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Blended Learning Technologies in Dental Education: A case study in orofacial pain

Special Issue: Blended Learning Technologies in Healthcare

By James Mark Hawkins, Drew Fallis, Steven Durning / February 2023

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Many disciplines, such as engineering and health professions, have traditionally focused on face-to-face education. The skill sets required in these professions necessitate hands-on interactive training. This practice has become a part of the culture, and many educators in these disciplines are reluctant to adopt new educational technologies such as e-learning.

This situation changed in 2020 with the COVID-19 pandemic and subsequent shutdown of many educational institutions, including medical and dental colleges. This necessitated an instructional shift from in-person to primarily virtual learning within many health professions educational settings. Historically, many health professions education programs utilized in-person didactic and hands-on approaches to convey relevant information to learners. For example, surgical residency programs often utilize weekly grand rounds lectures to deliver important content [1]. During the pandemic shift, it has been important to transition to a system that allows pertinent information to be conveyed in both a safe and effective way. Blended learning, which combines face-to-face and online instruction, has been effectively used for many years in education and business to optimize outcomes [2]. In medicine, blended learning can help maximize learning while ensuring patient safety and accreditation standards are maintained [3]. One example demonstrated nurses who took a blended learning medication safety course had improved performance and reduced medication prescribing errors [4].

This article presents an educational case study detailing the effective transition of a postgraduate dental education class from an in-person environment to a blended learning environment. While this case study focuses on the creation of a blended curriculum utilized in dentistry, and specifically for teaching orofacial pain (OFP), the core concepts developed and discussed are applicable to many disciplines that need to create optimal blended learning environments to thrive moving forward.


OFP is a specialty of dentistry that encompasses the diagnosis, management, and treatment of pain disorders of the jaw, mouth, face, head, and neck. There are currently less than 300 board certified OFP specialists within the United States, limiting access to care within this specialty. Therefore, OFP patients often present to their general dentist, a dental specialist (endodontist, prosthodontist, oral surgeon, etc.), or a physician for initial evaluation and management of their OFP complaint. Consequently, it is imperative that both the dental and medical healthcare communities be knowledgeable of this important topic to maximize care and minimize harm [57].

In response to this need for quality OFP education in the midst of the pandemic, the Naval Postgraduate Dental School (NPDS) launched a blended 12-week OFP course for 17 postgraduate dental residents enrolled in two to three year training programs at NPDS during the academic year 2020–21. This course utilized multiple platforms and techniques that fostered effective blended learning (see Figure 1). Based on the unique and diverse modalities of content delivery, these can be grouped into four educational strategies. The description of each ES and the discussion that follows is an exploration of how blended learning technologies can optimize translation of didactic knowledge into clinical application.

[click to enlarge]
Figure 1. Blended Educational Strategies to Promote Improved Patient Outcomes.
ES1, ES2, ES3, and ES4 synergistically combine to enhance learner understanding and collaboration, thereby ultimately improving patient outcomes.(A special thank you to Dr. Faiza Talybova for her artwork contribution).

ES1: Virtual Presentations

Learners viewed a weekly 20-to-40-minute didactic presentation covering a broad array of relevant OFP topics. Two viewing options were available to learners. The first option was to watch pre-recorded presentations by the instructor that were posted on a video management platform (Panopto). These were watched at the learner’s convenience and allowed the learner to pause and rewind to ensure content understanding was achieved. This also allowed the learner to set the viewing speed to a faster or slower pace, based on learner preference. The second option was to watch the instructor present the same content live at preselected times via an online platform (Microsoft Teams). Learners who participated in the live session were able to ask the instructor questions during and after the presentation. Learners were encouraged to use both formats to facilitate content mastery, but only one was required. At the end of the week, each learner was required to complete a five-question online quiz (hosted on consisting of multiple choice and short answer questions to ensure content understanding.

ES2: Hands-On Training

Learners actively participated in three hands-on instructional sessions to learn interventional pain management techniques. This required face-to-face instruction with each learner demonstrating the technique on a classmate. The class was divided into three small groups for these sessions to optimize safety. Participation was mandatory but did not elicit a grade.

ES3: Virtual Interactive Case-Based Learning

The class was divided into small groups in breakout rooms of five learners each. Each group met virtually with an instructor (one of four OFP specialists) for four 90-minute sessions on Microsoft Teams. During each session, the instructor role-played as an OFP patient for three cases lasting 30 minutes each. Each case represented a different common OFP diagnosis the learners were exposed to during the previously viewed virtual presentations (LD1). The learners used this knowledge to virtually assess the simulated patient (by asking appropriate history and examination questions), as well as to diagnose and create a management plan for the simulated patient. The instructor provided feedback following each case. At the end of the 90 minutes, all groups virtually convened with the primary course instructor to summarize key concepts from the cases and answer any questions. Active participation in these sessions was required.

ES4: Student Created Multimedia and Peer-to-Peer Feedback

For the course’s final project, learners paired in groups of two. One learner role-played a doctor teaching OFP self-care management techniques to a patient, while the other learner role-played a patient receiving the self-care instruction. The roles were then reversed. Each session was video recorded on the learner’s mobile phone and posted on the learner’s personal YouTube account. A link to the video was made available on the online OFP course discussion forum (hosted on Microsoft Teams) where all learners could view it. Each learner was required to watch a minimum of two of their classmates’ videos and post peer-to-peer feedback on the discussion forum regarding the self-care demonstration.


Each of the four educational strategies provided instructional content that synergistically combined to equip learners to effectively evaluate and manage common OFP complaints. Among these, ES3 and ES4 utilized unique and innovative designs that enabled learners to translate didactic instruction to clinical application. The following three sections present thematic findings that encapsulate key concepts and benefits of the four educational strategies. Additionally, a summary of feedback solicited from the learners at the conclusion of the course is included at the end of each section to provide learner perspective on the educational strategies. This feedback was attained via an anonymous written survey that utilized open-ended questions. The lead author then extracted the major themes from this feedback and summarized them below.

Utilizing technology to promote collaborative content conceptualization. ES3 and ES4 were designed with multiple goals in mind. The primary goal was to help learners translate the novel OFP concepts and techniques they learned during the virtual presentations (ES1) and hands-on instruction (ES2) into effective clinical outcomes (i.e., improved patient care). Traditionally, each learner would have the opportunity to clinically receive direct supervision and mentoring by an OFP specialist while evaluating and managing multiple real patients with various diagnoses. Unfortunately, this was not possible due to COVID-based clinical restrictions and staffing limitations. ES3 was designed to minimize this impact and still equip learners to effectively treat OFP patients through virtual collaborative content conceptualization. The virtual patient encounters allowed the learners to work together to determine questions they needed to ask the simulated patient (role played by the instructor) in order to attain sufficient information to appropriately diagnose the patient. Additionally, it allowed the learners to collaborate as they determined the most appropriate management plan based on the patient’s diagnosis and risk factors. Given the novel and challenging nature of OFP concepts for most dentists [8­­10], this collaboration was key to translating the didactic instruction (ES1, ES2) to clinical application (ES3, ES4).

Summarized learner feedback: Learners found the combination of lectures (ES1) and case-based scenarios (ES3) to be an effective way to learn new material at their own pace, and then apply this material in a low-pressure environment when practicing their newly acquired diagnostic skills on mock patients.

Utilizing technology to enhance student-to-student interaction. Virtual learning has many benefits. However, virtual learning may cause some learners to feel isolated from their peers and/or instructor [11]. This sense of isolation was exacerbated during the COVID-19 pandemic, which also created isolation in other areas of life [12]. Both ES3 and ES4 required learners to interact with peers and instructors to complete the assignments, thereby creating a sense of community, reducing feelings of isolation, and increasing effective learning [13].

Learning how to effectively collaborate with others is also vital in developing the skills necessary to work as part multidisciplinary and interdisciplinary care teams. This is essential when treating OFP patients, as well as patients in other healthcare settings [14]. Furthermore, given the increased use of telehealth appointments and virtual collaboration in today’s healthcare environment, developing a strong virtual engagement skill set may increase effectiveness and productivity long-term [15, 16]. ES3 and ES4 helped learners grow in their ability to effectively collaborate virtually, helping to equip them to thrive in this evolving healthcare landscape.

Summarized learner feedback: Learners appreciated interacting with, and receiving input from, their peers during the case-based scenarios (ES3). This interaction encouraged a thoughtful questioning process, which reinforced the questions a doctor should ask their real patients. Learners also appreciated the opportunity to ask lingering questions to the OFP specialist (instructor) in a small group setting.

Demonstrating understanding through student-created multimedia and peer-to-peer feedback. Many OFP patients significantly benefit from incorporating OFP self-care techniques into their daily lives [17]. Therefore, an important course objective was for learners to demonstrate how to teach OFP self-care techniques to their patients. By recording oneself teaching OFP self-care techniques to a simulated patient, ES4 required learners to be self-directed and thoughtfully evaluate both their understanding of these techniques, as well as their ability to effectively teach these techniques to their patients. Additionally, by eliciting peer feedback, these recordings allowed for critical reflection of ways to improve in one’s own self-care instruction, as well as ways to more effectively provide feedback to others [18].

Summarized learner feedback: Learners thought the final exam (ES4) was a challenging but rewarding and beneficial experience. The video recording assignment was uncomfortable for most learners, but it forced them to practice delivering self-care techniques, which ultimately improved communication with real patients.

A primary limitation within this course was the accessibility of the technology for both instructors and learners within the government information system. Network security restrictions occasionally created redundancy or unnecessary challenges. For example, students had to learn and utilize multiple software products during the course to accomplish all required assignments, as there was no comprehensive learning management system available to the instructor at the time of course creation.


Utilization of combined educational strategies in a blended learning environment can promote more optimal learner collaboration, content conceptualization, and clinical understanding, contributing towards the ultimate goal of effective patient care. The strategies utilized in this OFP course can be used to enhance learning for students in other health professions that have similar applied science and hands-on approaches such as nursing, medicine, pharmacy, etc. That said, these strategies are not limited to the health professions. Educators in other disciplines can include these active learning strategies to engage their learners and enhance the learning experience in blended environments. Educators interested in pursuing a blended learning structure are encouraged to use interactive virtual environments, multimedia demonstrations, and peer-to-peer feedback to maximize learner growth.


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The views in this article reflect the results of research conducted by the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, Uniformed Services University of the Health Sciences, nor the US Government.

“I am a military service member or federal/contracted employee of the United States government. This work was prepared as part of my official duties. Title 17 U.S.C. 105 provides that `copyright protection under this title is not available for any work of the United States Government.' Title 17 U.S.C. 101 defines a U.S. Government work as work prepared by a military service member or employee of the U.S. Government as part of that person's official duties.”

Neither I nor any member of my family have a financial arrangement or affiliation with any corporate organization offering financial support or grant monies for this research, nor do I have a financial interest in any commercial product(s) or service(s) I will discuss in the presentation or publication.

About the Authors

Dr. James Hawkins currently serves as chair of the Orofacial Pain Center at the Naval Postgraduate Dental School (NPDS) in Bethesda, MD, as well as the orofacial pain specialty leader to the Navy Surgeon General. He is a diplomate of the American Board of Orofacial Pain and the American Board of Dental Sleep Medicine. He currently serves on the board of directors for the American Academy of Orofacial Pain, the American Board of Orofacial Pain, and the American Board of Dental Specialties. He is also an oral board examiner for the American Board of Orofacial Pain.

Dr. Drew W. Fallis currently serves as executive dean of the Postgraduate Dental College. He also holds an appointment as professor of orthodontics within the Air Force Postgraduate Dental School (AFPDS), USU. Dr. Fallis retired from the Air Force in the rank of Colonel after 29 years of active service. During that time, he served as Dean, Graduate Dental Education, 59th Dental Group, 59th Medical Wing, Joint Base San Antonio-Lackland, Texas and Dean, Air Force Postgraduate Dental School. He is a diplomate of the American Board of Orthodontics and a fellow of the American College of Dentists. He is also a clinical board examiner for the American Board of Orthodontics and has served as a site-visitor for the American Dental Association Commission on Dental Accreditation.

Dr. Steven Durning is a professor of medicine and pathology at the Uniformed Services University (USU) and is the founding director of the Center for Health Professions Education. He received his M.D. degree from the University of Pittsburgh, and he practices general internal medicine. He received his Ph.D. from Maastricht University, which addressed the influence of contextual factors on clinical reasoning. Dr Durning has published more than 400 peer-reviewed manuscripts and has won more 10 million dollars in educational grant funding. He has written multiple books and he has served on numerous leadership positions with the AAMC, NBME, AMEE, ABIM, and others.

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