBL is moderately expensive as the faculty to student ratio is usually 1:8.


4. Asynchronous Lectures Using Video Recording

Non-interactive recorded lectures are not better than a traditional lecture hall (F2F) lecture, just more convenient to watch!


5. Flipped Classroom Style Teaching

Flipped classrooms are great if the students watch the lectures before hand! The problem again is the faculty student ratio as most of the time the number of students that can work or discuss a problem is small (8-10 students in a discussion group)


Distance Education

Let’s review distance education and more specifically hybrid online learning! A hybrid style of distance education includes F2F instruction, online collaboration, and self-paced learning.

In part 600, Institutional Eligibility, the HEA-1965 lists the following elements that are used in distance education:

  1. Regular and substantive F2S interactions
  2. Interaction is synchronous or asynchronous
  3. Regular instructor initiated communication
  4. Instructor feedback on student progress
  5. Regular F2S interaction using discussion boards, video conference, or email/text.
  6. Faculty monitored student-run chatroom, option and guided & structured tasks with regular input from faculty.

Beyond audits by the Department of Education Office’s Inspector General, the distinction between distance education courses and correspondence courses is important because it is a rapidly growing style of education and if done right it is extremely valuable and if done wrong it is a rip-off! See the figure below showing the ever increasing number of online students.



Online vs. Traditional Education

Below are three studies that researched and discussed this issue along with my comments.

1. OB Palpation Skills for Web vs. Traditional Instruction

Mangala Gowri P, et al. compared web-based and traditional instructional methods to teach obstetrical palpation for antenatal mothers among B.Sc(N) II year students. The study randomly selected two groups of 15, 2nd-year nursing students in each group. Group 1 had web-based instruction while group 2 had traditional instruction in class. The study compared obstetrical palpation skills and knowledge, and the outcome was a test of both knowledge and OSCE skills.


The study found that knowledge on obstetrical palpation was higher in the web-based group, and OSCE scores on OB palpation were higher in the traditional training group.

Overall, the statistical analysis showed no significant group differences. In conclusion, both methods worked but the combination of these two methods of education may further enhance the students skill acquisition level.


The convenience of recorded lectures is very important to students but a recording without interaction is not better than a F2F lecture.


2. Grade-Based Student Learning Outcomes

Cavanaugh JK and Jacquemin SJ compared a large sample of grade-based student learning outcomes in online vs. face-to-face courses. The study used grade data from 5,000 courses taught by more than 100 faculty over 10 terms at a public, four-year university. They used multiple regression analysis and controlled demographic and GPA confounders.


  1. A significant difference was seen between the course formats.
  2. Difference was probably negligible however (<0.07 GPA pts).
  3. Primary influence on course grades was student GPA.

In conclusion, students with higher GPAs will perform even better in online courses. Conversely, struggling students perform worse when taking courses in an online format vs F2F.


When you are taking classes alone at home, you must be very disciplined otherwise you will not find the time to watch the lectures. I assume higher GPA students are more disciplined and therefore do better than low GPA students in the online world.


3. Blended vs. Traditional Course Delivery

Tseng H and Walsh EJ Jr. studied the impact of blended versus traditional course delivery on students’ motivation, learning outcomes, and preferences. The study compared results from two groups of 26 students taking an English Literacy course across three outcomes: 1.) level of learning motivation, 2.) level of learning outcomes and skills, and 3.) learning achievement. Group 1 used a traditional format and group 2 used a blended format.


  1. Group 2 (blended) had a significantly higher learning motivation
  2. Group 2 (blended) had a significantly higher learning outcomes.
  3. Final grades showed no significant group difference.

Blended learning students indicated that they would take more blended classes and would recommend them to their friends.


When you say blended this means an online element and a F2F component, which in my opinion is the best approach.


Can Hybrid Online Teaching be better than F2F?

Yes and no. Yes, if you compare a great hybrid online program to a traditional one-way lecture. No, but equivalent if you compare a great hybrid online program to active learning face-2-face classes. If you compare “correspondence type” online education to active learning F2F, I’d say it’s not even close. Outcomes are more important than student preference, but hybrid online is preferred, however an undisciplined student will do poorly in both formats.


What is good online teaching?

Here are some elements:

  • Recorded interactive and focused lectures with interactive elements such as pop-up questions and hotspots
  • Course manuals with interactive elements (e.g.polls, Easter eggs, thought-provoking discussion questions)
  • Hybrid courses where students are rewarded with accomplishment badges
  • Small group video conferences where live F2S discussion occurs and student presentations are given
  • Practicums where experience is gained and reflective journals are kept and commented on


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Woman on a Fixed-Time Session Conference Call - Online Postgraduate Degree Program in Orofacial Pain

Create an Asynchronous eLearning Experience in 4 Easy Steps

Woman on a Fixed-Time Session Conference Call - Online Postgraduate Degree Program in Orofacial Pain

Before we cover the four steps for creating an asynchronous eLearning experience, here are three studies that demonstrate the benefits of using interactive video content in eLearning courses.


The Effectiveness of Embedded Content as form of Active Learning

The best evidence for active learning was the systematic review and meta-analysis we have already discussed by Freeman et al.! Below are some additional abstracts which also researched this topic.

In the spring of 2013, Vural, OF published a study on the impact of a question-embedded video-based learning tool on eLearning in the journal of Educational Sciences: Theory & Practice journal. They held two interventions: one with question-embedded video, and one without questions. The video covered the same content and all used the same instruments to assess student achievement. Before and after the computer literacy course, 318 teacher education students were surveyed on their computer knowledge.

Results: Recording a Video Without Interactive Elements is not Enough!

  1. Q-embedded video promoted better student learning.
  2. Q-embedded video improved student-student interactions.
  3. Q-embedded video increased time with learning materials.

Incorporating video into eLearning environment does not always result with improving learning. However, using Q-embedded interactive videos leads to better learning outcomes and higher learner achievement


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Impact of Interactive Video on Learning Effectiveness

Zhang D, et al. assessed the impact of interactive video on learning effectiveness in relationship to instructional video in eLearning. They examined the effect of interactive video on learning by assessing the test results and student satisfaction of four groups:

  1. Interactive video
  2. Non-interactive video
  3. eLearning but without video
  4. Traditional classroom environment (control condition)


The findings suggest that it is important to integrate interactive instructional elements into video eLearning systems.

  1. Students given interactive videos had higher tests scores.
  2. Student given interactive videos had higher learner satisfaction.
  3. Students given non-interactive video did not improve vs control.


Course Satisfaction and Usefulness

Shu-Sheng Liaw and Hsiu-Mei Huang in their study, Perceived satisfaction, perceived usefulness and interactive learning environments as predictors to self-regulation in e-learning environments, published in volume 60 of the Computers & Education journal found that all three variables (perceived satisfaction with the online course, perceived usefulness of the course, and the course’s interactive learning environment) predicted high degree of self-regulation among a group of 196 university students. The authors noted that both “perceived usefulness” and “perceived satisfaction” were strongly influenced by the presence of an interactive learning environment.

This study shows that if the interactive elements are well thought out and the student’s see them as useful then the students spend more time engaged with the course!

There is reasonable evidence to support the effectiveness of “embedded content” in asynchronous eLearning materials (video lectures, course manuals). It certainly is easier to just walk into a class of students and talk to them, but with distance education this is not possible! Yes, it is more work initially, but if a lecture is used more than once this “evens out” and interactive videos are more effective!


How to Create an Asynchronous eLearning Experience

Asynchronous interactive eLearning experiences involve several elements:

  • You must record your presentation, and embed questions and hotspots inside your presentation
  • Include guided discovery questions, scenarios, or patient cases, for discussion at a fixed-time interaction
  • I strongly suggest a custom course manual that links directly with your focused short up-to-date recorded presentation
  • I also strongly suggest including in the manual a set of embedded questions, polls, and even some Easter Eggs
  • Students can post their answers to an online discussion board and the video conference is an opportunity to review and comment


What is a fixed-time interaction?

A fixed-time interaction is a weekly video conference where students and instructors connect.

Students and Faculty Meet for a Fixed-Time Session During an Online Postgraduate Dentistry Degree Program in Orofacial Pain and Oral MedicineStrictly speaking, this is not asynchronous since you and the students are in the same place at the same time, but any hybrid educational program should have these.

I recommend requiring students to keep their cameras on at all times during the conference. If you want to have your students on camera so you can see them, then I recommend not having  more than 10 students in a video conference, which means you may need to host multiple sessions or use breakout rooms.

The limitations of technology come into play however. The students have to have a reasonable bandwidth on their individual internet service and if you’re holding the conference at busy traffic times, you will still have problems with voice and video drop-out, jitter and even freezes. Overall these video conferences usually work well, although some students will have to upgrade their service.


1. Create a Customized Slide Deck

A Customized PowerPoint Presentation

If you know where you want to add pop-up quizzes and hotspots, I suggest customizing your PowerPoint deck before recording. Specifically, I suggest you add a place holder slide where you want to input the hotspot and where you want to have a pop-up quiz.  To reduce cognitive overload, I suggest using only 20 slides.


2. Record a Lecture

To record a lecture, at a minimum, you need a laptop with a microphone and a camera built-in and a recording-editing software on the computer. The built-in camera and microphone will not be the best sound or video but it will work.

As you get more creative you will need better lighting, a better microphone and a better camera. Once you have mastered this, you can even move onto more studio-like recording where you are standing up and using a light-board to illustrate your most important points.


3. Embed Interactive Elements in your Video

Video Editing Software With Markers where Interactive Content Should be Embedded

You will need a video editing software program to capture your video and PowerPoint slides. I like the software Camtasia. It is great and in my opinion an easy-to-use video editing tool. Once you have the recording finished, load it into the editing timeline and you can embed interactive elements.


Inside Camtasia you can stop the video so students can link out to a picture, video or maybe a table with data. I like to use YouTube videos that are 1-2 minutes long to supplement my lectures. The placeholder slide might say, “Click here to watch a YouTube video on Flipped Classrooms!”

YouTube has a massive amount of content. It has a lot of user-generated content where patients share their stories. Some of these videos are cheesy, but some are quite good and present a disease to a student who has never encountered a patient with such a condition. Just make sure you screen the videos so you don’t link out to inappropriate or misleading information.


4. Build a Custom Course Manuals

To create an interactive course manual, you need to convert your PowerPoint slides and text into a document. You need to pull the photos from the slides into the document, write your thoughts down, and provide citations, abstracts, and other scholarly supportive material to your lecture points.

The interactive elements that can be built into a course manual are mostly of two types:

  1. Quizzes (I like to use Poll Everywhere)
  2. Easter Eggs (using augmented reality software)

Place active links inside the document that will, when clicked on, take the student out to a multiple choice question students can answer to gain extra credit or experience points.

Related Reading: How to Motivate Students: EPAs, Badges, and Experience Points


Easter Eggs

Easter eggs can be interactive 3D models, short animations, videos, audio clips, or even 2D photos that pop up when you view an embedded QR code. These Easter eggs should supplement the content being discussed in the course manual.

On the pop-up that becomes visible, a word or number ID should provide the answer to a question in the course manual. Students who open the QR codes will get the question correct and receive bonus points that they can use to earn a better grade or badge.


11 Elements to Incorporate in your Teaching Style

Here is a consolidated list of the elements we covered in this article:

  1. Use focused, short, up-to-date lectures
  2. Don’t cause cognitive overload
  3. Use guided discovery questions
  4. Hold discussion sessions (tutorials) on guided discovery questions
  5. Record your lectures
  6. Embed pop-up questions and extra content links
  7. Create interactive course manuals
  8. Embed polls, Easter eggs and deep thought questions
  9. Require a reflective journal for observational practicums
  10. Require attendance at video conference sessions
  11. Require participation on web-based discussion board


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Older Man Studying for an Online Postgraduate Degree in Orofacial Pain and Oral Medicine on his Laptop at Home

How to Motivate Students: EPAs, Badges, and Experience Points

Older Man Studying for an Online Postgraduate Degree in Orofacial Pain and Oral Medicine on his Laptop at Home

The final installment in the F.I.S.G.R. acronym for effectively teaching online is “R,” which stands for rewards. In general, the principle is that rewards do in fact motivate students.

Before explaining badges and experience points, it is important to explain milestones and EPAs. As the name implies, milestones mark a student’s growth or progress towards the ultimate goal. EPAs are relatively new on the residency training scene.


Entrustable Professional Activities

EPA stands for Entrustable Professional Activities. Completing an EPA and being certified as completing it is critical in the education of both medical and dental residents. EPAs are used to determine when a resident (medical or dental) can be indirectly supervised as opposed to directly supervised. This is an important distinction since direct supervision requires the attending faculty be present when a resident works with a patient but indirect supervision does not.

The “father of EPAs” is Dr. Ollie Ten Cate who is a MD in the Netherlands. In his paper, Nuts and Bolts of Entrustable Professional Activities, in the Journal of Graduate Medical Education (March, 2013) he defines what EPAs:

  1. An EPA is a competency-based education target.
  2. Completing an EPA satisfactorily allows a resident to work with “indirect supervision” rather than direct.
  3. A program’s EPAs defines “proficiency to graduate.”
  4. Medical competencies are defined by CanMEDS.

In summary, EPAs use CanMEDS but translate these competencies into behaviors that occur in the actual real world of medical practice.


What are CanMEDs and OSCEs?

CanMEDs define needed qualities of a professional. The word is derived from two words: Canadian and Medical. They were originally written and published by Royal College of Surgeon of Canada and define the seven essential qualities and behaviors a physician needs to exhibit including being a: medical expert, collaborator, leader, health advocate, scholar, and professional.

Once you have EPAs (e.g. student must be able to conduct a thorough patient interview), you then need to have a set of Objective Standardized Clinical Examinations (OSCEs) that can be used to assess the students ability on this specific EPA.


Types of Supervision for Residents

The American Council of Graduate Medical Education (ACGME) defines three types of supervision they endorse:

  1. Direct Supervision – supervising doctor is physically present with the resident and patient.
  2. Indirect Supervision – supervising doctor is not physically present but immediately available to the resident and patient.
  3. Oversight – supervising doctor is available to review procedures/encounters with feedback provided soon after care is delivered.


Review and Reflection

Because none of the three types of ACGME supervision work if you are trying to train a resident in another city, state, or country, there is another type of supervision that is applicable in a hybrid online residency program called “Review and Reflection.”

Of course, if a faculty member has a resident who is in a location where the faculty is not physically present and licensed, they cannot be involved in direct, indirect or oversight supervision of patients as this could be considered practicing without a license.

Review and Reflection is a “non-supervision” style of supervision that involves discussions of patient care using de-identified cases and guided discovery questions. Review and Reflection can not be used not to directly or even indirectly guide ongoing treatment of a patient but instead to teach the principles of evidence-based care. Using “exemplar” de-identified cases the faculty can discuss, comment and teach the principles underlying Diagnosis and Treatment.

In our hybrid online “residency” training programs residents are onsite for part of their training so the supervision is different depending on the residents location. When residents are onsite they participate in direct, indirect and oversight. When they’re online we use we-identified exemplar cases, virtual patient cases, reflective journal reviews, and a final portfolio review.


How to Motivate Students and Increase Performance

F.I.S.G.R. Initialism - "R" Stands for RewardsUsing Rewards to Increase Student Performance and Participation

In this section we’ll cover using rewards to increase student performance and engagement through achievement badges, experience points, and we’ll cover the effects of game-based learning.


What are achievement badges?

Badges reward students for passing milestones and mastering specific EPAs. The future will tell if badges become more important in the professional world but certainly badges have personal value and maybe some will have a consumer value.

The personal value of badges is that they represent skills, competencies, activities, and achievements. If by earning a badge, an individual gains greater insight into themselves and their abilities, then the value of the badge is extremely high but entirely dependent upon the perception of the earner. The consumer value of badges largely depends on the consumer or market value. Earning a badge, or a series of badges is like earning currency. Some are silver while other badges are gold.

While programs will differ in how they award badges, students at USC will get a badge only after they:

  1. Successfully pass a USC course (usually 1 or 2 units) with a grade of B or higher;
  2. Pass a set of associated objective standardized clinical examinations [OSCEs] relevant to skill the badge represents
  3. Gain a minimum number of experience points (XPs) [documented with a mini-portfolio submission]


Experience Points

Experience Points (XPs) are gained based on experiences students have in an observational practicum and that are clearly documented in their “reflective journals.” Students must carefully document their experiences on their observational practicum and respond to all faculty questions in a Reflective Journal to earn XPs.

Related Reading: How to Increase Student Performance with Active Learning


What is the evidence that badges motivate students?

A 2016 and 2017 study examined student attitude about badges and found they were motivational and popular.


Game-Based Learning

Davidson SJ and Candy L.’s “Teaching EBP Using Game-Based Learning: Improving the Student Experience,” article from Worldviews on Evidence-Based Nursing (August 2016) evaluated game-based learning (GBL) tools.

Using an online nursing course with GBL methods student satisfaction was assessed at the middle and end of the term. The game platform’s analytics and narrative comments were used to assess student learning with end of course grades.


  1. Students showed high satisfaction with the course.
  2. 87% of the students (26/30) continued using game even after getting enough points to get an A grade
  3. Seven students completed every learning quest in game
  4. 17/30 students earned a final course grade of A+
  5. 13/30 students earned an A grade.

They concluded that individualized feedback and use of badges promoted student engagement and mastery.

Rather than use quizzes and a final exam you could use a complication of experience points and badges to issue a grade in a course to motivate students to engage in interactive activities.


Letter Grade to XP Conversion Table

Experience Points (XPs)Required BadgesLetter Grade
951 or higher5A+
901 - 9505A
850 - 900-A-
800 - 849-B+
750 - 799-B
700 - 749-B-
686 - 699-C+
675 - 6854C
650 - 674-C-
601 - 649-D+
551 - 600D
550 and belowF


One example of how we use game-based learning is through our Virtual Patient Game, which allows dental students opportunities to hone their diagnostic skills based on simulations of real-life patient case studies.


Play the Virtual Patient Game


Student Perceptions of Digital Badges

Here is a nice article by Fajiculay JR, et al’s, “Student perceptions of digital badges in a drug information and literature evaluation course,” from the Currents in Pharmacy Teaching and Learning (September 2017), which assessed student attitude about badges. Student perceptions were assessed with pre- and post-learning surveys.


  1. The response rate was 69% (106/153).
  2. At baseline, 53% of respondents thought badges could help.
  3. Badges posted on both LinkedIn (68%) and Facebook (19%).
  4. 73% with earned badges claimed increased confidence.
  5. 55% with earned badges claimed better knowledge

Digital badges were perceived by students as a positive adjunct to learning and may provide a novel mechanism for development of an electronic skills-based portfolio. Digital badges also helped increase confidence in course material, helped recall information for a quiz or exam, and should be implemented into other courses.


4 Things to Remember

One thing you must not do is expect that a course without a tangible and immediate benefit to the student will be popular.

That said here are the three things you SHOULD do:

  1. Design a set of competencies (badges) for each course and make sure each one has real value to the student.
  2. Place these achievement badges in a accessible password protected web-enabled locker.
  3. Each badge should contain metadata documenting the credentials of the issuer and all requirements to get it.


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Young Man Raising His Hand During an Online Postgraduate Dentistry Degree Video Chat

How to Use Guided Discovery Questions to Deepen Learning

Young Man Raising His Hand During an Online Postgraduate Dentistry Degree Video Chat

Guided discovery means that the instructor creates questions and suggests resources for students to research and on which to report. These questions are typically given to students at the end of a lecture or following a patient case problem.

The article, Student perceptions on using guided reading questions to motivate student reading in the flipped classroom, set out to determine the educational value of Guided Reading Questions (GRQs), and found that the use of GRQs positively impacted student motivation, reading comprehension, effort level, and understanding of the material before attending class.

Related Reading on Flipped Classrooms: How to Increase Student Performance with Active Learning

Like what you’re learning? Consider enrolling in our online, competency-based certificate or master’s program in Orofacial Pain and Oral Medicine to deliver appropriate and safe care to your growing and aging dental patients.


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Guided Discovery

F.I.S.G.R. Acroynm with "G" Highlighted to Represent Guided and Structured Discovery Questions

In my F.I.S.G.R. acronym, “G,” stands for guided and structured discovery. Some educational purists don’t like guided discovery, as they prefer students create their own learning needs based on a problem, and not be spoon fed questions to research.

I disagree with this approach. I’ve found the questions students generate are less sophisticated than one’s written by an expert in the field. My opinion is that questions written by faculty are more thoughtful, targeted and focused than those created by students.


Where should instructors ask guided discovery questions?

There are various places to do this inside a course:

  1. At the end of each chapter in the manual
  2. At the end of a case or a problem scenario
  3. At end of a video lecture recording
  4. In the faculty response to a reflective journal entry

Blackboard’s discussion board option allows students to respond to questions, upload their answers to case problems to a file exchange folder, and journal regarding what they see on observation practicums.

This is how it works in our classroom:

  1. Students respond to questions by opening the forum link in a Blackboard course.
  2. After students enter their answers, faculty and other students read the answers and comment on them.
  3. Once written, the answers are uploaded to the file exchange folder in Blackboard.
  4. In addition to writing and uploading their answers, students must present orally at a video conference.
  5. On observational practicums students are required to write reflections and respond to faculty comments in their journals.


Guided Discovery Question Examples

  1. Why do you think the TMJ is the only human joint that translates?
  2. If Posselt is correct and the mandible only rotates in the first 20 mm of opening, how would you get an early click?
  3. What is the main purpose of the other ligaments in the jaw (sphenomandibular, stylomandibular, TMJ ligament)?
  4. If Dr. Clark is correct and stretching of the lateral collateral ligament is what allows the disk to displace, how would this ligament become stretched?


Guided Discovery Questions for Patient Case Studies

Picture of a Dental X-Ray - Guided and Structured Discovery Questions for Patient Case Studies

When reviewing patient case studies, we recommend adding guided questions to deepen the student’s learning. For example, on the first few pages you’d have the medical questionnaire results, followed by the medical interview data, the physical exam data, photos and x-rays, and on the last page a set of questions for the student to research and report on. Here are some examples:

  1. Describe the growth pattern and site of growth in a normal TMJ.
  2. Research and report on the various surgical treatments used to treat unilateral condylar hyperplasia.
  3. Report on the article, Relationship between temporomandibular joint internal derangement and facial asymmetry in women, and do the conclusions of this article fit with this case?
  4. For this case, what additional diagnostic tests are needed and why?
  5. List the two or three most likely diagnoses (plus ICD-10 codes) that are appropriate in this case.
  6. What is your recommended treatment plan? Make sure you justify each element of your plan.

For examples of questions asked at the end of an interactive lecture, read our article on how to design an interactive course manual.


Do you encourage or demand participation?

You can do either but I require participation.  This means that faculty must also read, respond, and reward participation.

  • Make sure your guided questions are consistent with course learning outcomes.
  • Instructors should post the initial response to all discussion questions to establish presence.
  • Instructors should have a set of banked responses to post. Banked responses contain: thoughts on the topic, links to resources, or additional questions but all should be customized.
  • Reward great student posts with badge points, stars, or ribbons!


A Note on Using Reflective Journals

A Reflective Journal is where an individual student writes down their thoughts and faculty respond or comment on their thoughts. At a minimum the faculty should comment on the student’s writings weekly. You can grade journal entries or use them solely for communication and reflection.

Journals are great for pushing students to think deeper and learn more. While we do not use “reflective journals” for all courses, we do use them to document what the student learns on a observational practicum so they can capture their experiences. On the practicum the student will (hopefully) be exposed to new ideas and new ways of working.

This article, The Use of Journals in Legal Education: A Tool for Reflection, by J.P. Ogilvy describes that a reflective journal is a pedagogical tool worthy of more explicit attention by both clinical law teachers and non-clinical faculty alike. It introduces some of the literature on critical thinking and learning theory that supports the assignment of journals as an important tool in legal education.

This article also provides a starting point for articulating pedagogical goals that can be met through journal assignments, and it alerts the first-time user to the challenges inherent in the use of journals in legal education.


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Man in a Public Library Earning a Postgraduate Dentistry Degree Online

3 Best Practices for Creating an Interactive Course Manual

Man in a Public Library Earning a Postgraduate Dentistry Degree Online

There are several pieces of circumstantial evidence that exist to support the idea that students don’t read textbooks anymore. For example, Pearson, the largest publisher of educational textbooks has said they are phasing out print books and making all learning resources “digital first.” This isn’t definitive proof, but it is a strong piece of evidence.

If reading a print book is a dying behavior, who is to blame? The New York Times published an editorial, The iGen Shift: Colleges Are Changing to Reach the Next Generation, in 2018 claiming that Gen Z students rarely read print books, only digital media. In addition, in the Atlantic, a very respected magazine, there was even an editorial that declared the death of the textbook.

There are many research articles on this topic. For example, back in 2002, Sikorski, et al. reported that over 78% of freshman and sophomore students reported NOT reading the textbook at all, or reading it only sparingly, for at least one introductory course. There are others who have reported the same trend but I will spare you the review of these articles for now.

Related Reading: How to Increase Student Performance with Active Learning


3 Best Practices for Writing an Interactive e-Manual

S Stands for Supplement Lectures with an Interactive Course Manual - Online Teaching Strategies for Postgraduate Dentistry Programs

Fortunately, there are alternatives! Continuing our elaboration of the acronym F.I.S.G.R., we move to the next letter, “S,” which stands for the supplementation of your lectures (hopefully interactive lectures) with written content that also has interactivity.

Of course, maybe students won’t read this either, but if you make it essential and relevant to their goals (e.g. passing the course), they might! Here are some best practices worth considering when you create your own interactive course manual.


Best Practice 1.) Include a 30 second video intro to the course manual

On the first page of your course manual chapters, include instructions and a link to an introduction video to a video platform like YouTube. In a standalone document, the link to an introduction file (audio or video) is a good idea. However, if the chapter is associated with an actual video lecture you can omit an introductory audio file to avoid redundancy.


Best Practice 2.) Embed QR Codes

QR codes can be read by a smartphone with a free app, or if you have the latest iPhone, the camera detects and scans QR codes automatically. These QR codes link to a URL where an audio, video or even a 3D image file is available.

QR codes encourage students to look at the manual, and while viewing these supplemental materials don’t generate points automatically, you can let students know on the final exam that you’ll provide extra credit points if they viewed the materials.


What is gamification?

Wikipedia defines gamification as, “the application of game-design elements and game principles in non-game contexts.” In education, gamification means an instructor employs game design elements to improve user learning and reduce learner apathy.

One example of how we use gamification at the Herman Ostrow School of Dentistry of USC is through our Virtual Patient Game, which allows dental students opportunities to hone their diagnostic skills based on simulations of real-life patient case studies.


Play the Virtual Patient Game


A collection of research on gamification shows that a majority of studies on gamification find it has positive effects on individuals. The techniques used involve creating rewards for players who accomplish desired tasks or competitions to engage players.

Gamification Rewards

Types of rewards include points, achievement badges or achievement levels. Making the rewards for accomplishing tasks visible to other players or providing leaderboards are ways of encouraging players to compete.

Leaderboards in particular are used to rank players according to their relative success, measuring them against other users. However, the motivational potential of leaderboards is mixed. Most researchers regard leaderboards as effective motivators if there are only a few points left to the next level or position, but as demotivators if players find themselves at the bottom end of the leaderboard.

Higher education has used leaderboards for many years. For example honorable mention on the Dean’s list, the honor roll, and scholarships, which are equivalent to leveling-up a video game character.


Best Practice 3.) Use Thought-Provoking Questions

At the end of the lecture, handout, or course manual chapter, put in 3-4 deep questions that require the students to look at the suggested reading assignment and summarize what they learn on a class discussion board (usually in blackboard).


Example Questions:

  1. Do you think the characterizations that are given for Gen-Z are correct? Explain your answer!
  2. Do you think that the % of non-reading students decreases as you go up the academic ladder (i.e. do grad and professional students read more than B.S. degree or A.A. degree students)?
  3. Do you think it is unethical to “bribe” students with extra credit to read the manual by including polls and Easter eggs?


6 Things you Should Do to Create an Interactive eLearning Experience

Before we get to the six “dos” here’s one thing you mustn’t do when designing eLearning experiences: expect students will read your course manual or any other text-based supplemental materials just because you say it is good.

Here are six things we recommend you should do:

  1. Record an active learning lecture using TED talk format (~18 min)
  2. Regularly update content by checking Google and PubMed for new ideas, trends and even crazy stuff (must be evidence-based)
  3. Put links in your lectures to helpful, freely-accessible documents and media (e.g. YouTube, podcasts; Vlogs, recorded webinars)
  4. Embed questions and thoughtful discussion points inside your video
  5. Embed interactive content in a handout or online course manual
  6. Reward the students who interact with the embedded content with “bonus points”


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Female Dentist Earning a Postgraduate Dental Degree Online

How to Increase Student Performance with Active Learning

Female Dentist Earning a Postgraduate Dental Degree Online

In this installment of our series on effective online teaching, we will cover the basics of creating a recorded interactive lecture and an interactive course manual. In subsequent articles, we will explore the technology needed to do this.

Our goal is to go well beyond a simple video recording of an instructor talking to a class or a word document an instructor writes to supplement his or her course and then distributes to the students with a mandate to read it. Instead, I hope to show you how to create an interactive recording of your thoughts and a course document that student will want to watch and read.

When you really try to make your lecture content and your course manual an “interactive eLearning experience.” By the end of the course I hope you see that what you learn in this initial set of lectures can be applied to almost any situation where you want to teach someone in an asynchronous manner and yet keep them engaged and motivated.

Lectures Are Ineffective

The “lectures are ineffective” pronouncement comes from a variety of places, but the most convincing is an really thorough meta-analysis done in 2014 by Freeman and colleagues titled, Active learning increases student performance in science, engineering, and mathematics (PNAS June 10, 2014 111 (23) 8410-8415).

The study was a meta-analysis of 225 studies on teaching methods that used exam scores and failure rates from courses involved in STEM topics among undergraduates. The researchers compared lecturing and active learning styles, and analyzed the effect of class size for each method in each discipline.


  1. Effect sizes were significantly difference between 2 methods.
  2. Active learning had increase of 0.47 SDs on exams (n=158).
  3. Odds ratio for failing was 1.95 for traditional lecturing (n=67)

Active learning appears more effective overall but most effective in small (n ≤ 50) classes. This data raises the question about whether we should use traditional lecturing as a teaching methodology.

In other words, students in traditional lecture courses were 1.5X more likely to fail. In the graphic of the meta-analysis below, the data (B) shows that Active learning reduced failure rates by over 10%!

Chart Showing the Decrease in Failure Rate In Undergraduate STEM Courses in Classrooms that Use Active Learning

Effect sizes by discipline. (A) Data on examination scores, concept inventories, or other assessments. (B) Data on failure rates. Numbers below data points indicate the number of independent studies; horizontal lines are 95% confidence intervals.

Using a Flipped Classroom for Active Learning

The Freeman et al article essentially offers a suggestion on what to do, namely engage in Active Learning! An excellent example of a School that followed up on this idea comes from the Vermont Medical School (UVM). This school choose to eliminate all lectures and now only uses active learning style educational methods for their medical student classes.

The faculty at UVM create an active learning classroom environment by using a flipped classroom. Students learn about the subject before they get there, and in class they work in groups solving problems. You remember better and longer the problems you solve!

In large classes (~100 people) students are broken up in to groups of about 6 students and they are given a task to work on based on material that was sent to the students before they assembled for this class. There is usually only one or two faculty in the course. Of course, medical students are among the most competitive and therefore probably compliant to what the instructor is asking of them. This approach may not work as well in other setting with other students and more faculty may be needed.

Since many of us have transitioned to teaching online right now, Zoom Breakout Rooms are a great way to use a flipped classroom approach and guide group problem-solving in a digital-first classroom.

How to Teach Interactively

F is for Focused Lectures - Online Teaching Strategies for Postgraduate Dentistry Program and Teledentistry

In a recent article we explained five steps to teaching online effectively. The first letter, “F,” stands for “focused, short, up to date lecture.” I know I said they were dead, but give me a little time to explain what interactive eLearning experiences are and are not!

Reduce Cognitive Overload

The reason why 50 or 60-minute powerpoint-based lectures don’t work well is because of “cognitive overload.” In the early 1980s, researchers found that people suffer from cognitive overload, and is the basis for why “TED Talks” have a maximum length of 18 minutes.

Simply put, information acts like weights: the more you pile on, the more likely you are to drop everything. A 5-minute microlearning lecture produces a relatively small amount of cognitive backlog, while a 30-minute lecture produces a relatively large amount.

Now, recording a lecture does not make it inherently better than a standard lecture, but if you make it interactive you engage every student (which can’t be done in a large lecture hall), and it is certainly more convenient for the students to view! When you create lecture recordings there are some things you should and shouldn’t do.

Asynchronous Interactive lectures should not have links to external materials that are broken or quiz questions/hotspots that are not relevant to the topic. Asynchronous Interactive lectures should have links to some of the massive freely accessible documents and media (YouTube; Podcasts; Vlogs; Recorded Webinars) and pop-up questions that reinforce what the student really needs to know.

Finally it is suggested that you include a set of deep thought questions for discussion at follow-up video conference! Examples below!

Recap: 4 Ways to Create Interactive eLearning Experiences

  1. Record an active learning lecture using TED talk format (~18 min)
  2. Regularly update content by checking google and pub-med for new ideas, trends and even crazy stuff (must be evidence based)
  3. Put links in your lectures to helpful, freely-accessible documents and media (e.g. YouTube, podcasts; Vlogs, recorded webinars)
  4. Embed questions and thoughtful discussion points inside your video

Examples of Embedded eLearning Questions

I typically ask students to summarize (no more than 300 words) what they learn from the resource I suggest and post them to the Blackboard Discussion Board. The best responses look at more than the single suggested resource to formulate your answer! Students are awarded bonus points for good comments on other student’s reflections.

  • Read and summarize what exactly is cognitive overload and does it differ for different age groups?
  • Read and summarize why the Freeman paper was controversial? Did anyone dispute these results and what was their argument?
  • Read and summarize follow-ups to the Vermont Medical School lecture dropping experiment (i.e. does it work)?

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