Table 1. Frequency of responses for items, categorised into different themes.

Overall, most students provided positive responses regarding activity acceptance and effectiveness and the supporting role of supervisors. However, slightly more than half of the students felt neutral about the learning activity causing an increased workload compared to classroom learning. 

The thematic analysis of qualitative data yielded multiple themes that can be categorised into three main areas: 1) benefits of this education method, 2) limitations of this learning intervention, and 3) differing opinions on the integration of the group innovation project into the dental curriculum. 

A. Benefits of The Study

Within this area, the students expressed four main themes.

1) Enhances creativity and innovation: Most students felt that this teaching method had enhanced their creativity in finding methods to manage patients with special dental needs as well as in developing innovations for the group of interest. 

“This integrated learning helps me with my creativity and critical thinking so we could create an innovation that is appropriate with the current technology.”

Student 10

2) Improves knowledge and understanding of SCD: Using innovation in teaching made students delve into the subject matter, thus improving their knowledge of their patients and gaining a deeper understanding of SCD. 

“A good approach indeed. I have a chance to challenge my understanding and gain new information from my friends, supervisors, and postgraduate students. This helped me develop a new way of thinking and find good literature on SCD.”

Student 35

Subtheme 1: Encourages independent information-gathering about SCD

Some students noted that they had to rely on the resources they had and work by themselves due to the pandemic, which made them more independent when researching topics about SCD.

“In my opinion, this teaching method is helpful to help the students to understand the special needs module by asking the student to develop products according to the difficulties of the disabilities required.”

Student 25 

Subtheme 2: Development of critical thinking and problem-solving skills in SCD

By giving students the task of developing information, they were forced to solve problems the special interest group faced. Therefore, students believed this made them learn better critical thinking and problem-solving skills.

“Good to brainstorm ideas and put us in their shoes in order to address their different needs.”

Student 74

3) Instils interest and positive attitudes towards learning SCD: Due to their minimal patient experience, most students felt this task made them more interested in their special interest group, which improved their attitudes to learning SCD. 

“The integrated learning approach gives me ideas on how situations should be handled in real life on aspects like the expectation from special care patients and preparedness as a future dentist to have a special care patient.”

Student 12 

4) Encourages teamwork: Some students noted that, even with the isolation, they felt that this type of teaching method had encouraged them to work more closely with not only their teammates but supervisors as well.

“Innovative program. Good. Made students and supervisors unite as teammates.”

Student 62

B. Limitations of this Learning Intervention

Regarding limitations, two themes were noted.

1) Technological challenges: Several students experienced poor internet connection throughout the process, which hindered their efficiency. 

”Very helpful, but internet connection and environment are some of the barriers for me for not study effectively, I prefer face-to-face learning approach. ”

Student 72

2) Reduced physical access to purchasing of materials: The movement control order that was implemented throughout most of the pandemic left most students restricted from being able to access appropriate materials from local or distant suppliers.

“We faced problems buying materials due to the movement control order.”

Student 77

C. Differing Opinions on the Integration of the Group Innovation Project into the Dental Curriculum

Students had differing opinions on the following aspects.

1) Time commitment and workload: Despite the lack of face-to-face sessions, some students believed they were given adequate time to create and execute ideas comfortably.

“Since the project is given so much earlier than the deadline, we are able to create a better project without feeling any burden in completing the module.”

Student 36

However, a handful of students felt they needed more time to be able to have performed better for the task.

“It is an interesting method and helpful to learn special care dentistry, but it is quite time-consuming, and we have restrictions due to COVID-19.”

Student 65

2) Financial demands: Depending on the type of innovation they designed, some students felt that the funding provided was not sufficient for them to prepare a good product.

“Some innovations need to create prototype only because low budget, but it is understandable.”

Student 74

However, a few students believed the financial assistance was enough for them to complete their innovation. 

“The funding provided was sufficient.”

Student 43 

3) Guidance from supervisors: Many students noted that their supervisor provided ample guidance throughout the project. 

“Excellent. Students and supervisors can communicate and deliver knowledge well through this method.”

Student 19 

“Our supervisor introduced us to some deaf patients. So we were able to get the patient’s feedback on our product.”

Student 52

However, some students believed the transition from face-to-face to online consultations was not ideal for the guidance they needed. 

“However, there is lacking in communication and discussion between students and supervisors as this is still new to some students.”

Student 47 

4) Exposure to SCD practice: Because the students were supposed to have exposure to special care patients in their final year, they believed that this teaching module was sufficient to help them understand patients. 

“I think this method actually gives a realistic overview of how to work with patients.”

Student 43

On the other hand, a few felt that clinical sessions were more beneficial for them to apply the knowledge they have.

“In my opinion, direct exposure to SND patients would be better so we can apply the knowledge and innovation.”

Student 76 

IV. DISCUSSION

This study involved the undergraduate teaching of SCD for students in a Malaysian dental school. In Malaysia, SCD education has yet to become a compulsory component of the five-year undergraduate curriculum (Naimie et al., 2020). This may be related to various barriers to providing training in this area of dentistry, including a lack of clinical expertise and educational resources (Ahmad et al., 2014). Despite this, Universiti Teknlologi MARA, Malaysia has taken a proactive approach to provide training in SCD, at both undergraduate and postgraduate levels (https://dentistry. uitm.edu.my/index.php/en/). For undergraduate students, teaching and learning of SCD are provided in the final year, as part of the Comprehensive Care Dentistry course (Faculty of Dentistry, 2022). Students undergo a series of lectures, hands-on demonstrations, problem-based learning, tutorials, a clinical rotation in the SCD specialist clinic, and a community engagement activity project (Faculty of Dentistry, 2022).

Although various teaching and learning interventions have been successfully conducted in the undergraduate training of SCD in previous years (Naimie et al., 2020), the transition from face-to-face training to online distance learning imposed on higher learning institutions in this country during the COVID-19 pandemic (Halim et al., 2021) may lead to compromised learning experiences. This is especially pertinent for SCD training, which involves clinical exposure to various groups of patients (Dougall et al., 2014). As clinical training was limited at that point of time, alternative teaching and learning approaches were designed to ensure students were exposed to issues in managing patients with special health care needs, which in this case was achieved by developing an innovative product to address patients’ difficulty in maintaining satisfactory oral health.

This study found that students demonstrated favorable responses toward acceptance of such an education intervention. With dental students experiencing physical and mental health deterioration with online distance learning during the COVID-19 pandemic (Lestari et al., 2022), it was encouraging to observe that students in this study found the learning activities interesting. They also opined that the educational method enhanced creativity and innovative skills, which are the highest level of learning domains (Bloom et al., 1964; Miller, 1990). Therefore, acceptance of this training approach has positive implications for its future development and implementation in the undergraduate dental curriculum.

Various benefits of this learning activity, as reported by students in this study, also further supports the use of innovation-integrated learning for teaching SCD. Participants cited improved knowledge and understanding of SCD, which has been reported as lacking among members of the dental fraternity around the world (Ahmad et al., 2015; Borromeo et al., 2018; Mandasari et al., 2021). They also opined that this learning intervention allowed integration of SCD theory and clinical practice, supporting its effectiveness, which is comparable to a similar approach previously undertaken via face-to-face learning (Ahmad et al., 2020).

The enhanced student attitude and interest in learning SCD reported in this study suggest a positive impact of learning that could potentially be translated into practice. Those with educational experience in SCD have been found to feel more comfortable and positive in managing patients with special health care needs (Mohamed Rohani et al., 2021). Dental practitioners who received exposure to SCD during university education were also more likely to have provided care to these patients, in comparison with their colleagues without such training experience (Alumran et al., 2018).

To further enhance students’ attitudes and interest in learning, the role of academicians as supervisors is integral. Academicians who play an effective role could influence students’ active engagement in learning, guide students in achieving learning goals, and enhance their overall learning experience (Sølvik & Glenna, 2021). It was evident in the present study that despite being conducted virtually, this learning activity was successful in encouraging engagement between students and supervisors. Some students also reported receiving assistance from their supervisors in gaining access to patients, whose feedback was sought for improvement of their products. This is an encouraging finding, given previous studies reporting negative implications of virtual and remote learning on student–teacher relationships (Halim et al., 2021). To ensure that all students receive quality supervision, the faculty must monitor the roles and engagement of every academician, especially during learning activities that involve remote delivery.

Besides improving student–teacher engagement, this learning activity was also beneficial in enhancing peer interactions and teamwork, while allowing sharing of experiences and ideas between students. Although social interaction and group dynamics in learning have been reportedly compromised during the COVID-19 pandemic (Walker & Koralesky, 2021), this education activity was perceived to have overcome this issue. Enhanced teamwork and communication brought about by this activity could provide opportunities for students to develop professionalism, which is integral to the practice of dentistry. Teamwork and effective communication are especially important in the practice of SCD, where multidisciplinary collaboration is mandatory in addressing patients’ complex health care needs (Glassman et al., 2016). The development of skills (e.g., independent information-gathering, critical thinking, problem-solving skills) reported by the study participants is also beneficial in preparing them as competent practitioners who can function at a high level of professionalism.

Challenges reported by students while undergoing this learning activity (technological difficulties and reduced physical access to purchase materials) demand the attention of faculty and supervisors to be more proactive in addressing the related issues. Nevertheless, with allowance of physical classes recently, this issue would not compromised students’ learning experience should the faculty decide to continue such this approach. Differing opinions about time constraints, heavy workloads, and increased financial demands expressed by students in this study require further investigation and planning by the faculty to ensure that the students receive adequate assistance to support their learning process. Feedback from patients regarding the developed innovative products could be gained through the conduct of proper research that assesses the effectiveness and benefit of the intervention. Consequently, students’ innovative ideas could be further developed for commercialisation, thus equipping them with entreperneurial skills, which is highly recommended to be taught in the higher education curriculum (Tuononen et al., 2022).

This study also indicates that integrating innovation in the teaching and learning of SCD supports many aspects of student learning that targets the recommended core contents as recommended in the IADH guidelines. These contents include 1) Identifying and  addressing access and barriers to oral health faced by people with special needs (Domain 2), 2) Demonstrating appropriate communication skills when managing patients with special needs (Domain 4),  3) Understanding the impact of impairments, disabilities and systemic conditions on oral health and functions (Domain 5), as well as 4) Developing and applying effective methods when managing patient with special needs, including in planning oral health education program and designing interventions for clinical treatment (Domain 6) (Daly et al., 2014).

This study is limited by the non-participation of some students, whose responses were not included in the investigation. Nevertheless, the high response rate indicates the representativeness of the study population, hence supporting the validity of the study findings.

The results of this study provided important information for program developers, faculty, and the dental education fraternity at large. It identified the potential of innovation-integrated learning, for providing SCD training to undergraduate students, including in circumstances that may limit physical access to education.

V. CONCLUSION

Students’ acceptance of this teaching method proves it is sufficient and beneficial in improving their creativity and innovation, enhancing their knowledge and understanding of SCD, instilling interest and positive attitudes in learning SCD, and encouraging teamwork and effective communication between peers and supervisors. However, they provided differing opinions on the impact of the learning activity on their workload, time and financial demands, and exposure to SCD practice. Some faced technological challenges and reduced physical access to purchase materials.

Notes on Contributors

Aminda F. Omar was involved in literature search, data acquisitions and analysis and the manuscript preparation.

Tun Yasmin Iffah Mohd Suria Affandi was involved in data acquisitions and analysis.

Mohd Isyrafuddin Ismail was involved indata acquisition.

Mas S. Ahmad was involved in study conception and design, data analysis, manuscript editing and review.

Ilham W. Mokhtar was involved in the study conception and design and manuscript review.

All the authors approved the final version of the manuscript publication.

Ethical Approval

Ethics approval was obtained from the Research Ethics Committee (REC) Universiti Teknologi MARA, Malaysia in accordance with the Declaration of Helsinki (REC12/2021 [MR 1004]).

Data Availability

As per the requirement of the local ethics, data will be kept in an enclosed and dedicated facility in the faculty building.

Acknowledgement

The authors wish to thank the dental students from Universiti Teknologi MARA, Malaysia for participating in this study. The authors confirm that no financial support was received to fund this work. The authors also confirm they have no interests to declare.

Funding

No funding was provided for this study.

Declaration of Interest

There are no conflicts of interests.

References

Ahmad, M. S., Mokhtar, I. W., & Khan, N. L. A. (2020). Extramural oral health educational program involving individuals with disabilities: Impact on dental students’ professionalism. Journal of International Society of Preventive & Community Dentistry, 10(3), 323-328. https://doi.org/10.4103/jispcd.JISPCD_74_20

Ahmad, M. S., Radhi, D. S. M., Rusle, F. F., Zul, M. F., Jalaluddin, J., & Baharuddin, I. H. (2020). Photodentistry – An innovative approach to improving students’ empathy and learning experiences in comprehensive patient care. Journal of Dental Education, 84(11), 1219-1229. https://doi.org/10.1002/jdd.12295

Ahmad, M. S., Razak, I. A., & Borromeo, G. L. (2014). Undergraduate education in special needs dentistry in Malaysian and Australian dental schools. Journal of Dental Education, 78(8), 1154-1161.

Ahmad, M. S., Razak, I. A., & Borromeo, G. L. (2015). Special needs dentistry: Perception, attitudes and educational experience of Malaysian dental students. European Journal of Dental Education, 19(1), 44-52. https://doi.org/10.1111/eje.12101

Alumran, A., Almulhim, L., Almolhim, B., Bakodah, S., Aldossary, H., & Alakrawi, Z. (2018). Preparedness and willingness of dental care providers to treat patients with special needs. Clinical, Cosmetic and  Investigational Dentistry, 10, 231-236. https://doi.org/10.2147/CCIDE.S178114

Amir, L. R., Tanti, I., Maharani, D. A., Wimardhani, Y. S., Julia, V., Sulijaya, B., & Puspitawati, R. (2020). Student perspective of classroom and distance learning during COVID-19 pandemic in the undergraduate dental study program Universitas Indonesia. BMC Medical Education, 20(1), Article 392. https://doi.org/10.1186/s12909-020-02312-0

Bloom, B. S., College, C. O., & Examiners, U. (1964). Taxonomy of educational objectives (Vol. 2). Longmans.

Borromeo, G. L., Ahmad, M. S., Buckley, S., Bozanic, M., Cao, A., Al-Dabbagh, M., & Athale, A. (2018). Perception of Special Needs Dentistry education and practice amongst Australian dental auxiliary students. European Journal of Dental Education, 22(3), e321-e326. https://doi.org/10.1111/eje.12296

Chang, T.-Y., Hsu, M.-L., Kwon, J.-S., Kusdhany, M. F. L. S., & Hong, G. (2021). Effect of online learning for dental education in Asia during the pandemic of COVID-19. Journal of Dental Sciences, 16(4), 1095-1101. https://doi.org/10.1016/j.jds.2021.06. 006

Daly, B., Boyle, C., Mc Pherson, A., & Thompson, S. (2014). Core content for a curriculum in Special Care Dentistry at the undergraduate level mapped to the learning outcomes for “Preparing for practice” (GDC-UK, 2011). British Society for Disability and Oral Health, March, 1–23.

Dougall, A., Thompson, S. A., Faulks, D., Ting, G., & Nunn, J. (2014). Guidance for the core content of a curriculum in Special Care Dentistry at the undergraduate level. European Journal of Dental Education, 18(1), 39-43. https://doi.org/10.1111/eje.12054

Faculty of Dentistry. (2022). DS240- Bachelor of Dental Surgery Program Structure. Retrieved from https://dentistry.uitm.edu.my/index.php/en/programme/programme-offered/2-uncategorised/67-ds240-programme-structure

Glassman, P., Harrington, M., Namakian, M., & Subar, P. (2016). Interprofessional collaboration in improving oral health for special populations. Dental Clinics of  North America, 60(4), 843-855. https://doi.org/10.1016/j.cden.2016.05.004

Halim, M., Noorani, T., Karobari, M., & Kamaruddin, N. (2021). COVID-19 and dental education: A Malaysian perspective. Journal of International Oral Health, 13(3), 201-206. https://doi.org/10.4103/jioh.jioh_8_21

Lestari, W., Yazid, N. H., Azhar, Z. N., Ismail, A., & Sukotjo, C. (2022). Impact of COVID-19 on Malaysian dental students’ physical, mental, financial and academic concerns. BMC Oral Health, 22(1), Article 46. https://doi.org/10.1186/s12903-022-02081-w

Malaysian Dental Council. (2021). Code of Practice for Programme Accreditation – Undergraduate dental degree. (2019, effective, April 1, 2021). http://mdc.moh.gov.my/modules/mastop_publish/?tac=COPPA

Mandasari, M., Rahmayanti, F., Derbi, H., & Wimardhani, Y. S. (2021). Special care dentistry perception among dentists in Jakarta: An online survey study. PloS ONE, 16(4): e0249727. https://doi.org/10.1371/journal.pone.0249727

Miller, G. E. (1990). The assessment of clinical skills/competence /performance. Academic Medicine, 65(9), S63-S67. https://doi.org/10.1097/00001888-199009000-00045

Mohamed Rohani, M., Ahmad Fuad, N., Ahmad, M. S., & Esa, R. (2021). Impact of the special care dentistry education on Malaysian students’ attitudes, self-efficacy and intention to treat people with learning disability. European Journal of Dental Education, 26(4), 741-749. https://doi.org/10.1111/eje.12756

Mohamed Rohani, M., & Mohd Nor, N. A. (2021). Dental students’ perception on Disability Equality Training as part of the special care dentistry curriculum. Journal of Dental Education, 85(5), 690-698. https://doi.org/10.1002/jdd.12528

Naimie, Z., Ahmad, N., Shoaib, L., Safii, S., & Mohamed Rohani, M. (2020). Curriculum for Special Care Dentistry: Are we there yet? Journal of International Oral Health, 12(1), 1-7. https://doi.org/10.4103/jioh.jioh_146_19

Rowe, A. D., & Wood, L. N. (2008). Student perceptions and preferences for feedback. Asian Social Science, 4(3), 78-88. https://doi.org/10.5539/ass.v4n3p78

Royal Australasian College of Dental Surgeons. (2021). Specialist Dental Practice. https://racds.org/sdp/

Saleem, Z., Sethi, A., Hassan, M., & Wajahat, M. (2019). Assessments of dental students’ entrepreneurial self-efficacy to aid practice management. Health Professions Educator Journal, 2(2), 54-59.  https://doi.org/10.53708/hpej.v2i2.105

Samat, M. F., Awang, N. A., Hussin, S. N. A., & Mat Nawi, F. A. (2020). Online distance learning amidst Covid-19 pandemic among university students. Asian Journal of University Education 16(3), 220-233. https://doi.org/10.24191/ajue.v16i3.9787

Sølvik, R. M., & Glenna, A. E. H. (2021). Teachers’ potential to promote students’ deeper learning in whole-class teaching: An observation study in Norwegian classrooms. Journal of Educational Change, 23, 343-369. https://doi.org/10.1007/s10833-021-09420-8

Tuononen, T., Hyytinen, H., Kleemola, K., Hailikari, T., Männikkö, I., & Toom, A. (2022). Systematic review of learning generic skills in higher education—Enhancing and impeding factors. Frontiers in Education, 7, 1-13. https://doi.org/10.3389/feduc.2022.885917

Walker, K. A., & Koralesky, K. E. (2021). Student and instructor perceptions of engagement after the rapid online transition of teaching due to COVID‐19. Natural Sciences Education, 50(1), e20038. https://doi.org/10.1002/nse2.20038

Wang, J., Peng, B., Zhou, H., & Zhang, J. H. (2020). Dentists’ entrepreneurial intention and associated factors in public hospitals in major cities in Guangdong (South China): A cross-sectional study. BMC Oral Health, 20, 334 https://doi.org/10.1186/s12903-020-01331-z

*Ilham Wan Mokhtar
Faculty of Dentistry, Universiti Teknologi MARA,
47000, Jln Hospital, Sungai Buloh
Selangor, Malaysia
Email: ilham@uitm.edu.my