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 Table of Contents  
Year : 2022  |  Volume : 34  |  Issue : 1  |  Page : 100-105

Piloting of “blended learning” - An innovative educational intervention in oral medicine and radiology

Department of Oral Medicine and Radiology, KAHER'S KLE Vishwanath Katti Institute of Dental Sciences, Belagavi, Karnataka, India

Date of Submission05-Sep-2021
Date of Decision18-Oct-2021
Date of Acceptance28-Dec-2021
Date of Web Publication25-Mar-2022

Correspondence Address:
Dr. Zameera Naik
Professor, Department of Oral Medicine and Radiology, KAHER'S KLE Vishwanath Katti Institute of Dental Sciences, Belagavi, Karnataka - 590 010
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jiaomr.jiaomr_257_21

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Context: Various universities have set in a wave of adapting to the newer concepts of teaching–learning to keep pace with the millennial learners. Blended learning is a new teaching–learning method that combines online activity along with face-to-face activity. Flipped classroom approach is the use of Web-enabled strategies that free up class time to allow teachers to spend more time guiding their students. Aim: To assess the impact of flipped classroom approach on the teaching–learning outcomes of dental undergraduates. Settings and Design: A prospective comparative educational intervention was conducted in the Oral Medicine and Radiology department of a private dental college in Belagavi. Methods and Materials: Forty third-year undergraduates were equally allocated into the traditional learning group (20) and flipped classroom learning group (20). A pretest/posttest format was employed with mandatory feedback. For flipped classroom approach, an audio/video lecture of 10 minutes duration was shared through learning management software. The assessment was MCQs and case-based. Statistical Analysis: Mann–Whitney U and Wilcoxon matched-pairs tests were used for intergroup and intragroup comparisons, respectively. Results: The mean posttest score was significantly higher in flipped classroom method than in the traditional method (P = 0.0001). Performance on case-based questions was highly statistically significant in the flipped classroom group with a mean rank of 29.8 (P < 0.001). Intragroup comparison between the mean pretest and posttest scores in the flipped classroom showed a high statistical significance (P = 0.0001). Conclusions: Flipped classroom teaching should be recommended as it has the advantages of providing students with a pace of learning, peer learning, instant feedback, and using classroom time effectively. Faculty have to invest time, but nothing is greater than a meaningful teaching–learning experience.

Keywords: Dental, innovation, learning, oral medicine and radiology, self-directed learning, teaching

How to cite this article:
Naik Z, Kumar S L, Bagewadi AS, Keluskar V. Piloting of “blended learning” - An innovative educational intervention in oral medicine and radiology. J Indian Acad Oral Med Radiol 2022;34:100-5

How to cite this URL:
Naik Z, Kumar S L, Bagewadi AS, Keluskar V. Piloting of “blended learning” - An innovative educational intervention in oral medicine and radiology. J Indian Acad Oral Med Radiol [serial online] 2022 [cited 2022 Dec 6];34:100-5. Available from: http://www.jiaomr.in/text.asp?2022/34/1/100/340750

   Introduction Top

Teaching–learning of complex reasoning, communication, and decision-making skills which are thought to be at the core of higher education is ignored in higher education because of teachers at times restricting to the teacher-centered method of teaching. At the same time, there are rising issues of teachers facing challenges in understanding the ways millennial learners learn (those born between 1982 and 2002).[1] Millennial learners are different in the way they learn as they are determined, achievement driven, and groomed with technology since their birth. Teachers can combine face-to-face teaching with technology-assisted teaching to generate interest in classes and achieve successful teaching among the millennials. Teachers of yesterday have to update themselves with the technology of today to cope up with the learners of tomorrow.

A study conducted to assess the readiness of interns after 4 years of dentistry course, at an Indian dental institute, revealed that about 88% of the interns were not confident to start a dental practice immediately after their internship.[2] The majority of the students appeared to be doubtful about arriving at a clinical/radiographic diagnosis, performing root canal treatments on single and multiple rooted teeth, and effectively communicating with their patients. The interns felt they were unprepared and not competent to handle complex tasks. Another study revealed that 70% of interns demonstrated deficient knowledge to prescribe appropriate radiographs for the given case scenario.[3] In view of enriching patient care, these deficiencies in the course have to be addressed immediately.

Various universities globally and nationally have set in a wave of adapting to the newer strategies of teaching–learning to keep pace with the digital students of the current generation. Numerous student-centered learning strategies like problem-based and research-based learning are becoming increasingly significant.[4]

Blended learning is an innovative teaching–learning method, wherein there is a combination of online teaching–learning activity through the use of tablets, smartphones, and other technological devices which attract students' interests along with face-to-face teaching–learning activity.[5]

One among them is the flipped classroom wherein the Web-enabled strategies were used, which free up class time to allow teachers to spend more time guiding their students.[4] Flipped classroom promotes students' elaboration of competencies through cooperative learning, problem-solving, and the development of critical thinking.[6] The goal is to make learning student-centered and to promote the development of critical thinking, analytic skills which are the higher-level learning outcomes on Bloom's taxonomy.[7]

Hence, a flipped classroom approach was introduced for the third-year dental undergraduates in the specialty of Oral Medicine and Radiology for a discussion topic on periapical inflammatory diseases, with the objective of evaluating the effectiveness of flipped classrooms in comparison with the traditional teaching–learning. We also assessed the performance of students on case-based questions and appraised students' perceptions regarding flipped classrooms.

   Materials and Methods Top

This educational intervention was conducted in the Department of Oral Medicine and Radiology. Ethical clearance was obtained from the institutional review board with allotted IRB ethical clearance number 1398, and due care was observed to preserve students' anonymity. The study was conducted in accordance with the ethical standards of the responsible committee on human experimentation and with the 1964 Declaration of Helsinki and later versions. The sample size (n) was estimated to be 37.4 with 10% attrition using the formula n = (Z1-α/2 + Z1-β)2 (SD12 + SD22)/̅(x1 − ̅x2)2 where z = 1.96, α = 5%, 1-β = 95%, SD1 = 2.60, SD2 = 2.48, ̅x1 = 6.69, and ̅x2 = 5.12.

After obtaining a written informed consent, 40 third-year BDS students were included in the study. The students were posted in the Department of Oral Medicine and Radiology in batches of 4–5 students each. The students were oriented regarding the innovative teaching–learning method and protocol at the beginning of the third year during a lecture class.

A theory topic titled “Periapical inflammatory diseases” which is the “must-know” topic of the Oral Medicine and Radiology syllabus was selected based on faculty opinion. The faculty-in-charge had to prepare a blueprint to effectively execute the flipped classroom. The blueprint included the name of the topic, objectives, platforms of sharing the pre-class content, activity planned for the classroom phase, and assessment methods.

During the III BDS clinical posting in the Oral Medicine and Radiology department, the undergraduates were equally allocated into the traditional learning group (20) and flipped classroom learning group (20). Twenty students were divided into four batches with five students in each batch. So, on an alternate basis, four batches underwent traditional teaching and the rest four underwent flipped classroom teaching. The students in the traditional learning answered a pretest which was succeeded by discussion conducted by the faculty-in-charge for all the 5–6 students posted, routinely, followed by a posttest on the same day. Those students in the flipped classroom group were provided with an audio/video lecture of 10-min duration along with a PowerPoint presentation of the lecture shared through Edmodo (learning management software). Self-directed learning was observed as the students were directed to refer to textbooks or articles relevant to the topic. A week later, a case-based discussion on periapical inflammatory diseases was conducted by the same faculty-in-charge with the students working in pairs. Here, the faculty was a facilitator in promoting the development of decision-making, critical thinking, and analytic skills among the students. The students discussed the cases among themselves and then made a presentation, which promoted peer-assisted learning and collaborative learning. A pretest and posttest were conducted using the identical set of validated multiple-choice questions [Table 1] and evaluated by the same faculty.
Table 1: Pretest/ posttest questionnaire

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The identical set of five case scenarios (periapical inflammatory diseases) was used to conduct a written case-based examination for both the comparison and intervention groups and was assessed using a checklist at the end posting. Feedback was collected from all the participants at the end of the study. Instructions for the students and faculty-in-charge were prepared for the smooth conduct of the teaching–learning trial. This was followed by statistical analysis and outcome assessment. The methodology is depicted in [Figure 1].
Figure 1: Flowchart of Methodology

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In order to justify an equal teaching–learning method for all the students, the participants of the traditional group were also trained with the flipped classroom learning method in their second clinical posting.

Statistical analysis

The computerized data entry was performed using Microsoft® Excel 2019 version, and the statistical analysis was carried out using the IBM SPSS, version 21.0. The comparison between the pretest and posttest scores in traditional and flipped learning methods was made using the Wilcoxon matched-pairs test. The case-based examination scores were compared between the two groups using Mann–Whitney U test.

   Results Top

In the current study, the results revealed that the mean pretest and posttest scores differed between both traditional and flipped classroom groups; however, it was statistically significant only between the posttest scores of the two groups with a P value of 0.0001 [Table 2] and [Figure 2]. Performance on case-based questions in terms of rank was statistically highly significant in the flipped classroom teaching group with a mean rank of 29.8 and P value of <0.001 [Table 3] and [Figure 3]. Intra-group comparison between the mean pretest and posttest scores in the traditional method was statistically significant with a P value of 0.006; however, it showed a high statistical significance in flipped classroom group (P = 0.0001) [Table 4].
Table 2: Comparison of traditional and flipped classroom teaching methods with regard to pretest and posttest scores

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Figure 2: Comparison of pretest and posttest scores in traditional and flipped classroom teaching methods

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Table 3: Case-based examination performance scores in traditional and flipped classroom teaching methods

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Figure 3: Comparison of case-based examination mean ranks in traditional and flipped classroom teaching methods

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Table 4: Comparison of pretest and posttest scores within traditional and flipped classroom teaching methods

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Students' feedback obtained for flipped classroom revealed that the majority (95%) of students were confident to apply the information gathered during the classroom phase in a clinical setting to diagnose cases of periapical inflammatory diseases independently.

   Discussion Top

Effectiveness of flipped classroom: Blended learning improves student engagement during learning due to the important elements of small group discussion during the classroom phase and self-directed learning inherent in this approach. Students are made responsible for their learning under the guidance of the faculty.

In the current study involving dental undergraduates, significant improvement was observed catering to the specific learning objectives framed before the implementation of the flipped classroom. Student performance in flipped approach had improved significantly with an average posttest score of 8.05 compared to 5.78 of traditional teaching–learning which is in accordance with previous studies globally.[6],[8],[9]],[10],[11] A formally trained faculty took up the task of preparing an audio/video for the topic and framing the multiple-choice questions and case-based questions incorporating critical thinking and decision-making skills pertinent to the learning objectives. It was prepared with a consensus from all the department faculties, thus adding to the content validity. The faculty had to invest time only for the initial batch followed by regular revisions overtime for consecutive batches of flipped approach. In the current study, there was an improvement in students' case-based performance scores, conducted as a formative assessment in the flipped classroom approach as compared with the traditional teaching approach. This is similar to results reported by Xiao N (2018),[10] wherein there was a 13% increase in scores for case-based questions in flipped approach.

Benefits of flipped classroom: Peer learning was also encouraged during the flipped approach as the students worked in pairs gave feedback to peers, made inquiry-based learning, searched information together, and explained certain difficult concepts to their peers. The same time which was dedicated to the didactic discussion was replaced by meaningful interaction with the teacher and peers, thus promoting collaborative learning.

Due to the online availability of the study material, students learn at their own pace anytime, anywhere, which is the unique feature of flipped classroom approach, which was strongly agreed by the students, and is in accordance with studies reported in the literature.[12],[13],[14]

Prompt feedback was provided by the facilitator to the students during case presentations, thus promoting reasoning and decision-making. Park SE (2015)[15] reported students' perceptions regarding flipped classes to be more fun, interactive, and collaborative than traditional lectures. Most of the students in the current study suggested that all the theory topics in the subject should be taught using flipped classroom approach as the discussions facilitated an active learning environment.

Challenges in implementation: Faculty training to prepare videos and investment of time was a challenge, but was facilitated by the Principal. Faculty adapted to traditional teaching may be resistant to this teaching model but need to weigh the student benefits. There are challenges in terms of participation by all the students, as students may not be able to access the content due to technical issues; however, those can be overcome by providing extra time to the students to watch the videos immediately ahead of the classroom phase.


Though flipped classroom teaching–learning had demonstrated higher posttest scores among the students, some students faced challenges accessing the pre-class content due to Internet connectivity issues. This was resolved by providing them extra time before the classroom phase so that they could watch the videos just before the start of the classroom phase.

Another limitation was the small sample size which was just incidental, due to the batch of students available during the piloting of this educational intervention. However, we will continue to explore this teaching–learning model for the subsequent batches of students with the incorporation of peer evaluation and long-term assessments.

   Future Prospects Top

In flipped classroom model, the students are made accountable for their learning, thus inculcating a sense of responsibility. Further, as the students are getting in-depth knowledge, they get an opportunity to realize the scope of the subject, thereby promoting academic careers.

The faculty are provided with an opportunity for creating interactive teaching–learning activities in terms of games, quizzes, or role-plays to increase learner engagement.

Flipped classroom flips the traditional design of large group lecturing to small group activities during the classroom phase, thus catering to the current situation of the COVID-19 pandemic that has revolutionized teaching–learning at a greater pace.

   Conclusion Top

Flipped classroom approach is a model of blended learning that makes the teaching–learning process student-centered with teachers being the guide to the students rather than being an autocrat on the stage. Though the results of flipped classroom approach are promising, there is a need to follow up the student performance in summative assessments too.

Declaration of participant consent

The authors certify that they have obtained all appropriate participant consent forms. In the form, the participant(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The participants understand that their names and initials will not be published, and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.


The authors would like to acknowledge the support of Dr. Shivalingappa B Javali and Dr. Ram Surath Kumar K in statistical analysis.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

Key messages

Adapt and excel toward innovative teaching learning to keep pace with millennial students of the current era.

   References Top

Strauss W, Howe N. Millennials Rising: The Next Great Generation. New York: Vintage Books; 2000.  Back to cited text no. 1
Jirge V, Umarani M. Evaluation of readiness to practice among interns at an Indian dental school. J Contemp Med Edu 2014;2:227-31.  Back to cited text no. 2
Tyagi P, Naik Z, Sequeria M. Knowledge of appropriate prescription of dental radiographs amongst interns of two dental institutes of Belagavi city, a questionnaire study. Int J Res Foundation Hosp 2016;4:61-5.  Back to cited text no. 3
Berwick DM, Finkelstein JA. Preparing medical students for the continual improvement of health and health care: Abraham Flexner and the New “Public Interest”. Acad Med 2010;85(Suppl 9):S56-65.  Back to cited text no. 4
Capone R, De Caterina P, Mazza G. Blended learning, flipped classroom and virtual environment: Challenges and opportunities for the 21st century students. In: Proceedings of EDULEARN17 conference 2017. p. 10478-82.  Back to cited text no. 5
Moraros J, Islam A, Yu S, Banow R, Schindelka B. Flipping for success: Evaluating the effectiveness of a novel teaching approach in a graduate level setting. BMC Med Educ2015;15:1-0.  Back to cited text no. 6
Anderson LW, Krathwohl DR. A Taxonomy for Learning, Teaching, and Assessing: A Revision of Bloom's Taxonomy of Educational Objectives. Longman; 2001.  Back to cited text no. 7
Sajid MR, Laheji AF, Abothenain F, Salam Y, AlJayar D, Obeidat A. Can blended learning and the flipped classroom improve student learning and satisfaction in Saudi Arabia? Int J Med Educ 2016;7:281-5.  Back to cited text no. 8
Qutieshat AS, Abusamak MO, Maragha TN. Impact of blended learning on dental students' performance and satisfaction in clinical education. J Dent Educ 2020;84:135-42.  Back to cited text no. 9
Xiao N, Thor D, Zheng M, Baek J, Kim G. Flipped classroom narrows the performance gap between low-and high-performing dental students in physiology. Adv Physiol Educ 2018;42:586-92.  Back to cited text no. 10
Chutinan S, Riedy CA, Park SE. Student performance in a flipped classroom dental anatomy course. Eur J Dent Educ 2018;22:e343-9.  Back to cited text no. 11
Kiviniemi M. Effects of a blended learning approach on student outcomes in a graduate-level public health course. BMC Med Educ 2014;14:47.  Back to cited text no. 12
Bakr MM, Massey WL, Massa HM. Flipping a dental anatomy course: A retrospective study over four years. Educ Res Int 2016;2016:1-9.  Back to cited text no. 13
Tain M, Schwartzstein R, Friedland B, Park SE. Dental and medical students' use and perceptions of learning resources in a human physiology course. J Dent Educ 2017;81:1091-7.  Back to cited text no. 14
Park SE, Howell TH. Implementation of a flipped classroom educational model in a predoctoral dental course. J Dent Educ 2015;79:563-70.  Back to cited text no. 15


  [Figure 1], [Figure 2], [Figure 3]

  [Table 1], [Table 2], [Table 3], [Table 4]


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