Choice of electronic v / s printed documents by southern Chilean dental students

In recent decades, the use of digital texts has replaced printed documents. This has generated changes in the way texts are presented and diffused as well as the students’ choice and the way of reading materials related to medicine. While some reports have evaluated the use of digital compared to print formats, there is no evidence about dental students’ preferences. The objective of this study is to determine preferences among dental students from six universities in the south of Chile for using printed versus electronic documents. A descriptive study based on a survey which was conducted among dental students in May and June, 2013, was designed. The proposed survey was adapted for collecting general student data and preferences for using electronic or traditional printed documents. Six schools and a total of 1,022 students, with an average age of 21.4 years, participated. A 93.3% of them reported using both types of documents.  However, a 59.7% preferred printed documents. Only a 9.3% read documents directly from an electronic device. Students overwhelmingly preferred using printed documents than the electronic type. It is imperative to investigate the impact of new learning technologies in Chilean dental education. Keywords: Dentistry, dental education, electronic devices, e-learning, learning technologies. Uso de documentos electronicos v/s impresos por estudiantes de odontologia del sur de Chile. El uso de textos en formato digital ha reemplazado en las ultimas decadas el uso de documentos impresos, generando cambios en la disposicion y difusion de estos como tambien en la eleccion de los estudiantes y la forma de lectura de materias relacionadas con la medicina. Si bien existen reportes que valoran el uso de formato digital en comparacion a textos impresos, no existe evidencia de las preferencias en estudiantes de Odontologia. El objetivo de este estudio es determinar la preferencia de uso de documentos en formato impreso versus electronico en estudiantes de odontologia de seis universidades del sur de Chile. Se diseno un estudio descriptivo basado en una encuesta aplicada a estudiantes de Odontologia entre mayo y junio del ano 2013. Se adapto la encuesta propuesta para ello, recolectando datos generales del estudiante, preferencia de uso de documentos electronicos y documentos tradicionales impresos. Participaron seis escuelas, con un total de 1.022 estudiantes con un promedio de edad de 21.4 anos. El 93.3% declara usar ambos tipos de documentos, sin embargo, el 59.7% prefieren el uso de documentos impresos versus documentos electronicos. Solo el 9.3% lee directamente los documentos desde un dispositivo electronico. Los estudiantes prefieren mayoritariamente el uso de documentos impresos por sobre los de tipo electronicos. Es perentorio investigar el impacto de nuevas tecnologias de aprendizaje en la educacion odontologica chilena. Palabras clave: Odontologia, educacion dental, dispositivos electronicos, e-learning, tecnologias del aprendizaje.


Introduction.
Electronic books have been around since 1970.However, their use begins to increase with the massive appearance of electronic devices such as computers and tablets, causing major changes in the editorial industry 1 .Besides, the current generation of students has evolved and presents a remarkable difference from twenty years ago.This is mainly because of their greater familiarity with digital technology 2 which has even surpassed their teachers' pre-computing capabilities.
In medical science, this digital evolution has been observed in the new students' preference for reading and learning with digital versions of books and documents.Although studies indicate there are no significant differences in students' scores regarding the use of digital or print book versions [3][4] , there are still few reports comparing the students' preference for electronic versus printed books.Christianson 5 noted that electronic books were more popular than printed ones in the scientific area.In relation to medical students, Phua 6 found interns and residents prefer printed books.Also, Ditmyer 1 concluded that dental students in the United States, Puerto Rico and Canada do not have a specific preference.
Although the main advantage of e-books lies in their mobility and visualization so far, these were not considered sufficient reason to replace printed texts.Research has described the disadvantages such as higher consumption of time 7 , difficulty in use 7 and many more distracting elements in the reading process 8 .
While universities have only been implementing the use of e-books in recent times and the stock is considerably lower than printed ones, it is important to define the profile of the students' preferences for one format or the other.The result could be interesting for the development and modernization of libraries and for modifying dental curricula.
The objective of this study is to determine preferences for using printed versus electronic documents among dental students from six universities in the south of Chile in 2013.

Materials and methods.
This descriptive study was based on a survey conducted among dental students at universities in the south of Chile between May and June, 2013.This study was approved by the Ethics Committee of the Faculty of Medicine of the Universidad Austral de Chile.
The principal investigators (KS, AP) adapted the survey provided by Ditmyer 1 .For this purpose, a researcher (KS) translated the survey into Spanish.Then, it was presented to ten teachers and twenty five students from the School of Dentistry of the Universidad Austral de Chile.The idea was to obtain, though open questions, opinions on its layout and interpretation of the questions.Afterwards, two researchers (PA, CR) made changes and linguistic adaptations of the original scale by consensus.Finally, it was obtained an instrument with four sections: 1) general information; 2) use of electronic documents, 3) traditional printed documents and 3) general demographic information (Table 1).
By e-mail, the directors of dental schools from cities between Talca and Puerto Montt in the south of Chile were requested authorization to apply the survey to their students, prior presentation and acceptance through informed consent.
In case of approval, dental students from first to fifth year were surveyed.These students and those who were available on the day and time agreed by each principal were surveyed, obtaining a convenience sample.The universities which did not respond to the first request to participate or did not allow the investigators at the time of applying the survey were excluded.Also some sixth-year students were not able to participate for being in activities outside the campus.
Two investigators (AP, KS) conducted the printed survey in person, anonymously and voluntarily.The survey process was administered at the beginning or end of classes at each university.At the same place, both researchers orally presented the objective and survey instructions to the students.They were handled the document and given ten minutes to answer.In case of doubt, these were answered by the researchers, without interfering in their final decision.
In the survey, the formats: doc, docx, PDF, DjVu, ePub, HTML, lit, mobi, OEB, OPF, prc, rtf, aeh, azw, BBeB, CBR / CBZ, CHM, DTB, FB2, Irf, pdb, pml, rb, TCR, TR2, TR3, WOLF were considered as a choice of electronic documents.Additionally, any digital or scanned version of a printed document was also considered as electronic.All electronic documents had to be visible through a computer screen, mobile device, cell phone, tablet or e-book reader.On the other hand, any text printed on any kind of paper was considered as a printed document.The definition of device comprises any appliance or electronic equipment designed to control and take advantage of electrical signals, facilitating the dynamic dissemination of information to meet the knowledge and training needs of humankind, for instance, mobile phones, tablets and computers among others.The mode of acquisition is seen as the way in which the student has acquired the document, either electronic or printed.
Regarding the use of electronic or printed documents, the survey collected data on: type of document used in college and preferred type.For the use of electronic documents, students were consulted about their preference for: i) print; ii) electronic format; iii) the way the electronic document was obtained; iv) usage time; v) type of electronic device and vi) preference for the same e-book in print.For printed documents, students were asked about: i) the origin of the document; ii) usage time and iii) mode of preservation (Table 1).
Personal student data was obtained for gender (male / female), age (years old); year in the dental program (1st to 5th year) and university.
Data were tabulated in a spreadsheet from Google Drive (Google Inc., CA, USA).Then they were presented using descriptive statistics (mean values and standard deviation) and were analyzed using STATA 10.0 software (STATA Corp., TX, USA).

Results.
Six dental schools were included and a total of 1,022 students with an average age of 21.4 (SD: 2.4) years old.Details of demographic data are presented in Table 2.
From the participating universities, a 93.3% reported using both types of documents.However, a 59.7% preferred the use of printed versus electronic documents (Figure 1).
Depending on the use of the electronic document, a 50.2% download it for free from internet (Table 3).From them, 81.7% prefer printing and only 9.3% read directly from the device.Most of them do it on a daily basis (49.76%) (Figure 2) using the computer a 60.3% of the time, followed by the use of computer or cell phone (22.7%) and the use of computer, cell phone or tablet (9.2% ) and other devices (7.8%).
Regarding the use of printed documents, an 83.9% printed them from an electronic device.Only nine students (0.88%) stated they purchased books from a bookstore (Table 3), 48.1% use them daily (Figure 2).Most students reported keeping them once used (90.5%),followed by dispose (4.89%) and recycle paper (2.94%).

Discussion.
Most dental students in the south of Chile prefer using printed documents.These findings are similar to those about medical students reported by Phua 6 but contrary to those about students in North America reported by Christianson 5 and Ditmyer 1 .This fact reveals the easy access students currently have to both formats, but preferably to the choice of the printed type.The reasons to support this election are based on the possibility of making handwritten notes on page, carrying the document without electric power consumption or physically transferring the material to student peers 9 .It could also depend on the student's socioeconomic status and the chance of owning a portable and ergonomic electronic device (tablet or touch phone) to freely carry the document 10 .
This reveals the impact of the internet and free documentation available for studying, either by direct availability at universities or download platforms, including internet sites offering original scanned documents without formal authorization from the authors or journal editors 11 .This digital evolution has been observed in the new students' preference for reading and learning with digital versions of books and documents.The factors which benefit their use lies in saving time regarding acquisition and portability.However, their use can be affected given the attached elements (social networks, internet) which could distract the student 7 and be detrimental for their reading comprehension 8 .
While e-books supply has significantly increased over the past two decades with global online stores like Amazon and Apple Ebook Store 12 , this impact is not reflected in the studied population.Less than 1% reported having paid for material obtained either at electronic stores or bookstores.This fact makes one reflect on the real impact these stores have when distributing content that students learn, at least in the context of the south of Chile.This reality suggests that texts currently used by students are not from reliable sources of information.Instead, they are either notes from professors who do not report their source of information as well as handwritten entries created by undergraduates using scanned texts or images from original works with registered authorship.This makes textbooks in digital format unreliable or generate plagiarism [13][14] , something university authorities are often not aware of.Nevertheless, according to the data presented in this study, it is necessary to review such materials in order to know the type of document they are and the origin or source of their content.Moreover, data recorded at least one third of the students obtained digital documents from the teacher or the university library.This makes it necessary to analyze the type of given text by the teacher, including texts like original scientific papers displayed on electronic databases which are properly acquired by the study center.
Some of the limitations of the study include: Students are a sample of the participating universities, since only some subjects available at the time of the interview were consulted.At the same time, the survey had closed questions which required the students to select one of the proposed alternatives even when it does not wholeheartedly express their real personal thought.Despite these limitations, it is important to present this work because it is the first report on the type of device used by Chilean dental students for reading and studying available on electronic databases.The results of this study call to investigate on the type of information being used in both formats (original articles, scanned books, notes or transcripts of expository lectures, etc.) to assess the level of scientific evidence students have access to.It is also relevant to determine whether the texts, electronic databases or information sources have been duly authorized and paid for by universities in order to avoid unaware plagiarism or misuse of data by the students.
Future research should further explore the use of other information and communication technologies (ICTs) in our country 15 and how they have evolved in recent years.On the other hand, the impact that using tools with a more interactive multimedia character tested in other countries, such as podcasts 16 , classes on video available on internet 17 , online tutorials 18 among others, could have on the context of the Chilean dental education should be analyzed.Finally, it is important not to forget that ICTs are tools available to improve dental education, in this case.Therefore, no educational methodologies of this kind should be implemented only to justify some modernization in the professional formation 19 .
In conclusion, dental students in the south of Chile mostly prefer using printed documents than the electronic type.It is necessary to continue investigating patterns of use for these tools, the opinion of other national universities, as well as the impact of other ICTs in Chilean dental education.

Table 3 .
Distribution of mode for obtaining electronic or printed documents.
Figure 1.Percentage distribution by type of document and preference of dental students in the south of Chile, 2013.