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Blended learning for reinforcing dental

pharmacology in the clinical years:
Aqualitative analysis
Prashanti Eachempati, K. S. Kiran Kumar, K. N. Sumanth1

Website:
www.ijponline.com
DOI:
10.4103/0253-7613.193315

Abstract:
Objectives: Blended learning has become the method of choice in educational institutions because of its
systematic integration of traditional classroom teaching and online components. This study aims to analyze
students reflection regarding blended learning in dental pharmacology.
Subjects and Methods: Acrosssectional study was conducted in Faculty of Dentistry, MelakaManipal Medical
College among 3rdand 4thyear BDS students. Atotal of 145 dental students, who consented, participate in the study.
Students were divided into 14 groups. Nine online sessions followed by nine facetoface discussions were held. Each
session addressed topics related to oral lesions and orofacial pain with pharmacological applications. After each week,
students were asked to reflect on blended learning. On completion of 9weeks, reflections were collected and analyzed.
Statistical Analysis: Qualitative analysis was done using thematic analysis model suggested by Braun and Clarke.
Results: The four main themes were identified, namely, merits of blended learning, skill in writing prescription for
oral diseases, dosages of drugs, and identification of strengths and weakness. In general, the participants had
a positive feedback regarding blended learning. Students felt more confident in drug selection and prescription
writing. They could recollect the doses better after the online and facetoface sessions. Most interestingly, the
students reflected that they are able to identify their strength and weakness after the blended learning sessions.
Conclusions: Blended learning module was successfully implemented for reinforcing dental pharmacology. The
results obtained in this study enable us to plan future comparative studies to know the effectiveness of blended
learning in dental pharmacology.
Key words:
Blended learning, dental pharmacology, thematic analysis
Key message:
Blended learning can be successfully integrated into undergraduate pharmacology education in dentistry.
This could provide a favorable transition from the pre-clinical to clinical years with enhanced flexibility, location
convenience and time efficiency. The next generation of blended learning courses should enhance the function
of the internet as an absolute repository for all teaching and learning activities and minimize or even replace the
number of classroom settings with online video-based features.

B
Departments of
Prosthodontics and
1
Oral Medicine and
Radiology, Faculty
of Dentistry, MelakaManipal Medical
College, 75150 Melaka,
Malaysia
Address for
correspondence:
Dr.K. N. Sumanth,
Email:sumanth@
manipal.edu.my
Submission: 26072016
Accepted: 11102016

lended learning has become the method of

choice for many students in education and
training because of its systematic integration
of an online component to traditional teaching
[Figure1].[1]
In our experience, dental students are taught
pharmacology in their preclinical years
and often forget the drug interactions and
dosages in their clinical years. Hence, dental
pharmacology is revised in 3rdand 4 thyear
with an emphasis on clinical application.
In our study, we have used the blended
learning to reinforce dental pharmacology and
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2016 Indian Journal of Pharmacology Published by Wolters Kluwer - Medknow

qualitatively analyzed the student reflections

regarding the same.

Subjects and Methods

One hundred and fortyfive students of 3rd(78)
and 4 th (67) year BDS, who consented to
participate, were involved in the study. The
students were divided into small groups of 1011,
thereby forming 14 groups.
Blended learning module development: the
blended learning module was prepared by
two subject experts for the 14 groups according

How to cite this article: Eachempati P, Kiran Kumar KS,

Sumanth KN. Blended learning for reinforcing dental
pharmacology in the clinical years: A qualitative
analysis. Indian J Pharmacol 2016;48:S25-8.
S25

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Eachempati, etal.: Blended learning for dental pharmacology

to the sequential model of blended learning and online

activities proposed by Koohang.[2] This model illustrates how
transitioning from traditional teaching to a model of online
learning can be conducted.[3] A timetable of nine online sessions
followed by nine facetoface discussions was planned to replace
the traditional course structure of 15h of classroom teaching.
Each online session addressed topics from dental pharmacology
related to oral lesions and orofacial pain. The sessions were
in the form of a quiz, MCQs, or scenariobased questions.
Learning objectives were formulated for each session[Figure2].
At the start of the week, the online session was uploaded in
Moodle, and students were given 1week time to complete the
exercise. Each weekly online assignment was commented on
and assessed by the course instructor. At the end of the week, a
facetoface discussion was conducted by faculty who clarified
the doubts and helped students correct their mistakes. After
each week, the students were asked to reflect on the blended
learning session under a standard format which included the
following:(a) What happened?(b) So what?(c) What next?

Figure1: Blended learning

On completion of 9 weeks, reflections were collected and

analyzed. We followed Braun and Clarkes six phases for
conducting an inductive thematic analysis.[4]
Steps followed in thematic analysis[Figure3]:
1. Step 1: Familiarization with the data: We read the data a
few times before identifying codes and themes
2. Step 2: Initial Coding: We identified repeated words in each
reflection and coded them
e.g.Dosage, prescription writing, blended learning merits,
application to clinical practice, and my strength and
weakness.
3. Step 3: Generating themes: The codes were organized into
meaningful themes
4. Step 4: Checking for validity and reliability/reviewing
themes generated: Two independent reviewers analyzed
the data and derived themes. We compared our themes
with those of the two reviewers, and conflicting aspects
were discussed
5. Step 5: Defining and naming themes: After thematic analysis,
we defined and named themes based on emerging trends
6. Step 6: Interpretation and producing the report: The themes
were analyzed, and a report was formulated. Institutional
Research and Ethical Committee approval was obtained.

Results
A total of 108 forms were collected, in which one was
incomplete and two forms were illegible and hence were
excluded from the study.
The four main themes identified were:
Merits of blended learning
Skill in writing prescription for oral diseases
Dosages of drugs
Identification of strengths and weakness.
Merits of Blended Learning
The potential merits of the blended learning module were
emphasized in the students comments. In general, the
participants liked blended learning structure. Greater
S26

Figure2: Blended learning model used in our study

Figure3: Thematic analysis by Braun and Clarke

flexibility, convenience, and time efficiency were reflected

as major benefits in the participants comments. Further,
it was mentioned that online learning activities helped to
make learning more fun. Fortysix percent of the students
reflected that blended learning was better than traditional
classroom lessons with continuous lectures. They felt they were
more prepared for the lessons and sessions were more fun.
Seventyfour percent of the students opined that in blended
learning, teachers have become facilitators and resource
providers rather than just lecture givers[Table1].
Skill in Writing Prescription and Selecting Right Drugs for
Different Oral Diseases
The students felt that their prescription writing skills improved.
Eightyfive percent of the students opined that their ability to
identify correct drug improved after the session. Twentythree
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Eachempati, etal.: Blended learning for dental pharmacology

percent of the students reflected that due to reinforcement

in online and facetoface modules, students were able to
remember better. Ten percent of the students also suggested
that they mastered not only know the correct drugs to be
prescribed but also what are not to be prescribed for patients
with different medical conditions[Table2].
Remembering Dosage of Drugs
Thirtythree percent of the students could recollect the dosages
better after the online quiz and facetoface discussions.
Reinforcement in different sessions was appreciated by them.
Nine percent were more confident regarding dosages after this
session and felt it was difficult to concentrate during lecture
classes[Table3].
Identification of Strengths and Weakness
The most interesting reflection identified was that the
students received effective feedback during facetoface
discussions as well as online assessments. Comments from
lecturers helped the students to identify their strengths and
weakness. Fortyfour percent of the students suggested
that solving online assignments all by themselves made
them realize where they lack and where they needed
improvement. Fifteen percent of the students reflected that
they were able to integrate and apply the subject learned
in oral medicine and oral pathology for identification of
diseases and its management pharmacologically. Fiftysix
percent of the students felt the need to practice and read
more[Table4].

Discussion
Over the past few decades, there has been an exponential
rise in the computing technologies leading to a surge in
online teaching methodologies.[1] In spite of the technological
advancements, many researchers, trainers, and teachers
believe that facetoface traditional teaching methodologies
have their own merits and especially cater to the needs of
the less independent students.[2] To overcome these issues,
educational researchers have come up with an amalgamation
of the traditional and modern teaching methodologies
which led to the concept of blended learning.[2,5,6] Blended
learning has been used widely in many medical and dental
subjects.[7,8] Literature review by Rowe suggested that blended
learning has a potential to improve clinical competencies
among healthcare students and they find it intellectually
stimulating.[9]
The blended learning module had an overall positive feedback
from the students. We chose the blended learning technique
for the 3rdand 4thyear students because they were exposed
to the traditional pharmacology teaching in their preclinical
years. Repeating the lectures for reinforcing such topics is
time consuming. Moreover, the objective of revising dental
pharmacology in clinical years is to emphasize on the clinical
application. This was possible by introducing online sessions
with casebased scenarios. Furthermore, the sessions were
based on clinical scenarios rather than on individual drugs.
The blended learning was received well by the students,
who enjoyed the online sessions due to their technosavvy
inclination. Dividing the students helped us to conduct
onetoone sessions allowing us to give effective feedback.
Indian Journal of Pharmacology | October 2016 | Vol 48 | Supplement

Table 1: Student reflections for merits of blended

learning
Themes
identified
Merits of
blended
learning

Examples of participant reflections

I could finish assignments whenever I felt like and the
quiz sessions were fun
It was better than traditional classroom lessons with
continuous lectures. Here we are more prepared for
the lessons and sessions are more fun
We were our own teachers for a few sessions and
it was great to work in your own way. You have to
rationalize your time as much as possible
This course gave me the ability to get the content
repeated more often. Its very important for me
I am very satisfied with blended learning
I sat at home and completed the online sessions.
Iwas surprised I could learn so much without actually
being lectured in a closed class room
Class room lectures can be boring and exhaustive.
With blended learning you can use your time more
efficiently to find the information you really are
searching for
It is very interesting. It widened my knowledge so that
we can treat patients more confidently in future
In blended learning teachers have become facilitators
and resource providers rather than just lecture givers

Table 2: Student reflections for skill in writing

prescription and selecting right drugs for different
oral diseases
Themes identified
Skill in writing
prescription and
selecting right
drugs for different
oral diseases

Examples of participant reflections

The online sessions followed by the
discussions helped us know and understand
better which drugs to be given in which
situation based on patients conditions
I know the correct drugs to be prescribed and
not to be prescribed for patients with different
medical conditions
I know when not to give a drug
We have enhanced our knowledge in
pharmacology and be clear what to prescribe
to patients with different medical conditions
There are many drugs that cannot be
prescribed in medically compromised patients.
Blended learning helped me learn the same
Now I know how to write a prescription

Table 3: Student reflections for remembering dosage

of drugs
Themes identified
Remembering
dosage of drugs

Examples of participant reflections

I could memorize the dosages and remember
them better
I learnt to calculate drug dosages after the
discussions and am confident now
We have to find out the proper dosage for
each condition along with duration
I am more confident after this session. In
theory class I hardly concentrate on dosages

Asimilar finding was also reported in the study by Pahinis

etal.[10] at the end of blended learning course.
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Eachempati, etal.: Blended learning for dental pharmacology

Table 4: Student reflections for identification of strengths and weakness

Themes identified
Identification of strengths and weakness

Examples of participant reflections

I realised that I was able to integrate and apply what I have learnt in oral medicine and oral
pathology for identification of diseases and its management pharmacologically
I realised that I was developing more communication and group study between group members.
Focus on discussion rather than passive listening with lectures. Irealised I do better this way
I need to practice more examples and read up about the drugs so that I will be more efficient.
Need to memorize and learn more about drugs and learn more about drugs which are indicated
and contraindicated for diseases
Able to apply this knowledge in dental practice and selection of drugs in each treatment
depending on the patient health condition This is my strength now

Flexibility and location convenience were key matters in the

students comments on a blended learning course.[11] Combined
with online activities, the learning was more student centered
and teacher acted as a facilitator. Rather than just a provider
of answers and content, the teacher becomes a guide, resource
provider, and expert controller. The blended learning module
led to a change in teacher activity toward providing guidelines
and creating learning environments where students are helped
to arrive at their own conclusions.[6] These advantages were
also highlighted by Goodyear.[12]
Studies have a stressed need for knowledge construction,
problemsolving, critical thinking, communication skills, and
lifelong learning to build good professionals.[13,14] Blended
learning has given students a chance to explore their knowledge
all by themselves through the online sessions which included
the components of problemsolving and critical thinking.
Feedback given during the facetoface sessions led to the
reinforcement of knowledge as well as a selfrealization of the
students regarding their areas of improvement. Students had
an active interaction during the discussions which led to peer
learning and active communication.

Financial Support and Sponsorship

Nil
Conflicts of Interest
There are no conflicts of interest.

References
1.
2.
3.

4.
5.

6.

7.

Our findings suggest that a blended learning format could be

successfully integrated into undergraduate dental education
and provided a favorable transition from the preclinical to
clinical years with enhanced flexibility, location convenience,
and time efficiency. With the results obtained in this study, we
are planning to analyze the effectiveness of blended learning in
reinforcing dental pharmacology in comparison to traditional
classroom teaching.

8.

As suggested by Rosenbaum etal.,[3] the next generation of

blended learning courses should enhance the function of
the internet as an absolute repository for all teaching and
learning activities and minimize or even replace the number
of classroom settings with online videobased features, for
instance, synchronous online video conferencing.

11.

9.

10.

12.

Conclusion
Blended learning module was successfully implemented
for reinforcing dental pharmacology. The results obtained
in this study enable us to plan future comparative studies
to evaluate the effectiveness of blended learning in dental
pharmacology.

S28

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