key: cord-257161-lx3ar43e authors: Yang, Xu; Li, Deli; Liu, Xiaoqiang; Tan, Jianguo title: Learner behaviors in synchronous online prosthodontic education during the 2020 COVID-19 pandemic date: 2020-10-03 journal: J Prosthet Dent DOI: 10.1016/j.prosdent.2020.08.004 sha: doc_id: 257161 cord_uid: lx3ar43e STATEMENT OF PROBLEM: Synchronous online prosthodontic courses became a popular learning mode during the 2020 COVID-19 pandemic crisis. Nonetheless, the extent of learner participation and completion of these courses remains unknown. PURPOSE: The purpose of this study was to assess learner behaviors in synchronous online prosthodontic continuing education lectures in China during the 2020 COVID-19 pandemic. MATERIAL AND METHODS: All live online prosthodontic courses held by an online dental school in China from February to May 2020 were retrieved. The no-cost lectures could be accessed anonymously and viewed repeatedly on the day of broadcast. Learning behavior data (teacher speaking time, audience total, timing of first visit to the online classroom, viewing time, and completion rate) were obtained. Learning progress was calculated by dividing viewing time by teacher speaking time. When a learner progressed through 95% of a lecture, the lecture was considered completed. RESULTS: A total of 41 781 learners participated in 18 online prosthodontic courses, which had a mean duration of 77.2 ±15.8 minutes. For each lecture, 2321 ±1454 participants attended, with 510 ±404 participants completing each session. There were 13 098 participants (31.35%) who viewed the lectures for less than 1 minute. Approximately half of the participants viewed the lectures for less than 10 minutes, with their learning progress failing to pass 10%. The average completion rate was 21.97%, with variation in completion rate dependent on when a learner first visited the online classroom. Significant differences were found among the lecture completion rates and the timing of the first visit to the online classroom (P<.001). CONCLUSIONS: Synchronous online prosthodontic education courses in China had a high number of participants but low learning progress and completion rates during the 2020 COVID-19 pandemic. Learner behaviors in synchronous online prosthodontic education during the 2020 COVID-19 pandemic Since early 2020, coronavirus disease 2019 (COVID-19) has become a worldwide pandemic crisis. 1 Countries and regions have established pandemic prevention policies, which have had major impacts on social, economic, medical and dental activities, as well as lifestyles. Countries have adopted social distancing policies with varying degrees of success. People are increasingly realizing that even after the pandemic dissipates, social distancing may continue long into the future. Important changes have also occurred in the provision and utilization of dental care and education, [2] [3] [4] with the emergence of COVID-19 disrupting, in particular, how medical education, including dental education, is structured and provided. [4] [5] [6] [7] [8] The COVID-19 pandemic highlighted the need for alternative educational methods such as distance learning. [4] [5] [6] [7] [8] In traditional dental education, high-quality practical skills training is inseparable from iterative, face-to-face guidance and communication. 9 Today, dental education methods are increasingly diverse, with distance learning becoming an important supplement to on-site education. 10, 11 Distance education may prove to be an effective alternative to traditional education methods, and students have been enthusiastic about online learning. [12] [13] [14] [15] Synchronous online learning occurs via a live, virtual interactive classroom. In response to the COVID-19 crisis, dental educators have converted university courses to an online format to avoid the risk of COVID-19 transmission during in-person education. 4, 16 Using modern technology, students can access lectures at home, thereby avoiding on-site attendance and reducing the risk of infection. Since the onset of COVID-19, most face-to-face academic meetings have been suspended or canceled. 17, 18 Synchronous online dental education courses and their participants have increased significantly, in part because of the courses' ability to overcome the geographical constraints typically found in traditional modes of education. 5, 19 However, synchronous online courses are not as regulated as on-site classes. [20] [21] [22] Often, instructors cannot supervise learners with respect to their attendance and participation. Furthermore, the current era of information overload can create a multitude of distractions and obstacles for learners when joining and completing an online course. Importantly, the extent of learner participation and completion of these courses remains unknown, and the authors are unaware of research that has investigated the effectiveness of synchronous online learning during the 2020 COVID-19 pandemic. The present observational study assessed learner behaviors in synchronous online prosthodontic continuing education lectures in China during the 2020 COVID-19 pandemic. The primary purpose was to evaluate the participation, learning progress, and completion rate of the courses. A secondary purpose was to determine whether the completion rate was affected by the participant's first visit (FV) time to the online classroom. This study aimed to illustrate the reality of synchronous online learning and provide a reference for improving the effectiveness of distance prosthodontic education. The null hypotheses were that the completion rate of synchronous online prosthodontic education during the 2020 COVID-19 pandemic would not be influenced by the specific lectures and the learners' first-visit time to the online classroom. This research was conducted by using lectures from a well-known dental online education institution, Tsmile, based in PR China. All live online prosthodontic lectures held from February to May 2020 were retrieved. These lectures covered contemporary clinical topics in fixed prosthodontics, implant dentistry, and esthetic dentistry. Each lecture consisted of 60 to 90 minutes of instruction, with some exceeding 90 minutes because of interactive discussion. The no-cost lectures could be accessed anonymously from smartphones or laptop or tablet computers. Each lecture could be viewed repeatedly on the day of broadcast. Learning behavior data (teacher speaking time, audience total, timing of FV to the online classroom, viewing time, and completion rates) were obtained from the online platform. No demographic information was collected, so ethical approval was not required. Only participants with data points for each variable were included for analysis. Learning progress was calculated by dividing viewing time by teacher speaking time. When a learner progressed through 95% of a lecture, the lecture was considered completed. The online classrooms allowed early access to the course introduction before the course officially started, giving learners to FV the online classroom anywhere between several hours to several days before the start of the course. The participants were divided into 3 groups as per the timing of their FV to the online classroom: early group (FV60 minutes before the lecture began); punctual group (FV<60 minutes before the lecture began); and late group (FV occurred after the lecture had started). Differences in completion rates among lectures were analyzed, as well as differences among FV times. Normally distributed continuous variables were presented as mean ±standard deviation. Non-normal continuous variables were presented as median (interquartile range). Count variables were presented as n (%). During the COVID-19 pandemic crisis, synchronous online prosthodontic education became a popular learning mode and was highly engaged. Nonetheless, the students' learning progress and completion rate remained low. When conducting synchronous online courses, course content and teaching skills must be optimized, and learners guided to visit the online classroom for the first time within 1 hour of the start of the course to improve the completion rate. The chi-square test for significant differences between lectures and FV time was used with a statistical software program (IBM SPSS Statistics, v22.0; IBM Corp) (a=.05). Overall, 41 781 learners participated in 18 online prosthodontic lectures, which had a mean instruction duration of 77.17 ±15.83 minutes (Table 1) . For each lecture, 2321 ±1454 participants attended, with 510 ±404 participants completing each session. The viewing time and learning progress followed skewed distributions (Fig. 1) . A total of 13 098 participants (31.35%) viewed the lectures for less than 1 minute (Fig. 1A) . Approximately half of the participants viewed the lectures for less than 10 minutes (Fig. 1A) , with their learning progress failing to pass 10% (Fig. 1B) . Some participants viewed parts or all of the lecture repeatedly; 19.51% of participants had learning progress values that exceeded 100% (Fig. 1B) . The completion rate ranged from 9.27% to 31.85%, with an average completion rate of 21.97% (Table 2 ). There were significant differences among the completion rates of the lectures (P<.001) ( Table 3) . Learners who visited the online classroom for the first time less than 60 minutes before the lecture began (punctual group) had the highest completion rate of 50.75% (Table 4 ). In contrast, the learners whose FV occurred more than 60 minutes before the lecture began (early group) had the lowest completion rate (14.00%). The completion rate of those first visiting the online classroom after the lecture started (late group) was 19.09%. There were significant differences among the completion rates of each FV group (P<.001) ( Table 5) . This research assessed learner behaviors in synchronous online prosthodontic education courses in China during the 2020 COVID-19 pandemic. The participation, learning progress, and completion rates of learners and the data's relationship to the lectures and to the timing of learners' first visits to the online classroom were evaluated. The results indicated that synchronous online prosthodontic education courses were highly engaged with low learning progress. The overall completion rate was low and was affected by lectures and the FV time to the online classroom. Therefore, the null hypotheses were rejected. Synchronous online courses became a popular learning mode with a high number of participants in China during the 2020 COVID-19 pandemic. Different factors contributed to its recent popularity. Time is an important factor restricting dentist participation in continuing education. 23 During the pandemic, dental clinical work was greatly reduced, 3 providing dentists with more free time for continuing education. 5 In addition, synchronous courses are easily accessed, free from space constraints, and do not require face-to-face contact, helping to reduce the transmission risk of COVID-19. These attributes may contribute to a high number of participants in such courses, participation that is rarely matched by in-person classes. Nevertheless, more attention must be paid to learner levels of engagement. 5, 19 Participant behavior in synchronous online courses has not been regulated. 20 As a result, one third of the participants viewed lectures for less than 1 minute, and nearly half of the participants progressed through less than 10% of the lecture content. Only one fifth completed the online class. This may be because the focus of responsibility for the class has shifted, to some extent, from the teacher to the students. 21 Learners can enter and leave the online classroom freely and may get distracted by their surroundings, particularly as they participate in courses outside a formal classroom. 22 Distance learners may find it difficult to motivate themselves to stay engaged for long periods. In addition, deficient hardware or software infrastructure, inadequate technological abilities, and a complex learning environment are also difficulties that students may face in distance education. 21, 22 Nonetheless, to increase the effectiveness of online education, learning progress and completion rates need first to be increased. The learner total and completion rate was significantly related to specific lectures, perhaps because of varying interest in the lecture topics, content, and speakers. Therefore, the course design needs to consider the interest of learners to increase attentiveness throughout each class. For online classes, it may be more difficult to engage in timely and effective interaction with students, which is a key component of generating interest in online education. 21 The development of online courses requires effort from both experts and learners. When developing online lectures, attention should be paid to teaching methods and teacher abilities, experience, and presentation skills. 10 The course must contain effective visual learning elements, as well as easy-to-express and easy-to-understand content. 10 To achieve this goal, it is necessary to provide systematic training for teachers. 22 Learner completion rates were also related to the timing of their FV to the online classroom. Audience members who visited the online classroom for the first time within 60 minutes before the course began had the highest completion rate of 50.75%, exceeding the average completion rate of 21.97%. Some learners entered the online classroom more than 60 minutes before the start of the course, visiting the classroom a few hours or days previously e they may be distracted by their surrounding environment, which leads to a decline in completion rate. For learners who entered the online classroom for the first time less than 60 minutes before the lecture began, they were less likely to be disturbed by their surroundings, which is conducive to completing the course. Some learners entered the live online classroom after the lecture started. Being late suggests they may not have paid enough attention to the course and could not fully comprehend the course content when entering midway through. This may explain why the completion rate was low for the late group. Given the "new normal" ushered in by the pandemic, dental educators are being forced to develop innovative strategies to continue educational tasks during the crisis. 8 Dentists are willing to conduct synchronous online dental continuing education courses, indicating that this educational model may be broadly adopted in the future. 15 It is possible to continue to teach theoretical content online. However, face-to-face classrooms are significantly more conducive to student-teacher and student-student interactions. 20 When discussing clinical treatments, an Internet-based discussion is a less effective educational method compared with in-person discussions, which involve more natural ways of communicating. 11 Therefore, when conducting synchronous online courses, the focus should be on theoretical explanations, not clinical treatment discussions. Limitations of this study included that the synchronous online prosthodontic education institutions and courses evaluated were limited in scope. There may be differences between institutions and their courses, and the course quality and teaching effectiveness were not evaluated. Participation and completion rates only reflect the act of viewing course content online and do not necessarily reflect effective learning. In addition, the data were derived during a unique historical period; thus, the results cannot be generalized excessively. Additional studies about the effect of synchronous online education courses on learner theoretical knowledge and practical skills, in China and worldwide, are necessary. Based on the findings of this survey study, the following conclusions were drawn: 1. Synchronous online prosthodontic courses had a high number of participants but low learning progress and completion rates. 2. 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