Development and questionnaire-based evaluation of virtual dental clinic: a serious game for training dental students

Figures & data

Figure 1. The development and validation of the virtual dental clinic

Figure 2. Screenshots from the virtual dental clinic

Figure 3. The timeline of VDC self-learning and related assessments

Table 1. The S-CVI of VDC

Themes		Items	S-CVI/Ave
			Original	Modified
1	Dental clinic environment	10	0.90	1.00
2	Dental materials	2	0.90	n/a
3	Whole-person dental care: first visit (OD)	6	0.73	0.90
4	Whole-person dental care: second visit (ENDO)	6	0.80	0.87
5	X-ray arrangement	10	0.98	n/a
6	Orthodontics	8	1.00	n/a
Total		42	0.90	0.96

Table 2. The proportions of full score between expert and novice

Themes		Full score, n (%)		p	Difficulty level
		Clerk (n = 14)	PGY (n = 9)
1	Dental clinic environment	11 (78.6)	9 (100.0)	0.136	Easy
2	Dental materials	8 (57.1)	9 (100.0)	0.022*	Moderate
3	Whole-person dental care: first visit (OD)	1 (7.1)	9 (100.0)	0.000***	Difficult
4	Whole-person dental care: second visit (ENDO)	0 (0.0)	9 (100.0)	0.000***	Difficult
5	X-ray arrangement	14 (100.0)	9 (100.0)	n/a	Easy
6	Orthodontics	1 (7.1)	9 (100.0)	0.000***	Difficult

Fisher’s exact test.

* p < 0.05; *** p < 0.001.

Table 3. The impressions of VDC

Items		Agree, n (%)			p
		Total	Clerk (n = 14)	PGY (n = 9)
1	Effective in education	19(82.6)	13 (92.9)	6 (66.7)	0.147
2	Teach dental knowledge	18 (78.3)	12 (85.7)	6 (66.7)	0.283
3	Teach clinical skills	20 (87.0)	11 (78.6)	9 (100.0)	0.206
4	Effective feedback	16 (69.6)	9 (64.3)	7 (77.8)	0.418
5	Sense of presence and immersive	18 (78.3)	11 (78.6)	7 (77.8)	0.673
6	Fun, wants to play again	19 (82.6)	11 (78.6)	8 (88.9)	0.483
7	Long-lasting learning efficacy	16 (69.6)	10 (71.4)	6 (66.7)	0.582
8	Necessary for learning	15 (65.2)	8 (57.1)	7 (77.8)	0.290

Fisher’s exact test.

Table 4. Game quality and usability of VDC

Items		Agree, n (%)			p
		Total	Clerk (n = 14)	PGY (n = 9)
1	The game design is good	15(65.2)	10 (71.4)	5 (55.6)	0.367
2	Good quality of image, sound, and presenting	15 (65.2)	8 (57.1)	7 (77.8)	0.290
3	It’s good for preview	18 (78.3)	10 (71.4)	8 (88.9)	0.327
4	The test design is good for learning	19 (82.6)	12 (85.7)	7 (77.8)	0.517
5	It’s a good simulation game	16 (69.6)	9 (64.3)	7 (77.8)	0.418
6	The feedbacks are good for learning	15 (65.2)	8 (57.1)	7 (77.8)	0.290
7	The case scenarios are true to life	16 (69.6)	9 (64.3)	7 (77.8)	0.418

Fisher’s exact test.

Table 5. VDC experiences and student performances

Variables	Mean±standard deviation			p	LSD post comparison
	0^a (N = 13)	1^b (N = 9)	≥2^c (N = 12)
Qualification test	70.00 ± 13.54	80.00 ± 5.59	79.58 ± 6.90	0.029*	b, c > a
Academic achievements of clerkship
Oral Maxillofacial Surgery	84.58 ± 0.49	84.44 ± 1.13	84.42 ± 1.16	0.905
Oral Pathology & Maxillo-Facial Radiology	78.80 ± 8.28	80.38 ± 5.64	80.14 ± 2.92	0.801
Periodontics	82.46 ± 2.47	84.56 ± 2.19	82.33 ± 1.30	0.037*	b > a, c
Paediatric & Special Needs	85.11 ± 6.65	85.43 ± 5.89	88.49 ± 2.50	0.236
Conservative Dentistry	84.92 ± 2.33	86.78 ± 1.48	86.42 ± 1.16	0.040*	b, c > a
Family Dentistry	85.69 ± 6.33	86.56 ± 1.24	86.50 ± 1.45	0.847
Prosthodontics	77.85 ± 9.94	84.44 ± 2.35	82.17 ± 2.52	0.064
Orthodontics	88.46 ± 2.70	89.89 ± 0.60	90.00 ± 0.85	0.074
Overall score of clerkship	84.58 ± 0.49	84.44 ± 1.13	84.42 ± 1.16	0.905

one-way ANOVA.

* p < 0.05.

Table 6. Summary of VDC mentioned in the students’ homework

No.	Quotes
S1	The learning resources for self-directed learning gave us an opportunity to practice, and the mini game on the computer further enhanced our understanding of treatment procedures and apparatus preparation.
S2	I really liked how there were suture practice kits and dentistry mini game in the clinic!
S3	Although sometimes there were few patients at the family dentistry clinic, this provided us with the opportunity to borrow the toolkit for self-directed learning and play interesting dentistry games. Thus, as a whole, I thoroughly enjoyed it!
S4	There were many tools and electronic mini games for clerks and interns to use for practice, and some dentists even took the initiative to teach us suture techniques. This gave us many opportunities for self-directed learning and hands-on operations, which was greatly beneficial to forming impressions in learning as well as knowledge retention.
S5	[In the clinic] there were some interactive learning resources (sutures, learning tools for anaesthetic injections, and clinic games), through which I could learn some basic knowledge while having fun at the same time.
S6	The self-directed learning area at the family dentistry clinical was cool. Answering questions in the mini games helped us familiarise ourselves with the necessary apparatus for different treatments. It was very practical.
S7	I think the learning environment at the family dental clinic was exceptional, and there were many learning resources for self-directed learning. This allowed us to practice some dental treatment procedures and methods in real life besides observing in the clinic. For example, there were learning equipment for OD fillings and scaling.
S8	With regard to the self-directed learning area, I am very thankful that the teachers provided us with opportunities to practice treatments using a simulated dental chair [VDC] so that we could familiarise ourselves with all the clinical operations.

Table

Themes	Original items	Average score	ICVI	Failed	Modified items	Average score	ICVI
(1) Dental clinic environment	1. Where is the basic setup?	4.6	1
	2. Where is the alginate mixer?	3.4	0.4	V	Where is the upper stock tray (No. 12)?	4.4	1
	3. Where is topical anaesthetic agent?	4.2	0.6	V	Where is the local anaesthetic cartridge (no epinephrine solution)?	4.4	1
	4. Where is the surgical mask?	4.6	1
	5. Where is the dental health history form?	4.8	1
	6. Where is the light curing machine?	4.6	1
	7. Where is the apex locator?	4.8	1
	8. Where is the automated electronic blood pressure device?	4.8	1
	9. Where is the disclosing agent?	4.8	1
	10. Where is the articulating paper?	4.4	1
(2) Dental material	1. Which is the correct mixing zinc oxide-eugenol for the temporary cementation?	4.4	0.8
	2. Which is the correct mixing zinc phosphate for the permanent cement?	4.8	1
(3) Whole-person dental care: first visit (OD)	1. Which are personal protective equipment before the treatment?	3.6	0.6	V	What do you need to wear before the treatment?	4.4	0.8
	2. Which are the basic instruments that are needed before the oral examination of Miss Luo?	3.8	0.6	V	Which are the basic instruments that are needed from the dental unit before the oral examination of Miss Luo?	4.8	1
	3. According to treatment plan for tooth filling, which equipment and supplies are needed for cavity preparation?	3.8	0.8
	4. Miss Luo chokes on water during the tooth cavity preparation. Which items did you fail to prepare?	4.2	1
	5. Which items do you need to prepare for the composite resin filling for tooth cavities?	3.6	0.8
	6. Which items do you need to adjust after filling the tooth cavity, besides the items that have been placed?	3.4	0.6	V	Which items that are absent from the dental unit do you need to adjust to fill the tooth cavity?	4.4	1
(4) Whole-person dental care: second visit (ENDO)	1. Which document and equipment do you need to prepare for Miss Luo to accept topical anaesthetic before the root canal treatment?	3.6	0.6	V	Which document and inspection do you need to prepare before Miss Luo accepts the topical anaesthetic?	4.6	1
	2. Which items do you need to prepare for Miss Luo to accept the topical anaesthetic before the root canal treatment?	4.0	0.8
	3. Which items do you need to prepare and place for the rubber dam besides the basic setup?	4.0	0.8
	4. Which items are needed to open the chamber besides the aforementioned equipment, supplies, and X-ray?	4.4	1
	5. Which items are need for the root canal enlargement procedure?	4.0	0.8
	6. Which items are needed for the root canal filling procedure?	3.6	0.8
(5) X-ray arrangement	1. Upper right second molar	4.4	1
	2. Upper right second premolar	4.4	1
	3. Upper right canine	4.6	1
	4. Upper right central incisor	4.6	1
	5. Upper left canine	4.6	1
	6. Upper left second premolar	4.4	1
	7. Upper left second molar	4.2	0.8
	8. Lower left second molar	4.4	1
	9. Lower left central incisor	4.4	1
	10. Lower right canine	4.6	1
(6) Orthodontics	1. Which instrument or method can be used to assist with the elastomeric ring separators placement before the orthodontic treatment?	4.6	1
	2. Which are the three items that can be used to assist with the orthodontic bands’ placement?	4.6	1
	3. Which item is required to hold the bracket?	4.8	1
	4. Which are the items and tools that can be used to assist with the ligature ties’ placement?	4.2	1
	5. Which items can be used to remove the orthodontic bands?	4.6	1
	6. Which item that has a smooth and rounded head can be used to remove and bend orthodontic wires?	4.6	1
	7. Which are the items that can be used to remove and place elastomeric ties?	4.2	1
	8. Which are the five basic kits for orthodontic treatment in the KMUH?	4.4	1

S-CVI/UA = 34/42 = 0.81.

S-CVI/Ave = (8 × 0.8 + 34)/42 = 0.96.