European Journal of Dental Education ISSN 1396-5883

Comparison of dental students’ performances and

perceptions in preclinical and clinical pharmacology in an Irish
Dental School
O. P. Barry1 and E. O’Sullivan2
1
Department of Pharmacology and Therapeutics, University College Cork, Cork, Ireland,
2
Department of Oral Surgery, Cork University Dental School and Hospital, Cork, Ireland

keywords Abstract
education; dental; pharmacology;
undergraduate students; teaching; assessment. Introduction: Knowledge of pharmacology is essential for dental students and for its
safe application in the clinical environment.
Correspondence
Orla Patricia Barry
Aims: The goals of our study were to assess dental students’ performances in pharmacol-
Department of Pharmacology and Therapeutics
ogy with and without shared instruction, to investigate correlations between students’
Room 3.89, Western Gateway Building
final grades in pre-clinical and clinical pharmacology, to determine if gender affects test
Western Road
performance and to explore characteristics of effective dental student learning.
University College Cork
Cork, Ireland
Tel: 353-21-4205493 Methods: A 9 year mixed method study was undertaken comprising (i) quantitative
e-mail: o.barry@ucc.ie analysis of undergraduate performances in basic and clinical pharmacology (n = 320)
and (ii) quantitative and qualitative exploration of student perceptions on teaching
Accepted: 3 May 2016 and learning in pharmacology.

doi: 10.1111/eje.12210
Results: Mean basic pharmacology scores were not significantly different when dental
students were co-taught with medical and pharmacy students. Regression analysis
showed a statistically significant correlation (r = 0.582, P < 0.01) between basic and
clinical pharmacology dental student scores. Interestingly, correlation was independent
of gender with female student scores demonstrating a correlation of r = 0.480,
P < 0.01 and males a correlation of 0.684, P < 0.01. Quantitative and qualitative feed-
back highlighted four thematic areas of effective dental student learning namely:
(i) quality of instructors, (ii) lecture content, (iii) assessment type and (iv) learning
environment.

Conclusions: Teaching basic pharmacology in a multidisciplinary environment did

not adversely affect dental students’ examination performances. Dental students who
perform well in basic pharmacology perform similarly well in clinical pharmacology.
However, whether students’ understanding and the application of pharmacology affects
the quality of patient care in the clinical environment awaits further investigation.

as a scientific discipline and academic subject is relatively

Introduction
Dental education became a formal field of study in 1828 when
Dr. JM Harris started the world’s first dental school in Bain-
bridge, Ohio. However, the importance of effective pharmacol-
ogy teaching to dental students was not recognised for almost
150 years (1–3). Whilst pharmacology emerged as a basic
science in the mid-nineteenth century, clinical pharmacology
young originating from the middle of the twentieth century
(4). Basic pharmacology refers to the basic science of individ-
ual drug classes whilst clinical pharmacology, which is essential
to dental practitioners is defined as the use of drugs to treat
disease. It is important that basic pharmacology teaching and
learning is integrated with clinical pharmacology within the
dental curriculum as such an integrated curriculum permits

ª 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd 1
Undergraduate dental student assessment in pharmacology
students to go beyond simple memorisation and regurgitation
of facts and concepts to develop proficiency in their respective
discipline.
Knowledge of pharmacology is essential to dental students as
future dental practitioners to ensure safe prescribing and
appropriate use of drugs pertinent to oral health, effective and
safe management of medical emergencies that may occur dur-
ing dental treatment and to aid the assessment/prevention of
adverse drug interactions in patients with co-morbid condi-
tions/polypharmacy. The aims, learning outcomes and assess-
ment methods of our basic and clinical pharmacology modules
are clearly stated and well-aligned (5). Basic pharmacology is
taught in year two of the dental curriculum by three faculty
members from the department of Pharmacology and Therapeu-
tics, University College Cork (UCC). Course delivery involves
thirty contact hours and instruction is shared with students
from other healthcare professions that is medical and pharmacy
students. In this instance, shared instruction is driven by strate-
gic utilisation of resources rather than a desire to increase the
interprofessional education in the dental curriculum (6–10).
Core instruction is through didactic lectures as well as com-
puter-based laboratory practicals, which are strategically posi-
tioned within the module to follow the five traditional didactic
lectures which cover the theory and practice of related pharma-
cological topics. In addition, several small group tutorials allow
for more active teaching, learning and assessment of knowledge.
Clinical pharmacology is taught in year three by faculty mem-
bers within the departments of Pharmacology and Therapeutics
and Medicine, UCC, and the Cork University Dental School.
Instruction consists of forty contact hours and excludes stu-
dents from other disciplines. Students continue didactic phar-
macology instruction but problem-based learning (PBL) is
heavily utilised permitting students to focus on key issues as
well as enhancing and integrating their knowledge and applying
it to real-life scenarios. PBL is also critical in fostering critical
thinking, self-directed learning and ultimately safe practice
(11).
Few reports regarding students’ performance in dental
schools are found in international literature (12). Furthermore,
there is a dearth of literature outlining the role of pharmacol-
ogy in dental education (13). In fact, no studies were detected
on students’ performance in pharmacology, despite the impor-
tance of this subject in both the non-clinical and clinical years
of the dental curriculum. Thus, an investigation of dental stu-
dents’ performance in pharmacology is both timely and essen-
tial to enable dental educators to make informed decisions
regarding future changes. Therefore, this study assesses student
performances and feedback in pharmacology at different junc-
tures in the dental curriculum and investigates correlations
between students’ final grades in pre-clinical and clinical phar-
macology.
Materials and methods
Participants
The study population included 320 students, 58.1% female.
Institutional ethics was not required as there was no disclosure
of confidentiality or reference to any individual students. In
2 ª 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Barry & O’Sullivan
addition, no patients or patient records were utilised in this
study.
Modules
The modules examined in this study are as follows: Pharmacol-
ogy BDS2 (PT2201) and BDS3 (PT3201); Pathology BDS2
(FM2004) and BDS3 (PM3009); Clinical Dentistry BDS2
(RD2007) and BDS3 (RD3006). Web links to each of these
modules appears in Appendix 1. Any changes to the modules
will be available in the UCC Book of Modules and can be
accessed at the following website: http://www.ucc.ie/modules/.
Student assessment methods
The basic and clinical pharmacology examinations used to
assess students’ learning in dental pharmacology are outlined in
Table 1. Where possible, students receive objective feedback fol-
lowing assessments. Assessment formats included multiple
choice questions (MCQs), short answer questions (SAQs),
extended matched questions (EMQs), open-ended essay ques-
tions and case-based assessments. Borderline Pass/Fail students
that is those who attain an aggregate mark of 45—49% are
required to attend a viva voce. Marks are raised if the student
performs well in the oral examination whilst marks remain
unchanged following an unsatisfactory performance.
Multiple choice questions
In our study, student performances in pharmacology MCQs
were explored in three ways. First, computer-based assignment
(CBA) MCQs were completed by students in their own time
following attendance and completion of each practical session
(basic pharmacology module only, Table 1). Second, MCQs
were embedded in tutorials to assess student understanding
(for both basic and clinical pharmacology, Table 1). Third, the
EOM examination comprised 50 and 70 single-best answer
(SBA) MCQs in basic and clinical pharmacology modules,
respectively, Table 1).
Construction of MCQs
Multiple choice questions were designed based on Bloom’s tax-
onomy (14) testing students’ rote recall, comprehension, appli-
cation, analysis, synthesis and evaluation. All instructors
involved in basic and clinical pharmacology modules con-
tributed questions which were vetted by three members of
the Pharmacology and Therapeutics department for content
accuracy.
Problem-based learning
In contrast to medical education, (15) the use of problem-
based learning (PBL) in the dental curriculum and in particular
pharmacology instruction in dental education is somewhat
lacking (13, 16, 17). Whilst not all pharmacology topics are
equally appropriate to PBL (18), we adopted a PBL approach
[Azer and Frauman (11)] for teaching, learning and assessment
in dental pre-clinical and clinical pharmacology modules
Barry & O’Sullivan Undergraduate dental student assessment in pharmacology

TABLE 1. Assessment formats in basic and clinical pharmacology

Percentage of
Assessment score (%) Format Formative Summative

Basic pharmacology 0 Tutorials, 1 h Yes No

3 X tutorials
MCQs (single-best answer format)
EMQs
10 CBA, not timed Yes Yes
3 X CBAs
30 on-line MCQs (single-best answer format)
20 EOM MCQ, 1.5 h No Yes
50 MCQs (single-best answer format)
70 EOY written, 1.5 h No Yes
Section 1, 1 short open-essay question
Section 2, 10 SAQ (attempt 8/10)
Section 3, 4X EMQ (15 options, 5 stems)
Viva voce No Yes
Clinical pharmacology 0 Tutorials, 2 h Yes No
2 X tutorials
PBL (case-studies)
MCQs (single-best answer format)
25 EOM MCQ, 1.5 h No Yes
70 MCQs (single-best answer format)
75 EOY written, 1.5 h No Yes
Section 1, PBL (case-based question)
Section 2, 2X open-essay questions (attempt 3/6)
Viva voce No Yes

MCQ, multiple choice questions; SAQ, short answer questions; EMQ, extended matched questions; CBA, computer-based assignment; EOM, end of
module; EOY, end of year; PBL, problem-based learning.

(Table 1) to foster students’ critical thinking and to gauge their
ability in interpreting, analysing and evaluating basic and clini-
cal pharmacology information. In tutorials, PBL was utilised in
two different ways: (i) case-studies and extended matching
questions (EMQs) were provided on-line 1 week before the
tutorial, (ii) students were given additional case-studies and
EMQs during the tutorial. In both instances, students were
divided into groups to analyse the clinical scenario followed by
individual presentation of their findings. In assessment, PBL
usage included EMQs on basic pharmacology and case-study
based essay questions on clinical pharmacology in the EOM
written examinations (Table 1).
End of module assessment
Open-ended essay questions form part of the EOM written
examination (Table 1). This format allows students to articulate
basic and clinical pharmacology ideas in a clear and effective
manner with supporting and relevant examples of critical
reflection. This is more difficult to achieve with the use of
MCQs and/or EMQs only.
End of module questionnaire
An EOM anonymous on-line questionnaire was designed using
Likert-type scale responses and open-ended questions to collect
qualitative and quantitative data on dental teaching, learning
and assessment methods (19). Quantitative data was obtained
from students, when asked to rate the value/benefit of the tuto-
rials as ‘very useful’, ‘quite useful’, ‘of little use’ or ‘no use’ and
whether assessments in basic and clinical pharmacology mod-
ules were fair and appropriate by indicating whether they
‘strongly agreed’, ‘agreed’, were ‘neutral’, ‘disagreed’ or
‘strongly disagreed’. Qualitative and quantitative data were also
obtained from the following five open-ended questions:
Q1. What aspect of the teaching and module organisation
helped you most?
Q2. Which activities in the module did you learn most
from?
Q3. Which activities in the module did you learn least from?
Q4. Do you have any suggestions for improvement of the
module?
Q5. Do you have any other comments about the module
you would like to make?
Students completed the questionnaire within a month fol-
lowing module completion. Whilst all closed-ended questions
were answered some students (36.7% BDS2, 12.8% BDS3)
failed to complete the open-ended questions, in which free-text
was required.
Data preparation and analysis
Data was analysed statistically using SPSS 16.0 for Windows
and significance level was set at P < 0.01. Cumulative examina-
tion scores in basic and clinical pharmacology (as well as

ª 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd 3
Undergraduate dental student assessment in pharmacology Barry & O’Sullivan

pathology and clinical dentistry) were recorded and analysed difference in overall mean student performance between the
for each student (AY06/07 to AY14/15). Correlation outcome dental second year (BDS2) basic pharmacology results and the
(s) were measured using the Pearson’s correlation coefficient dental third year (BDS3) clinical pharmacology results
(r value) estimated using the Pearson’s product-moment (Table 2).
method (20, 21). Fischer r-to-z transformation was used to Traditional studies of the impact of gender on student per-
identify the significance between correlation coefficients (22). formance found that men outperform women (23). When
We also investigated the differences in exam scores between the looking at the impact of gender, our study found no signifi-
three independent discipline groups (dental, medical and phar- cant difference in mean student grades, minimum and maxi-
macy) co-taught basic pharmacology. Student’s t-test and the mum scores or in the coefficient of variation (CV) that is
ANOVA test were used to compare exam performance by mul- comparison of variation in results for male and female stu-
tidisciplinary student groups. As the results were in agreement dents in both the basic and clinical pharmacology examina-
using both methods, only results for the Student’s t-test are tions (Table 3).
shown. Quantitative and qualitative questionnaire data were
transferred to an Excel spreadsheet and simple analysis carried
Comparison of dental student performances in
out to identify frequencies and trends.
basic and clinical pharmacology
To examine the association between pre-clinical and clinical
Results performance, we performed regression analysis using each
BDS2 student’s basic pharmacology result with their BDS3
Mean scores and ranges in basic and clinical
result in clinical pharmacology. Our findings indicate a strong
pharmacology examinations
statistical correlation between student performances in basic
A total of 320 dental students sat the basic and clinical phar- and clinical pharmacology examinations (Fig. 1A, r = 0.582,
macology examinations (continuous and final) between AY06/ P < 0.01), suggesting that students who performed well in basic
07 to AY14/15. Interestingly, the mean exam performances of pharmacology were also likely to do well in their clinical phar-
students with shared instruction in basic pharmacology (dental, macology examinations. Conversely, dental students who per-
medical and pharmacy) were not statistically different during formed poorly in one assessment type were also likely to
the 9 year period (Table 2). Similarly, there was no significant perform poorly in another. Interestingly a similarly strong cor-
relation existed when the student cohort was divided by gender
TABLE 2. Student performances in basic and clinical pharmacology with females demonstrating a significant r value of 0.480,
cumulative examinations from AY06/07 to AY14/15 P < 0.01 (Fig. 1B) and males with an increased r value of
Year of
0.684, P < 0.01 (Fig. 1C).
teaching Discipline Mean  S.D. Min Max CV (%) NS
We next sought to identify whether the correlations observed
in pharmacology were unique to the discipline. When we
Year 2 Dental 61.41  1.39 23 89 2 examined pathology modules, BDS2 (FM2004) and BDS3
Medical 62.66  0.49 20 89 1 *P = 0.410 (PM3009) we also observed a strong correlation between overall
Year 1 Pharmacy 59.45  0.60 15 84 1 **P = 0.234 student performances in second year and third year pathology
Year 3 Dental 57.06  7.56 22 73 13 ***P = 0.383 examinations (r = 0.676, P < 0.01), which was not significantly
different to pharmacology, (z = 1.97, P = 0.024) (Table 4). In
No significant difference was noted between 2nd dental and 2nd medi-
contrast, however, when we examined two different clinical
cal student mean scores in basic pharmacology (*), 2nd dental and 1st
dentistry modules, BDS2 (RD2007) and BDS3 (RD3006), we
pharmacy (**) mean scores in basic pharmacology and (***) 2nd dental
basic pharmacology and 3rd dental clinical pharmacology student scores.
observed a significantly weaker correlation when compared to
Results shown are the mean  S.D. of cumulative (formative and sum- pharmacology (r = 0.349, P < 0.01, z = 3.79, P < 0.01)
mative) assessment results from AY06/07 to AY14/15. (Table 4). Of note a significant difference between male and
P values were determined by application of Student’s t-test. CV; co-effi- female correlation coefficients was only observed in the disci-
cient of variation, NS; not significant. pline of pharmacology (z = 2.74, P < 0.01) (Table 4).

TABLE 3. Dental student performances in basic and clinical pharmacology cumulative examinations from AY06/07 to AY14/15 according to gender

Gender Pharmacology Mean  S.D. Min Max CV (%) NS

Males Basic 61.80  10.72 23 89 17 *P = 0.912

Clinical 57.15  7.75 22 73 14
Females Basic 60.84  9.22 32 82 15 **P = 0.987
Clinical 57.04  7.40 26 73 13

No significant difference was noted between 2nd dental male and female basic pharmacology examination results (*) and 3rd dental male and female
clinical pharmacology examination results (**). Results shown are the mean  S.D. of cumulative (formative and summative) assessment results from
AY06/07 to AY14/15.
P values were determined by application of Student’s t-test. CV; co-efficient of variation, NS; not significant.

4 ª 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Barry & O’Sullivan Undergraduate dental student assessment in pharmacology

A Comparison of dental student performances in pharmacology from AY06/07 to AY14/15 pharmacology questionnaires. The questionnaire provided both
(n = 320 students, r = 0.582, p< 0.01)
quantitative as well as qualitative data.
100 Quantitative data from our EOM questionnaire identified
that a significant proportion of the BDS2 (64.1%  3%) and
80 Hons BDS3 (63.6%  2.8%) student groups ‘agreed’ that both the
basic and clinical pharmacology assessments (both continuous
60
and EOM) were fair and appropriate (Fig. 2A). In addition a
Pass

significant proportion (P < 0.01) of BDS2 (67.6%  8.2%) and

Clinical Pharmacology
Score (%)
Fail

40
BDS3 (69.2%  5.9%), dental students thought that the tutori-
als were ‘very useful’ in aiding their learning (Fig. 2B). BDS2
20
students identified tutorial associated practice type MCQs
Fail Pass Hons
(Fig. 3A) whilst BDS3 studies thought that MCQs and case-
0
0 20 40 60 80 100 based studies (Fig. 3B) were most beneficial in aiding their
Basic Pharmacology Score (%)
learning. In addition, the BDS2 students also highlighted the
on-line CBA practicals and the accompanying on-line MCQs as
B Comparison of female dental student performances in pharmacology from AY06/07 to AY14/15 being the least beneficial way of aiding their learning (Fig. 3A).
(n = 186 students, r = 0.480, p< 0.01)
Qualitative feedback from our open-ended questions and the
100
associated data analysis resulted in the identification of four
key thematic areas namely: (i) quality of instructors, (ii) lecture
80
content, (iii) assessment type and (iv) learning environment.
Fail Pass Hons

Outlined below is a summation of the most frequently identi-

60
fied points by both BDS2 and BDS3 students with inclusion of
Clinical Pharmacology
Score (%) some individual student comments. Additional individual stu-
40
dent comments associated with each topic appear in
Appendix 2.
20

0
0 20 40
Fail Pass
60
Hons
80 100
Quality of instructors
Basic Pharmacology Score (%)
BDS2. Students felt the instructors were engaging, highly
knowledgeable and capable of communicating the material
C Comparison of male dental student performances in pharmacology from AY06/07 to AY14/15
(n = 134 students, r = 0.684, p< 0.01) effectively. They were approachable and welcomed questions
100 and student feedback. ‘I thought that overall they were all very
prepared for their lectures and I really appreciated how friendly
80 they were and willing to stay behind class and answer any ques-
tions’.
Fail Pass Hons

60 BDS3. Students outlined that instructors were enthusiastic,

Clinical Pharmacology
Score (%)
40
20
Fail
0
0 20 40
Basic Pharmacology Score (%)
Fig. 1. Comparison of dental student performances in basic and clinical
pharmacology examinations from AY06/07 to AY14/15. (A) Scatter plot
of 320 individual student final scores in basic pharmacology vs. clinical
pharmacology (r = 0.582, P < 0.01). (B) Scatter plot of 186 individual
female student final scores in basic pharmacology vs. clinical
pharmacology (r = 0.480, P < 0.01). (C) Scatter plot of 134 individual
male student final scores in basic pharmacology vs. clinical pharmacology
(r = 0.684, P < 0.01). Pearson’s correlation coefficient (r value) was
estimated by using the Pearson’s product-moment method. A fail mark is
<50%, pass mark is 50% to 59% and an honours mark is 60% to 100%.
End of module questionnaire
A significant number of BDS2 (54%  10%) and BDS3 stu-
dents (83%  8%) completed the EOM basic and clinical
motivated and knowledgeable but differed widely in the way
they taught. Some individuals failed to identify student prior
knowledge and used unfamiliar terminology. The teaching by
medical practitioners in particular was at times at a post-gradu-
ate rather than an undergraduate level and was oftentimes diffi-
Pass Hons
60 80 100
cult to follow due to excessive and irrelevant medical
information that was not pertinent to dental students and den-
tal pharmacology. ‘There should be a template that lecturers
follow as some are teaching information that is too medical
and not relevant to dental students’.
Lecture content
BDS2. Students thought the module in general was well struc-
tured and organised. Overall lectures were very well laid out
and very well organised. Having clearly defined learning out-
comes was important for students’ understanding. The use of
animation in the lectures aided student learning and made
complex issues more readily understandable. Importantly the
lectures focused on dental relevance. ‘Overall very well laid out
and very organised’.
BDS3. Some lectures were well laid out and relevant to den-
tal practice. However, some students felt that too much

ª 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd 5
Undergraduate dental student assessment in pharmacology Barry & O’Sullivan

TABLE 4. Comparison of correlation coefficients in pharmacology, pathology and clinical dentistry in BDS2 and BDS3 examinations from AY06/07 to
AY14/15

Discipline Gender r value z value

Pharmacology Females + Males 0.582, P < 0.01

Females 0.480, P < 0.01 2.74, *P < 0.01
Males 0.684, P < 0.01
Pathology Females + Males 0.676, P < 0.01 1.97, **P = 0.024
Females 0.634, P < 0.01 1.62, *P = 0.053
Males 0.732, P < 0.01
Clinical Dentistry Females + Males 0.349, P < 0.01 3.79, ***P < 0.01
Females 0.508, P < 0.01 2.3, *P = 0.011
Males 0.288, P < 0.01

Correlation coefficients (r value) are shown for dental student performances in BDS2 and BDS3 examinations according to discipline and gender. Fischer
r to z transformations were used to determine the significance of the difference between female and male r values within each discipline (*P) as well
as between pharmacology and pathology r values (**P) and between pharmacology and clinical dentistry r values (***P). P values were determined by
application of Student’s t-test.

A Basic Pharmacology lacked detail leaving students unclear of the lecture learning
80
Clinical Pharmacology outcomes. More lectures delivered by pharmacologists and den-
tal practitioners with defined learning outcomes are required.
‘More dentally qualified individuals are needed to teach on this
60
module so that they can specifically identify the learning needs
of dental students’.
%
respondents 40

Assessment type
20
BDS2. Students felt that periodic assessments (including MCQs
and EMQs) and the associated high-quality feedback were
0
strongly disagree disagree neutral agree strongly agree
timely, constructive and specific allowing them to plan appro-
priately and effectively for the next assignment. On-line com-
Basic Pharmacology puter practicals and associated MCQs were difficult and at
B 80 Clinical Pharmacology times discordant with lecture material. Additional tutorial type
assessments would benefit student learning more in place of
such practicals. ‘Re-evaluate the use of the computer labs and
60
the relevance they have to the lecture and course materials’.
%
BDS3. Students highlighted that additional periodic assess-
respondents 40 ments (including MCQs and case-based studies) in clinical
pharmacology are necessary. Scheduled assessments following
specialised pharmacology topics would help clarify essential
20
learning and aid focused revision. ‘There should be more con-
tinuous assessments and/or quizzes throughout the course to
0 keep students up to date and give them an idea as to whether
very useful quite useful of little use no use
or not they are studying the material properly’.
Fig. 2. Mean occurrences of positive, negative and neutral feedback
from dental students in the end of module questionnaire from AY06/07
Learning environment
to AY14/15. (A) Students were asked to indicate whether they thought
the formative and summative assessments in basic and clinical BDS2. Students identified the tutorials as an excellent tool to aid
pharmacology were fair and appropriate. (B) Students were asked to their learning. The relaxed and interactive atmosphere allowed
indicate whether they thought the tutorials (and associated MCQs, students to focus on learning rather than on testing and grading
EMQs and case-based studies) were or were not useful in aiding student performance. They also helped gauge the standard of future
learning. examination questions. ‘I appreciate greatly the work done in the
tutorial. It helps focus studying by testing understanding. It also
information was delivered in the allotted one hour time period helps give a clinical twist on the material covered in lectures’. ‘In
including information that was not dentally relevant and was particular I found the tutorials to be beneficial as it was easier to
more suitable to medical students. Lecture content varied sub- ask questions in a smaller class setting’.
stantially with some lectures delivering too much information BDS3. Both the tutorial based MCQs and case-based studies
(especially on physiological and medical aspects) whilst others were particularly effective at aiding students’ knowledge and

6 ª 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Barry & O’Sullivan
Basic Pharmacology
EMQs Lectures
18% 30%
2%
MCQs
50%
Fig. 3. Dental students identified activities in the basic and clinical pharmacology modules that aided their learning. An end of module anonymous
questionnaire provided quantitative data on student’s perceptions of which module activities they felt most aided their learning. Mean percentage of
BDS2 student (A) and BDS3 student (B) feedback on an annual basis from AY06/07 to AY14/15. EMQs; extended matched questions, MCQs; multiple
choice questions (single-best answer format), practicals; computer-based practicals and associated on-line MCQs.
understanding created by the right environment for interactive
consolidation of basic and clinical pharmacology knowledge.
PBL afforded students, the opportunity to grasp important
concepts, integrate knowledge and transfer basic pharmacology
knowledge into real clinical situations. Others, however, found
the use of PBL difficult to grasp, felt they did not benefit from
the experience and found the task daunting in terms of pre-
senting the case to their peers in a classroom environment.
‘The tutorial was right on point and the discussions were super.
There were lots of case studies which helped and provided a
good assessment of the application of dental pharmacology’.
Discussion
Assessment in all areas of dentistry has an important ‘gate-
keeper’ role by ensuring that the student has the required pro-
fessional knowledge, skills and attitudes required of
professional and statutory bodies. Furthermore, assessment has
been identified as probably the most important event to aid
student learning and is a fundamental component of teaching
and learning (7). Our study has now afforded us an insight
into key characteristics of both effective and ineffective teach-
ing, learning and assessment in both the basic and clinical den-
tal pharmacology modules. The quality of teaching in the basic
pharmacology module was commended by students owing to
its structured and focused nature despite the shared instruction
with students from other disciplines. In contrast, students felt
teaching in the clinical pharmacology module was inconsistent
at times and importantly lacked dental relevance. This is some-
what understandable as the basic pharmacology module is
delivered solely by three pharmacologists from the Pharmacol-
ogy and Therapeutics department whilst the clinical pharmacol-
ogy module incorporates teaching contributed by a larger
number of instructors from disparate clinical backgrounds. A
resolution to this issue, as outlined by the students could be
readily obtained if clear learning outcomes were identified for
every lecture [which should be automatically included as part
ª 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Undergraduate dental student assessment in pharmacology
Clinical Pharmacology
Lectures
20%
Case-studies MCQs
40% 40%
of the Bologna Declaration, 1999, (24)]. A noteworthy point to
pharmacology course directors, curriculum committees and
other dental educators is that intuitively students also identified
that improved, focused and relevant clinical pharmacology
teaching in dentistry may occur with increased involvement of
dentally qualified personnel. Presently, the majority (64%) of
clinical pharmacology lectures are delivered by medical profes-
sionals followed by dental professionals (20%) and pharmacol-
ogists (16%), who also deliver 100% of tutorials. Thus,
appropriate redistribution of academic workload within our
BDS3 module warrants attention. Effective learning in both the
basic and clinical pharmacology modules was attributed to the
interactive opportunities within tutorials using sample MCQs,
EMQs and case-studies. In fact, a growing number of dental
schools are steadily increasing the student time spent in active
learning situations as opposed to the traditional lecture format
(25). In contrast, there was an overwhelming lack of apprecia-
tion of the on-line practicals and CBA MCQs assessments
which students considered time consuming and did not com-
plement the lectures. Thus, re-evaluation of their use and rele-
vance to the BDS2 basic pharmacology module as a whole is
warranted. Finally, requests for additional (formative) assess-
ments were frequently reported by BDS3 students to aid their
overall knowledge and understanding in a timely fashion.
Our study also examined whether student performances in
second year basic pharmacology examinations differed signifi-
cantly to their third year clinical pharmacology examinations.
The high correlations seen in our study occurred despite vari-
ables such as different faculty grading second and third year
examinations and multiple assessment techniques [which pro-
vides better correlation than relying on any single method of
assessment alone (26)]. Our correlative findings are likely due
to a combination of vertical and horizontal teaching of dental
pharmacology (27, 28), the use of valid and reliable assessments
of knowledge and having just 1 year between assessments (29).
Another likely explanation is that students have gained suffi-
cient and relevant prior basic knowledge of pharmacology in
7
Undergraduate dental student assessment in pharmacology
second year which is associated with good performance in third
year (30). In addition, students’ may have an increased appreci-
ation of the importance of pharmacology to the dental practi-
tioner as they reach more senior clinical levels.
Interestingly, our findings within the discipline of pharma-
cology are mirrored within the discipline of pathology. In con-
trast, however, when we compared student performances in
BDS2 and BDS3 clinical dentistry modules, there was a weak at
best correlation which was significantly different to that
observed in pharmacology. Importantly, the strong correlations
observed in both the disciplines of pharmacology and pathol-
ogy occur in the absence of direct patient involvement. In con-
trast, student assessment in the clinical dentistry modules either
involves evaluation of patient management in a simulated clini-
cal environment (BDS2) or direct patient assessment and treat-
ment (BDS3). Previous studies examining correlations between
pre-clinical and clinical grades in dental education have
demonstrated mixed findings with some studies indicating a
positive correlation (29, 31) whilst other studies indicate virtu-
ally no correlation (32–34). Thus, it appears that teaching,
learning and assessment of dental students in the presence or
absence of patient involvement differs substantially with the
former requiring a whole different skill set for successful stu-
dent performance (35, 36). Future directions for our research
could involve reproducing the study such that the pharmacol-
ogy clinical grade involves utilising the student’s clinical phar-
macology knowledge in examinations of patients such as in the
use of a patient’s medical history (37, 38).
Finally, we also examined whether gender affects test perfor-
mance amongst dental students as traditional studies found that
men outperform women (23). In general, in the dental context,
gender-related performance appears to be examination type
specific with male students outperforming female students on
high-stakes dental examinations such as national board examina-
tions (26, 39, 40). However, no apparent significant difference is
observed in classroom and course-related tests (26). In this study,
whilst we did not observe a significant gender difference in mean
student scores in either basic or clinical pharmacology, there was
a significant difference between the weaker female and stronger
male correlation coefficients. Interestingly, no such observations
were evident for correlation coefficients in the pathology mod-
ules whilst in the clinical dentistry modules, it was the male
cohort that demonstrated a weak correlation coefficient com-
pared to the females. Thus, when assessment of patients is
included in gauging overall student performance, it is the female
student cohort that may transfer their skill set to the clinical envi-
ronment more readily than their male counterparts.
Conclusion
One of the key goals of assessment in dental education is to
make decisions on a student’s progression towards a competent
dentist in the future. We observed that shared teaching of basic
pharmacology does not adversely affect dental student perfor-
mances. In fact, our study has demonstrated a good relation-
ship between assessment results in pre-clinical pharmacology
and clinical pharmacology. Importantly, our studies highlight
the strengths as well as the weaknesses of our pharmacology
teaching, learning and assessment within the dental curriculum.
8 ª 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Barry & O’Sullivan
Our results are somewhat limited by the scope of the study as
participants were from a single dental school. Thus, whether
our findings relate to pharmacology assessment(s) (as well as
pathology and clinical dentistry) in other national schools
(University College Galway, Trinity College, Dublin and the
Royal College of Surgeons in Ireland) or indeed international
dental schools (there are in excess of 200 dental schools in
Europe and 100 in North America) (41) remains to be investi-
gated. Additional studies in other dental schools and the use of
patients in a clinical context could be useful to provide further
interesting research data.
Conflicts of interest
The authors declare no conflict of interest.
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Appendix 1
Link to Pharmacology BDS2 module PT2201 in UCC
http://www.ucc.ie/modules/descriptions/PT.html#PT2201
Link to Pharmacology BDS3 module PT3201 in UCC
http://www.ucc.ie/modules/descriptions/PT.html#PT3201
Link to Pathology BDS2 module FM2004 in UCC
http://www.ucc.ie/modules/descriptions/FM.html#FM2004
Link to Pathology BDS3 module PM3009 in UCC
http://www.ucc.ie/modules/descriptions/PM.html#PM3009
Link to Clinical Dentistry BDS2 module RD2007 in UCC
http://www.ucc.ie/modules/descriptions/RD.html#RD2007
Link to Clinical Dentistry BDS3 module RD3006 in UCC
http://www.ucc.ie/modules/descriptions/RD.html#RD3006
Appendix 2
Individual student qualitative feedback from open-ended ques-
tions in the end of module questionnaire.
Quality of instructors
BDS2. ‘Dr. A. was an excellent lecturer, very passionate about
his subject. I answered a question once and he was so enthusi-
astic about it that I wouldn’t have minded asking/answering
another one, even if I was wrong’.
BDS3. ‘Dr. B. is a very good co-ordinator of the module
and is very dedicated to the students. I would like to com-
mend Dr. B. and the Pharmacology Department for striving
to inspire and involve students in the course. I believe it is
working!’.
Lecture content
BDS2. ‘To be honest I can’t think of anything to improve it.
Without doubt I have found this to be the most interesting
module I’ve done since coming to UCC’.
BDS3. ‘Most lectures were made dentally relevant which was
very good. However, I found the lectures to be at varying
depths of knowledge for the different classes of drugs’. ‘I felt
some of the lecturers lacked direction in knowing exactly what
sort of things were relevant to dental students. As a lot of them
are specialist in their own field, I felt some lectures were very
vague, and I felt I had no lecture material to build on and
studied completely from the book’.
Assessment type
BDS2. ‘I found the practicals quite difficult and almost irrele-
vant so I didn’t learn much from them at all’.
BDS3. ‘More periodic assessments or sample questions from
the different sections of the course would ease the bombard-
ment with information’.
9
Undergraduate dental student assessment in pharmacology
Learning environment
BDS2. ‘The tutorials helped me the most as things were
explained in more detail’. ‘Tutorials were a good way to help
us improve understanding and exposure to exam questions’.
BDS3. ‘Genuinely the best tutorial that I have ever attended.
Well structured and made everything concise in my own head
10
Barry & O’Sullivan
even though I hadn’t all the material revised’. ‘The tutorial that
we had was very, very useful for me personally. Now I know
which types of drug I should really focus on and which ones I
am going to encounter repeatedly in the coming years as a den-
tal practitioner’.
ª 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd