Synchronous vs. asynchronous education: Questionnaire-based survey in dental medicine during the COVID-19 pandemic** - DZZ International
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206 RESEARCH ORIGINAL ARTICLE
Marius Crome*, Alexander Rahman*, Robin Michael Iversen, Anne-Katrin Lührs
Synchronous vs. asynchronous
education: Questionnaire-based
survey in dental medicine during
the COVID-19 pandemic**
Introduction: The rapid establishment of digital teaching in the dental cur-
riculum, which was necessary in the progress of the COVID-19 pandemic,
now poses new challenges for both students and teachers. The aim of this
study was to assess the impact of the sudden introduction of synchronous and
asynchronous online teaching on dental students.
Methods: The evaluation of digital teaching was conducted via online survey
using the survey program SoSciSurvey. Dental students at the MHH in the
2nd, 4th, 6th, 8th and 10th semesters were questioned (n = 204, mean age:
23.6 ± 3.7 years, male/female ratio: 28 %/72 %). By means of a sum value cal-
culation over 21 Likert-type items, as well as the evaluation of core aspects
(content, technical quality, interaction potential with the lecturer, clarifica-
tion possibilities of questions, general orientation on the digital platform) ac-
cording to school grades, the satisfaction of the students was recorded. The
statistical evaluation was carried out with the software RStudio.
Results: The evaluation of the sum scores showed a mean of 66.9 points
(median 68.5) for preclinical students (2nd, 4th semester, asynchronous teach-
ing concept) and 79.4 points (median 81) for clinical students (6th, 8th, 10th
semester, synchronous teaching concept). The difference of 12.5 points (medi-
an 12.5) between both teaching concepts is statistically significant (p < 0.001).
The grading of the core aspects also showed statistically significant differences
with regard to content and orientation on the digital platform.
Conclusion: The questionnaire-based survey of dental students at the MHH
revealed that students were more satisfied with synchronous online teaching
than with asynchronous teaching. However, whether there is a fundamental
superiority of the synchronous teaching format over the asynchronous ap-
proach cannot be answered by the data collected.
Keywords: covid-19 pandemic; dentistry; digital teaching; synchronous and
asynchronous learning; questionnaire-based survey
Department of Conservative Dentistry, Periodontology and Preventive Dentistry (Director: Prof. Dr. W. Geurtsen), Hannover Medical School: Marius Crome, PD Dr. Alexander
Rahman, Dr. Robin Michael Iversen, PD Dr. Anne-Katrin Lührs
* Equal first authors
** Translation from German: Yasmin Schmidt-Park
Citation: Crome M, Rahman A, Iversen RM, Lührs AK: Synchronous vs. asynchronous education: Questionnaire-based survey in dental medicine during the COVID-19
pandemic. Dtsch Zahnärztl Z Int 2021; 3: 207–215
Peer-reviewed article: submitted: 16.09.2020, revised version accepted: 15.01.2021
DOI.org/10.3238/dzz-int.2021.0025
© Deutscher Ärzteverlag | DZZ International | Deutsche Zahnärztliche Zeitschrift International | 2021; 3 (5)CROME, RAHMAN, IVERSEN ET AL.:
Synchronous vs. asynchronous education: Questionnaire-based survey in dental medicine during the COVID-19 pandemic 207
1. Introduction
The COVID-19 pandemic, as well as
the measures taken to contain it, are
showing far-reaching socioeconomic
effects [34]. In addition to the cur-
rently much-discussed economic
cuts, the education sector has also
been affected to a considerable extent
[55]. General bans on contact and at-
tendance in the sense of “social dis- Figure 1 Learning modalities of synchronous and asynchronous teaching in compari-
tancing” prohibit the implemen- son, modified from [12].
tation of “classical teaching ap-
proaches” in the form of face-to-face
instruction at schools and univer-
Synchronous Teaching Asynchronous Teaching
sities [59]. However, this form of
teaching plays an elementary role in
synchronous online synchronous offline asynchronous online/
the training of future dentists in par- (online seminar) (face-to-face) offline
ticular, since a large part of the train-
ing takes place in a practical manner – lecturer presence – instructor presence – individual time
at preclinical simulation units and on (verbal) – real time feedback management
– real time feedback – everyday structuring – arbitrary access/
patients in the clinical treatment – everyday structuring – collaborative flexibility
courses. This training step, which
Advantages
– spatial indepen- exchange – indirect interaction
takes place under the supervision and dence – real "face-to-face" possible
– ability to archive interaction – promotion of self-study
control of the dental teaching staff, is – increased question – lower drop-out rate – learning diversification
elementary to the acquisition of motivation – self paced study
manual skills. Theoretical knowledge – considered
communication
required to perform dental treatment
is taught at Hannover Medical School
by “blended learning” [4]. In its basic
orientation, this concept consists of a – physical isolation – spatial limitations – no multilayer interaction
hybrid of conventional face-to-face – drop-out rate – spatial dependence – responses delayed
increased – travel distance/ – time investment
teaching and teaching content which
Disadvantages
– need for: mobility costs increased
is available online [7, 15, 38]. This – technical equipment – one time experience
teaching concept allows a clear tem- – technical know-how – strict time planning
– technical painting – time window for
poral structuring of the student’s functions, if appli- questions limited
daily routine; in addition, the stu- cable – asking questions is
dent is comprehensively supported in – reduced non-verbal, not anonymous
extra-/paralinguistic
his self-study by the provision of digi- signals
tal teaching information without
time constraints [17, 30]. During the Table 1 Advantages and disadvantages of synchronous and asynchronous teaching,
COVID-19 pandemic, the original modified from [1, 3, 11, 25, 29, 37, 39, 52, 54].
teaching content of face-to-face
courses was completely digitized at
short notice at the start of the semes-
ter on 20.04.2020 in order to be able rect, simultaneous interactivity be- ary, for example for the acquisition of
to offer the students adequate dis- tween students and teaches [12, 44]. the qualification in radiation protec-
tance teaching in the absence of An overview of different modalities tion [60]. In addition, despite physi-
practical teaching units. This teach- of synchronous and asynchronous cal isolation, a sense of social cohe-
ing method is characterized by the teaching is shown in Figure 1. During sion can still be created through in-
use of one and or more technical the planning process, different pro- teraction opportunities with the lec-
means to bridge the physical sepa- viders of web conferencing systems turer and fellow students. An over-
ration between lecturer and students were compared with the aim of find- view of all advantages and disadvan-
[18, 26]. However, in contrast to ing a practicable, user-friendly and tages of synchronous and asynchro-
medical and dental students in pre- privacy-compliant software that nous teaching is shown in Table 1.
clinical semesters, this “distance allows online seminars to be espedi- The basic assumption that students
learning” should not be asynchron- ently used in teaching. The online can generally be classified as technol-
ous for students in clinical semesters, seminars allow to follow the sched- ogy-savvy “digital natives” due to
but should continue on a synchron- uled timetable, also virtual atten- their young age cannot be readily ac-
ous way for clear organization of the dance tools can be used to document cepted due to the heterogeneity with-
daily routine and continuity of di- student attendance, which is necess- in the student body [5, 50]. Neverthe-
© Deutscher Ärzteverlag | DZZ International | Deutsche Zahnärztliche Zeitschrift International | 2021; 3 (5)CROME, RAHMAN, IVERSEN ET AL.:
208 Synchronous vs. asynchronous education: Questionnaire-based survey in dental medicine during the COVID-19 pandemic
ing at Hannover Medical School
(MHH) at the time of the COVID-19
pandemic, 359 dental students were
invited by e-mail to complete an on-
line questionnaire. The questionnaire
was sent via the MHH e-mail dis-
tribution list, and all students receiv-
ed the questionnaire at the same
time. In addition to a cover letter,
each e-mail contained an individual
serial number that allowed for one-
time participation. The students were
informed about the aim and the pro-
cedure of this study, the voluntary
nature, as well as the whereabouts
and the handling of their data by the
participant information preceding
the questionnaire. Consequently, in-
formed consent can be assumed
when answering the questionnaire.
The survey instrument used was the
MHH-internally hosted program
SoSci-Survey (SoSci Survey GmbH,
Munich, Version 3.2.05-i) to in-
crease implementation objectivity.
The online survey of students took
place over a period of 3 weeks
(25.05.2020–15.06.2020). A positive
vote of the ethics committee of the
Hannover Medical School is available
(No. 9192_BO_K_2020).
2.1 Participants and software
Figure 2a (Descriptive legend see under Figure 2b) for online seminars
At the MHH, dental student are
teached basic natural science subjects
up to the preliminary dental examin-
less, it must be noted that digital methods into account, it can be as- ation after the 5th semester, with
technologies are successively opening sumed that synergistic effects have minor deviations, analogous to the
up all areas of life in a subtle, per- the potential to sustainably improve students of human medicine in the
vasive and invisible way, making a teaching [53]. As there are currently model study program “HannibaL”
differentiation between virtual and no findings on student perceptions of (Hanoverian integrated profession-
real spaces increasingly untenable dental teaching preformed only digi- ally oriented adaptive curriculum). As
[27]. In addition to “lifelong learn- tally at the time of the COVID-19 a consequence, the two preclinical
ing”, “ubiquitous learning”, which is pandemic, the aim of this study was semesters (2nd and 4th) were edu-
characterized by the convergence of to capture student perspectives using cated with conventional or lectures
learning locations and is also referred a questionnaire. The null hypothesis including sound on the teaching
to as ”seamless learning” when using which was set forth is that there is no platform “ILIAS” (Integrated Learn-
mobile, digital devices, is becoming difference between the examined ing, Information and Work Cooper-
increasingly important in order to be teaching formats (asynchronous vs. ation System) in accordance with the
able to develop new knowledge in a synchronous) in terms of satisfaction requirements for asynchronous on-
time-efficient manner [10, 56]. The measured by a sum score containing line teaching in medicine. The ILIAS
simple exchange of learning lo- 33 questionnaire items and the evalu- system is the technical basis for
cations is, of course, not yet an inno- ation of core aspects using school e-learning at the MHH since the in-
vation driver itself, nor are digital grades. troduction of the HannibaL model
teaching methods necessarily su- study programme in the winter term
perior to conventional ones. How- 2. Methods of 2005/2006. In contrast to the 2nd
ever, if digital media are used adju- During the present study on the and 4th semesters, dental teaching
vantly to traditionally proven con- qualitative evaluation of asynchro- content for the 6th, 8th and 10th
cepts, taking adequate, didactic nous and synchronous digital teach- semesters was taught synchronously
© Deutscher Ärzteverlag | DZZ International | Deutsche Zahnärztliche Zeitschrift International | 2021; 3 (5)CROME, RAHMAN, IVERSEN ET AL.:
Synchronous vs. asynchronous education: Questionnaire-based survey in dental medicine during the COVID-19 pandemic 209
tures within the semester or lectures
across all semesters. The program
“Microsoft Teams” was used for all
other lectures within the Clinic of
Dental, Oral and Maxillofacial Medi-
cine (phantom head course of conser-
vative dentistry, course of dental
prosthodontics I, integrated clinical
course, dental diseases I, clinic of
dental, oral and maxillofacial dis-
eases I, orthodontic treatment
course II), with the lectures being
held according to a timed lecture
plan. The students had to log in inde-
pendently at the respective start time
of the course, and attendance was
checked using the chat function of
the program.
2.2 Questionnaires
In order to assess student perception
and satisfaction with asynchronous
as well as synchronous teaching at
the time of the COVID-19 pandemic,
a fully standardized questionnaire (cf.
Fig. 2) with 33 items was developed,
as existing instruments for assessing
learning environments, such as the
Dundee Ready Education Enviroment
Measure (DREEM), the Dental Stu-
dent Learning Enviroment Survey or
the Dental Clinical Learning Environ-
ment Instrument (DECLEI) were not
sufficiently satisfactory [21, 28, 43].
Thus, in addition to the literature re-
view, feedback from students and the
opinions of two experts from the
dental faculty at MHH were relevant
for item development. In addition to
closed questions to collect basic in-
formation (age, gender, current sem-
ester, technical equipment, disruptive
Figure 2b Questionnaire with 33 items with closed questions to collect basic in- factors), 21 Likert-type questions for
formation (age, gender, current semester, technical equipment of the home office, the multifaceted evaluation of online
disturbing factors) and 21 Likert-type questions to evaluate online teaching, 5-point teaching could be answered by means
scale (“I cannot judge” = 1, “do not agree at all” = 2, “rather disagree” = 3, “unde-
of a 5-point scale (“do not agree at
cided” = 4, “rather agree” = 5, “fully agree” = 6). The response options to statements
16 and 18 had to be recoded (“strongly disagree” = 6, “strongly disagree” = 5, all” = 2, “tend to disagree” = 3, “un-
“undecided” = 4, “strongly agree” = 3, “strongly agree” = 2). decided” = 4, “tend to agree” = 5,
“fully agree” = 6) and an additional
“don’t know” category (“cannot
judge” = 1). Based on the coding of
these ordinally scaled questions, a
using online seminars. The open proved to be less suitable for groups sum value was formed, which as a
source video conferencing appli- of 20 or more participants. Con- global parameter indicates the stu-
cation “Jitsi meet” (Emil Ivov; Ver- sequently, the open source pro- dents’ satisfaction with the online
sion 2.10 Build 5550) was used for gramm was only used to instruct teaching that took place. Out of the
very few courses, but in direct com- small groups in the phantom head 21 question items, two statements
parison with “Microsoft Teams” course of conservative dentistry, but (16. I prefer to learn in a team and
(Microsoft Corporation, Redmond, not as a teaching instrument for sig- am now afraid of missing the connec-
Washington, USA, Version 1.3.0) it nificantly more participants in lec- tion; 18. I feel isolated due to digital
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210 Synchronous vs. asynchronous education: Questionnaire-based survey in dental medicine during the COVID-19 pandemic
Figure 3 Results of summative value calculation by semester, teaching format, and gender.
teaching) had to be recoded due to 2.3 Statistical analyses the interpretation criteria defined by
their negative connotation (“do not Statistical analysis of the question- Schönrock-Adema et al. (point of
agree at all” = 6, “rather disagree” = 5, naire was performed using RStudio strongest bend in the scree plot, ei-
“undecided” = 4, “rather agree” = 3, software (RStudio PBC; Boston, Mas- genvalue criterion > 1.5, minimum
“fully agree” = 2). As a result of the sachusetts, USA, version 1.2.5033) 3 items per factor, factor loadings
findings of a factor analysis (cf. para- and R (version 3.6.3) [41, 46]. Fur- ≥ 0.5 per item), one factor as well as
graph 2.4), 5 items (6, 14, 17, 20, 21) thermore, the distribution functions 5 questions (6, 14, 17, 20, 21) had to
were excluded from the sum value of the data were analyzed using the be excluded from the sum value cal-
calculation. An increased total score Kolmogorov-Smirnov test and, for culation [49]. The first factor describ-
in the evaluation was interpreted as non-normally distributed data, the ing the seminar structure includes
meaning that the implementation of Mann-Whitney-U-test was used to 6 items (1, 2, 3, 4, 5, 19). The second
digital teaching tended to be perceiv- test for differences in central tenden- factor includes the items (12, 13, 15,
ed more positively by the students. A cy (significance level ·= 0.05). Indi- 16, 18) and summarizes extrinsic, per-
score of 80 had to be reached (“tend vidual questions were analyzed son-related characteristics, while the
to agree”, 16 × 5) to conclude a posi- by Chi-square test. The follow- third factor (7, 8, 9, 10, 11) bundles
tive perception. A maximum of 96 ing R packages were used for data intrinsic characteristics. Overall, the
points could be achieved (“fully analysis and creation of graphs: three-factor model can explain 54 %
agree”, 16 × 6). The final questions “tidyverse” [57], “likert” [9], “HH” of the total variance. Finally, the con-
allowed the students to evaluate the [20], “colorspace” [58], “lattice” [47], firmatory factor analysis applied to
teaching carried out using classic “lavaan” [45], “psych” [42]. validate the given factor structure
school grades (“very good” = 1, yielded an acceptable model fit (CFI =
“good” = 2, “satisfactory” = 3, “suffi- 2.4 Factor analysis 0.94, RMSEA = 0.064) [8, 24].
cient” = 4, “poor” = 5, “insuffi- An exploratory factor analysis was
cient” = 6) with regard to the follow- conducted to investigate the internal 3. Results
ing aspects: Content, technical structure of the questionnaire. Using At the end of the survey period
quality, interaction potential with the principal component analysis with (25.05.2020–15.06.2020), the re-
instructor, the clarification options orthogonal varimax rotation, 4 fac- sponse rate was 56 % (response:
for questions, and general orientation tors were initially extracted in the 204/total questionnaires being send:
on the digital platform. course of data reduction. Following 359) of the students surveyed (2nd
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Synchronous vs. asynchronous education: Questionnaire-based survey in dental medicine during the COVID-19 pandemic 211
Fig. 1–4, Tab. 1 and 2: M. Crome
Figure 4 Comparison of online teaching questions in preclinical (asynchronous) and clinical (synchronous) settings.
semester (24/78), 4th semester 10th semester = 26.5 ± 4.5). Regarding addition to their studies due to pan-
(29/76), 6th semester (49/66), 8th the sum value, an average of demic-related kindergarten or elemen-
semester (47/64), 10th semester 66.9 points (median 68.5) could be tary school closures (4th semester: one
(55/75)). The participation rate of determined for the preclinical semes- female student, 6th semester: 3 female
clinical semesters (6th, 8th, 10th) was ters (asynchronous teaching concept) students, 8th semester: 4 female and
higher than that of preclinical semes- vs. 79.4 points (median 81) for the one male student[s], and one unspeci-
ters (2nd, 4th), namely 73 % clinical semesters (synchronous teach- fied parent, 10th semester: one female
(151/205) vs. 34 % (53/154). Overall, ing concept). Thus, the difference is and one male student[s]). Due to the
72 % (147/204) of the participants 12.5 (median 12.5) points, with a sig- small sample size, it was not possible
were female, 27 % (56/204) male, 0 % nificant difference between the groups to assess whether there was a statis-
diverse. One participant did not indi- (asynchronous vs. synchronous teach- tical relationship between potential
cate his gender. The mean age of all ing concept; Mann-Whitney-U-test: p stress due to simultaneous childcare
participants was 23.6 ± 3.7 years < 0.001). The sum score calculation is and work performance (distraction
(2nd semester = 21.8 ± 3.6/4th semes- shown in Figure 3. Twelve students, potential, ability to concentrate).
ter = 22.1 ± 4.2/6th semester = 9 of them female, indicated that they However, evaluated purely descrip-
23.8 ± 3.3/8th semester = 24.2 ± 3.0/ had to care for children at home in tively, 10 of the students with
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212 Synchronous vs. asynchronous education: Questionnaire-based survey in dental medicine during the COVID-19 pandemic
Clarification
Teaching format Content Orientation Interaction Technology
of questions
Preclinical, asynchronous teaching 2.21 (n = 52) 2.47 (n = 51) 2.42 (n = 52) 2.80 (n = 51) 2.62 (n = 52)
Clinical, synchronous teaching 1.72 (n = 151) 1.74 (n = 151) 1.93 (n = 151) 2.13 (n = 151) 2.14 (n = 151)
Kolmogorov-Smirnov-Test 0.0821 0.0028 0.0929 0.0074 0.0271
Mann-Whitney-U-Test p < 0.001 p < 0.001 0.004 p < 0.001 p < 0.001
Table 2 Grading of online teaching according to the school grading system (mean/n= number of responses evaluated) and statistical
evaluation of the comparison preclinical (asynchronous teaching) vs. clinical (synchronous teaching).
children indicated that their work-life dents stated that they found it sults showed that there is significant
balance was improved, and 8 of them easier to ask questions from the difference between the two teaching
also seem to have been less distracted anonymity at home, 62.7 % were in formats, the null hypothesis has to
during an online seminar despite the favor of the fact that they achieved a be rejected. In addition to statis-
presence of children. Regarding home higher depth of concentration in on- tically significant differences in the
office conditions, 92 % (188/204) of line seminars and were less often dis- comparison of the total values, dif-
students had a workspace that allowed tracted (52.4 %). An overview of the ferences could also be observed in
them to participate in digital teaching responses to questions about online the allocation of grades with regard
without disruption. Furthermore, teaching in the preclinical (asyn- to the ability to interact, clarification
90 % of the respondents also had the chronous) and clinical (synchronous) of questions and technique (cf.
necessary technical equipment (head- settings is shown in Figure 4. In addi- Tab. 2). However, it must be taken
set, microphones, webcam) to partici- tion, in a direct comparison of the into account that students from the
pate interactively in the online sem- preclinical (asynchronous concept) to preclinical phase were compared
inars. Nevertheless, 4 students stated the clinical (synchronous concept) with those from the clinical phase of
that they had neither an adequate setting, a significant difference in cen- dental studies and therefore the set-
workstation nor communication tral tendency was found in the evalu- ting was not homogeneous. In addi-
hardware (2nd semester: 2 students, ation of content and orientation tion, the participation motivation of
8th semester: one student, 10th sem- (compare Table 2). Looking at the de- students in preclinical semesters was
ester: one student). 87.7 % of the tails, there is a statistically significant significantly reduced compared to
students (“agree” = 91, “strongly difference between the presence of students in the clinical study section
agree” = 88) were satisfied with the ac- equipment (headset, microphones, (Δ = 39 %). Furthermore, the more
cessibility of the online seminars, re- webcam) and the grading of content, critical view of the asynchronously
gardless of whether they used an old technique as well as general orien- instructed students can possibly be
(> 3 years) or a new (< 3 years) tech- tation; Mann-Whitney-U-Test: con- explained by the fact that the ques-
nical device (PC, tablet, laptop). These tent (p = 0.00962), technique tionnaire was intentionally oriented
conventional devices were used by (p < 0.001), orientation (p < 0.001). If towards synchronous online teach-
98.5 % of participants, with 34.3 % of equipment is present, significantly ing, in the form of online seminars,
students also following the online better scores were given: Content which is why the asynchronously in-
seminars using smartphones. Eight (mean 1.7 vs. 2.3), Technique (mean structed participants could not have
students (3.9 %) indicated that access 2.20 vs. 2.89), Orientation (mean 1.97 found themselves fully reflected in
had not been unproblematic for vs. 2.89). the questions. This consideration is
them. The ability to interact with the supported by the fact that in the pre-
lecturer was considered unrestricted 4. Discussion clinical phase 7 % of the questions
by 76.5 % of the students and was The purpose of this questionnaire- were marked as not assessable,
rated 2.30 across semesters. Neverthe- based study was to assess student be- whereas in the clinical phase the per-
less, discrepancies in two-way inter- liefs regarding ad hoc, synchronous centage was only 2 %. On the other
action appear to be present, as suc- online teaching compared to asyn- hand, however, it can be argued that
cessful answering of questions was chronous teaching in dentistry at the this circumstance is due to the differ-
rated 1.74 in the clinical, synchron- time of the COVID-19 pandemic. ent characteristics of the two forms
ously taught semesters, whereas the This revealed that dental students, of teaching compared. For example,
preclinical, asynchronous semesters regardless of gender, generally asynchronous teaching does not pro-
only rated 2.47. This difference turns viewed both asynchronous and syn- vide for real-time feedback, which is
out to be significant (compare Table chronous online teaching favorably. why it seems plausible at first glance
2). Although only 36 % of the stu- Since the statistical analysis of the re- that the preclinical students were un-
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Synchronous vs. asynchronous education: Questionnaire-based survey in dental medicine during the COVID-19 pandemic 213
able to answer the questions regard- ing material is far more important more time in their self-study and
ing the feasibility of discussions, as than the chosen teaching format therefore could not use the time
well as the unrestricted ability to in- [35]. In this context, oral partici- saved profitably, for example, by not
teract with the lecturer, in the con- pation, i.e., direct interaction with having to travel to and from the
ventional, synchronous sense. How- the lecturer, but also with fellow stu- place of study. On the other hand,
ever, it must be noted at this point dents, seems to be closely related to students in the clinical semesters also
that the students were offered suffi- the process of learning [2, 14]. In this indicated that they would invest
cient communication possibilities respect, this correlation can also be more time in self-study, which again
through the learning platform drawn from the evaluation of the puts the explanatory approach into
“ILIAS” or via e-mail, which would preclinical students, where the ac- perspective.
have been ideally suited for asking quisition of competences was rated
clearly formulated, targeted ques- worst together with the opportun- 5. Conclusion
tions without time pressure [23]. ities for discussion and asking ques- The necessary restructuring of con-
Thus, it is surprising that the Likert- tions. Considering the fact that basic ventional, presentation-based teach-
question to elicit the willingness to knowledge is taught in preclinical ing in dental education at the time of
ask questions from the anonymity at courses, which at most belong to the the lock-down during the COVID-19
home was not considered assessable category of declarative knowledge ac- pandemic was rated positively by stu-
by 22.6 % of the students in the pre- quisition, the students’ perception dents overall. Synchronous teaching
clinical phase, since especially “dis- seems to be atypical at first glance, approaches were rated significantly
tance learning” can be advantageous since an asynchronous teaching better than asynchronous teaching
for shy students, among others [32]. format seems to be beneficial for approaches. Nevertheless, based on
Since the questionnaire design delib- conveying this content. Thus, just the results of this questionnaire-
erately offered an additional “don’t the arbitrary viewing of the content based teaching study regarding the
know” category in addition to the by pausing or rewinding the lectures, overall satisfaction of dental stu-
content-related response option “un- completely in the sense of “self- dents, the respective teaching format
decided” as the scale midpoint, so paced-learning”, is advantageous should be selected according to the
that students without a relevant atti- [19]. Furthermore, the learning suc- students’ learning situation. How-
tude would not be forced to make a cess and the engagement of the stu- ever, because the external validity of
content-related statement, it cannot dents is influenced by the feeling of this work is not comprehensively
be conclusively assessed to what ex- belonging to a group [6, 13, 51]. This given due to the chosen setting, the
tent any satisficing behavior, ignor- social affiliation is put to the test by results obtained can only be general-
ance of the communicative possibil- the geographical-physical separation ized to dental students at the Medical
ities, or lack of question comprehen- during distance learning. Moreover, School.
sion had an effect [16]. The literature an asynchronous setting creates a
review on asynchronous and syn- more difficult learning situation due
chronous online and face-to-face to time delays or a communicative
teaching showed that there is no sig- exchange reduced by paralinguistic Conflict of interest
nificant difference between the signals, but the dental students did The authors declare that there is no
teaching formats in terms of learning not consider this particularly isolat- conflict of interest as defined by the
success and student satisfaction [22, ing. Distraction potential scored sig- guidelines of the International Com-
40, 33, 36]. This finding could be nificantly worse in terms of evalu- mittee of Medical Journal Editors.
confirmed for dentistry by a meta- ation. Why the preclinical students
analysis from the field of orthodon- saw themselves significantly more
tic teaching [31], but is not confirm- distracted compared to the clinical
ed by the results of this study, as students cannot be plausibly ex-
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