IJDR_231_18R8

Original Research
1 1
2 2
3 Comparison of Routine Teaching with Fishbowl and 1‑min Preceptor for 3
4 Dental Undergraduate Students: An Interventional Study 4
5 5
6 6
7 Abstract Shefalika Priyam, 7
8 Aim: To compare routine teaching method with fishbowl and a one‑minute preceptor for Roopali M 8
9 undergraduate students. Objectives: 1. Evaluation of theoretical knowledge for WHO dentition Sankeshwari, 9
status and treatment need by fish bowl and routine teaching. 2. Effectiveness of the combination
10 Supriya Vyavahare, 10
of fish bowl and one‑minute preceptor in understanding WHO dentition status and treatment need.
11 Materials and Methods: This study was conducted on 38 third year undergraduate students, which Anil V Ankola 11
12 was divided into two groups (Group A: Fishbowl, Group B: One‑minute preceptor). Routine lecture Department of Public Health 12
13 for WHO dentition status and treatment need was taken, followed by baseline evaluation which was Dentistry, KLE Academy 13
14 done by giving 10 sets of clinical images to students and asked them to give WHO score. Furthermore, of Higher Education and 14
Research (KLE University’s)
15 fish bowl and one‑minute preceptor method were performed and students were subjected with the 15
KLE VK Institute of Dental
16 same set of clinical images again. At the end of the session, feedback was taken from the students by Sciences, Belagavi, Karnataka, 16
17 means of five open‑ended questions about their views on fish bowl and one‑minute preceptor. Data India 17
18 were analyzed with SPSS version 20 (Chicago IL). Wilcoxon Sign Rank test and Mann Whitney ‘U’ 18
test was performed for intragroup and intergroup comparison respectively. Results: Combination of
19 19
fishbowl and one‑minute preceptor shows statistically significant result over routine teaching method
20 with P value of. 000. Conclusion: Combination of Fish Bowl and OMP could be used for better
20
21 teaching method for students, as the students are actively involved and more learning takes place; 21
22 the deficiencies of one method would be compensated by the other. 22
23 23
24 Keywords: 1‑min preceptor, dental education, Fishbowl, treatment need, undergraduate, WHO 24
25 dentition status 25
26 26
27 Introduction that students be well trained in recording 27
28 dental caries. Quantitative measurement 28
29 Education has come a long way over the 29
of disease most commonly relies on
30 past few decades. It has evolved greatly 30
“index” as dental index is the main tool of
31 from the once blackboard‑oriented, 31
teacher‑centered approach to the use of epidemiological studies in dental diseases
32 to measure prevalence, incidence, and 32
33 various techniques that enhance the ability 33
of undergraduate students to think in severity.[3]
34 34
35 all the directions.[1] In dental education, A critical element of the learning 35
36 self‑assessment is widely accepted as a best environment is its effect on student 36
37 practice and is performed after preclinical well‑being.[4] There are various indices 37
projects or clinical procedures, for both Address for correspondence:
38 to record caries severity and one of the Dr. Shefalika Priyam, 38
39 formative and summative activities, in index which is internationally accepted Department of Public Health 39
40 the form of daily laboratory exercises, is WHO index. To simplify the concept Dentistry, KLE Academy 40
41 laboratory practical examinations, clinical of index, two emerging pedagogical
of Higher Education and
41
treatment, and clinical competencies.[2] Research (KLE University’s)
42 approaches— Fishbowl and One‑Minute KLE VK Institute of 42
43 Oral health is a part of general health. preceptor—are used in this study which Dental Sciences, Belagavi, 43
44 Dental diseases are the most prevalent has gained popularity in this era of general Karnataka, India. 44
E‑mail: priyam0908@gmail.com
45 and the most neglected of all chronic education. 45
46 diseases affecting mankind. Prevention of 46
47 Fish bowl technique can be used after the 47
disease rests on knowledge of the disease Access this article online
48 lecture class.[5] There are two circles: 48
occurrence, distribution, etiology and other
49 related factors [3] and hence it is imperative 1. Inner circle: Students are called “fishes;” Website: www.ijdr.in
49
50 they may be 2–11 in number, depending DOI: 10.4103/ijdr.IJDR_231_18 50
51 This is an open access journal, and articles are on the strength of classroom. Quick Response Code: 51
52 distributed under the terms of the Creative Commons 52
Attribution‑NonCommercial‑ShareAlike 4.0 License, which allows
53 others to remix, tweak, and build upon the work non‑commercially, How to cite this article: Priyam S, Sankeshwari RM, 53
54 as long as appropriate credit is given and the new creations are Vyavahare S, Ankola AV. Comparison of routine 54
licensed under the identical terms. teaching with fishbowl and 1‑min preceptor for dental
55 undergraduate students: An interventional study. 55
56 For reprints contact: reprints@medknow.com Indian J Dent Res 2018;XX:XX-XX. 56

© 2018 Indian Journal of Dental Research | Published by Wolters Kluwer - Medknow 1

 Priyam, et al.: Comparative study of routine teaching with Fishbowl and 1‑min preceptor for undergraduates

1 2. Outer circle: The rest of the students in class will form the steps step and rules were explained to them. Group B 1
2 the outer circle and they are called “fish watchers.” was routine teaching group. 2
3 3
According to the one‑minute preceptor (OMP) model which Further, the chairs in the class were arranged for the
4 4
is a clinical supervision technique, teaching‑learning occurs fishbowl method in two circles—an inner circle and an
5 5
in a short duration, in a realistic setting with the patient outer circle. Inner circle students with four members were
6 6
on the dental chair, providing experiential learning to the instructed to hold a discussion on the allotted topic with
7 7
students for future practice.[6] The one‑minute preceptor the representative member among them in time limit of
8 8
consists of five “micro skills.”[7,8] 20 minute. One chair was left open for the outer circle
9 9
1. Getting a commitment students to share their own aspects about the discussion and
10 10
2. Probe for supporting evidence after sharing, they must go back to their original places.
11 11
3. Teach the general rules This is done to achieve maximum participation, and rest of
12 12
4. Reinforce what was done right the students in group A were asked to arrange themselves
13 13
5. Correct mistakes. in the outer circle. The outer circle students were asked
14 14
15 Combining both the classroom and clinical supervision to focus and listen carefully to the discussion, they need 15
16 approach will enhance the ability of students to understand to note examples of when their peers in the discussion 16
17 the topic in a better way. Although there have been group are following the rubric and when they are not. The 17
18 few studies of one‑minute preceptor for undergraduate observers need to record anything else important they see 18
19 medical students, the literature available is limited for and be ready to share it. 19
20 dental students.[5,8] There is paucity of literature for the However, at the end of the discussion, a plenary session was 20
21 above‑mentioned technique in dental education and this conducted by the modulator and all the missed important 21
22 study is the first of its kind which has combined both the points were added and mistakes during discussion were 22
23 techniques. corrected. A similar topic was also given to the routine 23
24 group and they were also instructed to discuss among 24
The aim of the present study is evaluation of theoretical
25 themselves. 25
knowledge for WHO dentition status and treatment need
26 26
by fish bowl and routine teaching and effectiveness of Further, both the groups were again evaluated with the
27 27
the combination of fish bowl and one‑minute preceptor in same set of clinical images which were shown at the time
28 28
understanding WHO dentition status and treatment need. of baseline evaluation. In the third week, group A and
29 29
30 group B were allotted with patients for clinical evaluation. 30
Materials and Methods
31 Group A was asked to record WHO score according to 31
32 An interventional study was conducted among third year one‑minute preceptor steps as the sequence of micro skills 32
33 undergraduate students (n = 38) in the Department of fosters learner ownership of the clinical problem. At the 33
34 Public Health Dentistry of the institute. Ethical approval same time, learner’s knowledge is assessed and critical 34
35 was obtained from the review board of the institution. thinking is promoted, whereas Group B was instructed to 35
36 Students those who were willing to participate, present on record the score as a routine standard protocol. At the end, 36
37 the day of study and gave informed consent were included both the groups were compared and evaluated. 37
38 in the study, those who were absent on the day of study 38
were excluded. Feedback was taken from the students by means of five
39 39
open‑ended questions about their views and experience
40 Third year undergraduate students were recruited. The total 40
with fish bowl and one‑minute preceptor [Table 1].
41 sample size was 38. Each student was informed regarding 41
42 study design and protocol. A 22‑minute lecture for WHO Intra‑group and inter‑group comparison was done with 42
43 dentition status and treatment need were taken for the Wilcoxon signed rank test and Mann–Whitney U‑test. Data 43
44 students and base line knowledge was checked providing were analyzed with SPSS version 20 (Chicago IL). 44
45 them 10 different clinical scenarios and asking them to 45
46 give WHO score. Table 1: Questions was given to all the 38 students 46
47 having the following questions 47
48 The class were divided into two groups, i.e., intervention 48
1. Was the fish bowl and one‑minute preceptor discussion
49 group (21 students) and comparison group (17 students) 49
meaningful? Did the discussion advance the understanding of the
50 in group A and group B, respectively. Intervention group group and the class? 50
51 students were explained about fish bowl and one‑minute 2. Did you face any problem during discussion of the topic? 51
52 preceptor. 3. Did the fishbowl and one‑minute preceptor discussion cover 52
53 The study was completed in three weeks; the lecture was important concepts? Were all areas of topic discussed? 53
54 given in the first week, during the second week, the class 4. Did the diversity of students help them think actively? 54
55 was randomly divided into two groups with the lottery 5. Were the group members open to ideas that conflicted with his/ 55
56 method. Group A was fishbowl + one‑minute preceptor and her own? 56

2 Indian Journal of Dental Research | Volume XX | Issue XX | Month 2018

 Priyam, et al.: Comparative study of routine teaching with Fishbowl and 1‑min preceptor for undergraduates

1 Results Table 2: Change in magnitude between pre‑ and 1

2 post‑score of comparison and intervention group 2
In relation to age, level of previous knowledge and
3 n Mean Minimum Maximum 3
training, there was no difference amongst the comparison
4 Pre‑fishbowl 21 2.19 0 7 4
and intervention groups as all the participants were
5 Pre‑routine 17 2.00 0 6 5
6 students of III BDS. The minimum score in pre‑fish and 6
post‑fish was 0 and 2, respectively, whereas in pre‑routine Post‑fishbowl 21 6.86 2 10
7 Post‑routine 17 2.71 1 5 7
8 and post‑routine, it was 0 and 1, respectively, as shown in 8
9 Table 2. 9
10 Intragroup comparison for baseline evaluation between Table 3: Intragroup comparison for baseline evaluation 10
11 pre‑fishbowl and post‑fishbowl was done with Wilcoxon n Mean Sum of Z P 11
12 signed ranked test, showing statistically significant rank ranks 12
13 difference with Z value of ‑4.026 and P value of. 000, Prefishbowl ‑ postfishbowl 13
14 as among 21 students, all were found to give the correct Negative ranks 0a 0.00 0.00 −4.026b 0.000 14
15 Positive ranks 21 b
11.00 231.00 15
answer for the given clinical images, showing that
16 Ties 0c 16
post‑fishbowl was better scored than pre‑fishbowl.
17 Total 21 17
18 Pre‑routine and post‑routine did not show statistically Pre‑routine ‑ post‑routine 18
19 significant difference with Z value of − 1.536 and P value Negative ranks 5d 7.80 39.00 −1.536b 0.125 19
20 of 0.125, as out of 17 students, five were found to have Positive ranks 11 e
8.82 97.00 20
21 given incorrect answers both at the time of pre‑routine Ties 1f 21
22 and post‑routine, one student’s answer was the same at Total 17 22
23 both the times, and only 11 students gave the correct Wilcoxon sign rank test (P<0.05). aPostfishbowl <Prefishbowl, 23
24 answer [Table 3]. b
Postfishbowl >Prefishbowl, cPostfishbowl=Prefishbowl, dPostroutine 24
<Preroutine, ePostroutine > Preroutine, fPostroutine=Preroutine
25 Intergroup comparison with Mann–Whitney U‑test 25
26 between post‑fishbowl and post‑routine with z‑value 26
27 of −4.533 and P value of 0.000 showed statistically Table 4: Intergroup comparison between post‑fishbowl 27
28 significant result, manifesting post‑fishbowl better than and post‑routine 28
29 post‑routine, [Table 4]. Groups n Mean rank Z P 29
30 Post‑fishbowl 21 26.81 −4.533 0.000 30
31 Intergroup comparison between a combination of Post‑routine 17 10.47 31
32 one‑minute preceptor and fishbowl with routine group Total 38 32
33 again showed a statistically significant difference with Z Mann–Whitney U‑test (P<0.05) 33
34 value of −4.533 and P value of 0.000 [Table 5]. 34
35 Post‑study feedback was taken from all the students of Table 5: Intergroup comparison between 1‑min 35
36 fishbowl and one‑minute preceptor by means of five preceptor + fishbowl and routine 36
37 open‑ended questions [Table 1], in which out of 21 students, Groups n Z P 37
38 18 students shared their views with positive response with One‑minute preceptor + fishbowl 21 −4.533 0.000 38
39 all the questions and accepted both the techniques to be Routine 17 39
40 better over the traditional method. In answer to question Total 38 40
41 2, only three students were confused with the topic and Mann–Whitney U‑test (P<0.05) 41
42 expressed their views that they faced some difficulties in a 42
43 few cases. and actions of students.” Bloom and his team suggested 43
44 that students should also be taught to apply the acquired 44
45 Discussion knowledge along with higher‑order thinking skills.[11] 45
46 46
47 The common and the greatest challenge faced by the His committee designed a hierarchical framework of 47
48 teacher in a professional college is attentiveness of students learning statements based on the six major categories of 48
49 and their involvement as well as participation in the cognitive thought, beginning with knowledge, followed 49
50 classes.[9] Moreover, the teaching‑learning process enforces by comprehension, application, analysis, synthesis and 50
51 a great deal of expectations from the teacher, equivalent evaluation.[11] 51
52 participation from students and effective classroom 52
Keeping these steps in mind, in our study, it was thought to
53 management.[10] 53
begin with the idea to first instill the knowledge by taking
54 As per Bloom’s taxonomy, developed by a team of a lecture for the topic, i.e., the WHO dentition status and 54
55 American educators led by Benjamin S. Bloom, the treatment need, which was followed by comprehending 55
56 purpose of education was “to change the thoughts, feelings the knowledge by asking students to discuss the topic 56

Indian Journal of Dental Research | Volume XX | Issue XX | Month 2018  3

 Priyam, et al.: Comparative study of routine teaching with Fishbowl and 1‑min preceptor for undergraduates

1 and critically think to build up their thoughts by fishbowl one‑minute preceptor technique for clinical reasoning into 1
2 method, further to apply their piece of knowledge the the study. 2
3 students were given various simulated cases so that they 3
The students in the intervention group, post one‑minute
4 should understand and are trained well to give proper and 4
preceptor training, had revealed a significant improvement
5 correct score for the given case scenario. 5
in scoring the tooth with the appropriate WHO score with
6 6
After collecting their answer sheets, the correct score for Z‑value of‑4.533, leading to high accuracy in understanding
7 7
each image was discussed with them and they were asked the condition. This is essential for successful treatment
8 8
to rethink if any of their answers was incorrect so that outcome, which was similar to the study done by Naik
9 9
they can analyze how to think to give the correct score. et al., which shows a statistically significant difference
10 10
Further plenary session was given by the facilitator so that in performance of students of both the groups, and
11 11
students can synthesize their knowledge and the second demonstrates that there was a positive impact on learning
12 12
technique, namely the one‑minute preceptor test was used of the students, by either traditional or using the one‑minute
13 13
to evaluate each student by allotting them patients and preceptor model.[6] The findings are in contradiction to a
14 14
they had to record the WHO score in patients (real‑life study by Saunders et al.[17]
15 15
scenario).
16 It was found by Aagaard et al.[18] in his study that 16
17 The WHO dentition status and treatment need are preceptors using the one‑minute preceptor approach were 17
18 internationally accepted methods to record dental caries. equally or better able to diagnose the patient’s condition 18
19 The index has three segments—crown, root and treatment correctly, in comparison to those using a routine approach, 19
20 need. A patient can present with dental caries and the and student abilities and knowledge were better assessed 20
21 treatment need will change as per the severity of the with the one‑minute preceptor. The preceptors rated the 21
22 disease. Students need to understand the concept and apply one‑minute preceptor approach as more efficient and more 22
23 it, which could be a difficult task for new learners as the effective. 23
24 pattern of the disease changes from one person to another. 24
25 Thus, this index was selected in the present study and we Stheeman et al. showed that as the diagnostic confidence 25
26 evaluated if fishbowl, along with one‑minute preceptor, can of dentists increases, there is an increase in diagnostic 26
27 help students understand the concept in a better and easier accuracy, and they suggested that methods should be 27
28 way. devised to improve the diagnostic confidence.[19] The sample 28
29 of the study was a limitation due to restricted number of 29
The tough curriculum in a professional college must be students involved in specified duration and, further studies
30 made interesting by implementation of new teaching 30
31 with larger sample size and a follow‑up study to determine 31
learning strategies.[12] Lecture with fishbowl discussions and
32 the retention of the knowledge for correct scoring system 32
clinical reasoning with one‑minute preceptor instilled
33 amongst the students is the need of the hour. 33
interest in the class in majority (95%) of the students.
34 Lectures interspersed with discussions have always The present study concluded the use of fishbowl and 34
35 inculcated interest in students as seen by Baetty et al.,[13] one‑minute preceptor model to inculcate interest in 35
36 which was similar in our study. majority of the students. The students were able to retain 36
37 information better with both the techniques. 37
38 The teacher in fishbowl method acts more like a facilitator, 38
39 organizing friendly and favorable environment to A combination of fish bowl and one‑minute preceptor 39
40 thrive internal motivation towards learning and thereby could be used for a satisfactory teaching technique for 40
41 inculcating interest. Moreover, lecture with fish bowl is students, because students are actively involved, and the 41
42 more student‑centered, whereas lecture alone is more deficiencies of one method would be compensated by the 42
43 teacher‑centered.[14] other. 43
44 Approximately 95% of students were able to retain Conclusion: 44
AQ1
45 information better in “lecture with fishbowl.”[15] However, 45
46 ???. 46
only 5% students felt that they were having some confusion
47 regarding some clinical scenario. When compared to Acknowledgement 47
48 lecture alone method, all students in fishbowl group found 48
49 The authors wish to thank the students who participated in 49
this technique to be more effective and innovative way of
50 this study. 50
learning, and this was also appreciated by Gibbs et al. who
51 found that interactive discussions before or after a lecture Financial support and sponsorship 51
52 always led to retain information better.[16] 52
53 Nil. 53
54 Students need to retain information from classes for 54
Conflicts of interest
55 interpretation and application of information with respect 55
56 to importance of the content which gave the idea to add There are no conflicts of interest. 56

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 Priyam, et al.: Comparative study of routine teaching with Fishbowl and 1‑min preceptor for undergraduates

1 References 10. Kamran A, Rehman R, Iqbal A. Importance of clinically oriented 1

2 problem solving tutorials (COPST) in teaching of physiology. 2
1. Zhao Y. The use of a constructivist teaching model in Rawal Med J 2011;36:232‑6.
3 environmental science at Beijing normal university. China Pap 3
11. Objectives E. How to use Bloom’s Taxonomy in the Classroom.
4 2003;10:78‑84. 4
p. 1-19.Available from: https://www.researchgate.net/
5 2. Mays KA, Branch‑Mays GL. A systematic review of the use publication/283328372_Bloom’s_Taxonomy_and_its_Use_in_
5
6 of self‑assessment in preclinical and clinical dental education. Classroom_Assessment. [Last accessed on 2017 Jul 05]. 6
7 J Dent Educ 2016;80:902‑13. 7
12. Singh V, Kharb P. SciVerse ScienceDirect Review article
8 3. Dental Indices. 2-4.Available from: http://www.codental. 8
A paradigm shift from teaching to learning gross anatomy:
uobaghdad.edu.iq/uploads/lectures/3rd class community
9 Meta‑analysis of implications for instructional methods. J Anat 9
dentistry/1 Dental Indices.pdf. [Last accessed on 2017 Jul 04].
10 Soc India 2013;62:84‑9. 10
4. Wasson LT, Cusmano A, Meli L, Louh I, Falzon L, Hampsey M,
11 13. Beatty I. Transforming Student Learning with Classroom 11
et al. Association between learning environment interventions
12 Communication Systems; 2004. Available from: https://www. 12
and medical student well‑being: A systematic review. JAMA
educause.edu/ir/library/pdf/ERB0403.pdf. [Last accessed on
13 2016;316:2237‑52.
2017 Nov 17].
13
14 5. Souza MD, Chaturvedula L.Improving Listening Activity
14. Brophy J. Synthesis of research on strategies for motivating
14
15 and Student’s Active Participation in Group Discussion in 15
Pharmacology Lecture (theory) Class in Para Clinical M.B.B.S. students to learn. Educ Leadersh 1987;45:40‑8.
16 15. Pavani G. Fish bowl teaching technique for 2nd year MBBS 16
Students using Fish Bowl (group dynamics) N.T.T.C.; 2007.
17 p. 1‑10. students in AIMSR. J Evol Med Dent Sci 2016;5:1713‑5. 17
18 6. Zameera Naik MU. ‘One minutepreceptor’a teaching‑learning 16. Gibbs G, Habeshaw S, Habeshaw T. Improving student learning 18
19 model for oral radiographic interpretation skill. J Contemp Med during lectures. Med Teach 1987;9:11‑20. 19
20 Educ 2015;3:73. 17. Furney SL, Orsini AN, Orsetti KE, Stern DT, Gruppen LD, 20
21 7. Neher JO, Gordon KC, Meyer B, Stevens N. A five‑step Irby DM, et al. Teaching the one‑minute preceptor. A randomized 21
22 “microskills” model of clinical teaching. J Am Board Fam Pract controlled trial. J Gen Intern Med 2001;16:620‑4. 22
23 1992;5:419‑24. 18. Aagaard E, Teherani A, Irby DM. Effectiveness of the one‑minute 23
8. Neher JO, Stevens NG. The one‑minute preceptor: Shaping the preceptor model for diagnosing the patient and the learner: Proof
24 of concept. Acad Med 2004;79:42‑9.
24
teaching conversation. Fam Med 2003;35:391‑3.
25 19. Stheeman SE, Mileman PA, van ‘t Hof MA, van der Stelt PF.
25
9. Rehman R, Afzal K, Kamran A. Interactive lectures: A
26 perspective of students and lecturers. J Postgrad Med Institute Diagnostic confidence and the accuracy of treatment decisions 26
27 (Peshawar Pakistan) 2013;27:152-6. for radiopaque periapical lesions. Int Endod J 1995;28:121‑8. 27
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