Hygiene Class Utilizes Innovative New Video System

The Thursday afternoon session of Dental Hygiene course DH210 has been underway for about an hour as faculty member Martha McComas goes from student to student. She is watching the first-year students practice the proper techniques for using different dental scalers and is demonstrating how to reach various teeth on their typodont models. The conversation is filled with DH lingo.

“Bring your hand more towards your right, so get up on your fulcrum finger a little more,” McComas tells one student. “There … not out, but up. Keep going, keep going, right there.” Another student asks: “So when you get toward the mesial buccal, that’s when you want to start rotating?” “That’s right,” McComas answers, watching the student’s hand movements. “There you go, that’s better. Because if you keep going straight without rolling and adapting your fulcrum, then that point is going to be out in the gingiva and that’s going to be painful. Looks good, looks really good. Let’s go on to another area …”

It’s a typical instructional conversation that’s been held countless times between DH faculty and students, except for one big difference on this day: The participants are not at the School of Dentistry or even in the same room. The students are practicing in their apartments around southeast Michigan, and McComas is offering her expertise from the living room of her home in Dexter. She is watching a series of video feeds that allow her to see a close-up of each student’s hands as they practice on their typodont. In return, students can watch McComas demonstrate proper technique on her typodont.

DH faculty and students are using this innovative and newly developed video system in response to limitations created by the COVID-19 pandemic. New protocols allow fewer students to be in the Simulation Lab and clinics at once, so McComas knew by mid-summer that faculty would need a mix of in-person and online instruction, rather than the pre-pandemic routine, which was entirely in-person. Lectures and many classroom courses are fairly easy to convert to virtual Zoom meetings, but hands-on demonstrations that would normally have been done in the Sim Lab or Foundations Clinic are much more difficult to move online.

McComas, a clinical associate professor, began experimenting at home with how a Zoom meeting on her laptop computer could be paired with a second video feed using the camera on an iPad. She configured a tripod to hold the iPad so that its camera pointed down at her typodont. Through “lots of trial and error” she got close to a process that she thought might work. It requires the faculty member to alternate between talking to students on Zoom, then pivoting to demonstrate procedures on the iPad camera, making sure to switch back-and-forth between the proper settings so that everyone can see and hear both functions at the proper times.

McComas enlisted the help of Adam Barragato, lead instructional learner in the school’s Dental Informatics department. He helped refine how a laptop and iPad could be used simultaneously, and provided instructional support. DH and DDS students had already been supplied with iPads early in the switch to online learning when the pandemic first hit; now the school provided each firstyear DH student with a tripod, an iPad holder that attaches to the tripod and a small ring light to light up the typodont. “That would allow students to show their instrumentation techniques without having to ask their mom, dad, sibling or friend to hold the iPad while they did it!” Barragato noted. “The other challenge was how do we support faculty who have never taught this way before and with this technology that they are not familiar with.”

Several practice sessions were held with McComas and the other three faculty who would teach the class – DH Director and Clinical Professor Janet Kinney and Clinical Lecturers Brittany Forga and Sheree Duff – shortly before the class began in early September. New material is presented to the 32 students each Wednesday when they are all in-person in the dental school Sim Lab. McComas introduces new instruments and techniques, and the students use class time to practice. On Thursdays, from their homes, students log into the online video system where they practice and demonstrate their proficiency with the latest material. Much of the time is spent in virtual “break-out rooms” with two students demonstrating and watching each other’s work. Faculty check in on the pairings to answer questions and offer instruction. After that Thursday online class, students have until Sunday at noon to record a 10-minute video that shows themselves discussing and demonstrating the latest procedures on their typodonts. Faculty then review and grade the videos before the next class on Tuesday, which is an online session during which faculty provide individual critiques of the skills demonstrated in the student video. Then on Wednesday, it’s back into the Sim Lab for the next new section of the course.

Faculty member Martha McComas working in her living room.

During the online video sessions, each of the four faculty members deals directly with only eight of the 32 students to increase the amount of direct contact for the students. McComas said she believes students are learning the material faster than with the traditional method, in part because the new video method seems to enhance the educational approach known as Just-in-Time Teaching, or JiTT. That method encourages pre-class preparation by students, more active learning during classes and teachers adjusting classroom activities to meet student needs. “I believe that the type of virtual instruction we have created for this class has allowed us to really utilize the JiTT pedagogy to its full extent,” McComas said. “We always were able to utilize JiTT in the Sim Lab, but to be able to use this type of teaching on an individual basis, in every Zoom session, is really advantageous for the novice learner.”

Students and faculty reported that it took two or three weeks to get comfortable with the new teaching and learning method, but they have found positives with the process. McComas, her faculty colleagues and students say in-person, hands-on teaching remains essential for the Dental Hygiene curriculum, but McComas believes it is so effective that at least parts of it should be maintained even when the dental school is able to return to full-time, in-person instruction.

Several students in the class say they are generally happy with how the course has netted out after solving problems like finding the best ways to position the camera so classmates and faculty can see their hands at work as they move around the typodont. Making the weekly video was time consuming at first, but students say they’ve become faster and the end results are more polished now. Student Ashlee Hastings said the videos are a big advantage. “I love to review my videos once I have received feedback on what I need to improve,” she said. “If I were demonstrating this skill in person I would not have the ability to review my video as many times as I needed to perfect the skills I am practicing.”

Clinical lecturer Brittany Forga said her experience has been positive. “One strength to having the videos to assess student skill and progress is that we, as faculty, can hit rewind and watch a skill multiple times to ensure that any weaknesses are identified and corrected so our students are building a strong foundation,” she said. “That feedback is a great way to get our students thinking about what they missed in their video and they can practice before Sim Lab the following day. And it is also a great way to document all of the improvements, progress and strengths they have picked up from start to finish.”