Comparing the efficacy of live vs. video instructional demonstrations in dental education: a systematic review and meta-analysis

Abstract

Background

This systematic review and meta-analysis were conducted to investigate the effects of live and video demonstrations of various dental procedures on undergraduate students’ performance and satisfaction scores.

Materials and methods

A comprehensive search was conducted across multiple databases, including MEDLINE (OVID), PubMed, Scopus, and Web of Science, supplemented by a manual search of bibliographic references from retrieved articles. The aim was to identify relevant randomized controlled trials and quasi-experimental trials that compared live demonstrations to video demonstrations in dental education, specifically focusing on undergraduate students’ performance and satisfaction scores assessed using practical assessment rubrics and satisfaction questionnaires. The quality of included studies was assessed using the modified Downs and Black quality assessment tool.

Results

A total of 3686 studies were identified, of which 2222 studies remained following duplicate removal. Based on title and abstract screening 2188 studies were excluded and full text of 34 studies were comprehensively appraised for eligibility. This resulted in the inclusion of 10 studies in the systematic review, nine of which were classified as good, while one study was considered as fair. Of these, 8 studies were included in the meta-analysis.Students’ feedback reveals distinct preferences, with video demonstrations being commended for repeatability and clarity, while live demonstrations were valued for real-time interaction and guidance. Meta-analysis revealed that video-based learning significantly enhanced educational outcomes across various measures, including knowledge acquisition and practical skills over live demonstrations.

Conclusion

Video demonstrations emerge as viable alternatives to live demonstrations in dental education for teaching clinical procedures. Video demonstrations offer distinct benefits, including accessibility and repeatability, while live demonstrations provide essential interactive opportunities that contribute significantly to the learning experience in dental education.

Background

Psychomotor skills are regularly practiced by health professionals to perform procedures pertaining to patient care and wellbeing [1, 2]. Practicing dentistry, especially, requires mastering hand eye coordination as well as knowledge and cognition to efficiently perform daily clinical procedures [3]. Dental programs ensure that clinical skills are cultivated from the beginning of the program to ensure the technical accuracy, precision, and finesse required in dental treatments, staring from wax carving tasks, followed by pre-clinical practical work, before proceeding to clinical practice on patients. A standard of quality and proficiency in knowledge as well as in complex psychomotor skills are demanded from dental students to be able to deliver state-of- the-art patient care.

According to the literature, many methods have been proposed for teaching psychomotor skills to dental students, such as photographs, videos [4], live demonstrations [5], live video demonstrations [6], haptic virtual reality and force feedback technology [7, 8]. Regardless of the wide variety of teaching methods, many dental educators prefer to teach various clinical procedures through live demonstration.

As contemporary methods like written instructions and instructional images prove insufficient for teaching pre-clinical psychomotor skills, the demonstration of specific tasks becomes crucial. This approach enables students to visualize and comprehend procedures better, enhances communication skills through real-time interaction, and boosts confidence in task performance [9, 10] .

However, the efficacy of this teaching method faces challenges due to variations among instructors and insufficient faculty numbers. This will result in a high student-to-instructor ratio which impedes visibility during demonstrations [11, 12]. Additionally, time constraints limit instructors to a single demonstration to allow students enough time to practice. These factors collectively impact the overall effectiveness of live demonstrations in dental education.

The introduction of pre-recorded video demonstrations for dental procedures addresses limitations associated with live demonstrations. Pre-recorded video demonstrations offer students the flexibility to watch demonstrations repeatedly, overcoming constraints related to faculty shortages and time limitations. This teaching tool enables students to play the video while simultaneously performing the procedure.

Numerous studies comparing live and video demonstrations across various dental procedures, such as orthodontic wire bending [6, 12], orthodontic bracket placement [13], working length determination using an apex locator [5], arrangement of artificial teeth [14], and orthodontic dental cast trimming [15], reveal no significant differences in student performance scores. While Ramlogan et al. reported higher post-test scores following live demonstrations on clinical periodontal examination and charting, a greater number of students have reported preferring the video demonstration [16].

According to the literature, student satisfaction scores varied, with some studies showing no differences following live or video demonstrations [4, 6, 12, 15]. Others indicated a preference for video demonstrations [14], while some students favored live demonstrations for their interactive nature, which enhances understanding and boosts confidence [5, 10].

Although online video demonstrations have been widely available and accessible by students and faculty alike, they have been considered and still are, by many, as an adjunct to live demonstrations [17]. By introducing pre-recorded videos as an alternative to live demonstrations, educators have the ability to maintain a level of consistency in the information delivered, a close-up view of the procedure being practiced, and ensure that students are not negatively affected by the shortage in staff or time constraints. Students will have the advantage of viewing the video demonstration before, during, and after the laboratory session.

This systematic review will serve as a valuable resource for dental educators by providing the evidence needed to make informed decisions when selecting an effective and reliable instructional method. This study aims to systematically review and compare the effectiveness of live and video instructional demonstrations in dental education concerning student practical performance and satisfaction scores. This will provide comprehensive insights that can enhance the quality of dental education to better align with the evolving needs of students.

Methodology

This systematic review is conducted in accordance to the guidelines of Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) [18]. This systematic review addresses the following PICO (patient-intervention-comparator-outcome) question: In dental education, how do recorded video demonstrations compare to live demonstrations in terms of dental student performance and satisfaction scores?

Search strategy

The literature was searched independently by two reviewers (RNA and SM. AlJudaibi) using MEDLINE (OVID), PubMed, Scopus, and Web of Science databases, in addition to manual search of the bibliographic references of the retrieved articles aimed at the identification of potentially relevant papers (Table 1).

Table 1.

Databases and search terms used in the systematic review

Pubmed (10/1/2024)

(("education, dental"[MeSH Terms] OR "teaching"[MeSH Terms] OR "education, dental/methods"[MeSH Terms] OR "teaching materials"[MeSH Terms]) AND "teaching"[MeSH Terms] AND ("videotape recording"[MeSH Terms] OR "video recording"[MeSH Terms] OR "computer assisted instruction"[MeSH Terms]) AND ("educational measurement"[MeSH Terms] OR "clinical competence"[MeSH Terms]) AND ("surveys and questionnaires"[MeSH Terms] OR "Feedback"[MeSH Terms]) AND "english"[Language] AND "humans"[MeSH Terms]) OR (("dental education"[Text Word] OR "Education"[Text Word]) AND ("live demonstration*"[Text Word] OR "live presentation*"[Text Word] OR "instruction*"[Text Word] OR "dental demonstration*"[Text Word]) AND ("video demonstration*"[Text Word] OR "video recording*"[Text Word] OR "recorded video*"[Text Word]) AND ("Performance"[Text Word] OR "Competency"[Text Word] OR "grade*"[Text Word] OR "assessment*"[Text Word]) AND ("Feedback"[Text Word] OR "Satisfaction"[Text Word]) AND "humans"[MeSH Terms] AND "english"[Language])

Web of Science (2/1/2024)

1: (((ALL=(Dental education)) OR ALL=(Teaching methods)) OR ALL=(Dental education methods)) OR ALL=(Teaching materials) 2: ((((ALL=(Live demonstration)) OR ALL=(Live presentation)) OR ALL=(Instruction)) OR ALL=(Dental demonstration)) OR ALL=(Teaching) 3: ((((ALL=(Video demonstration)) OR ALL=(Video recording)) OR ALL=(Recorded Video)) OR ALL=(Videotape recording)) OR ALL=(Computer-Assisted Instruction) 4: (((((ALL=(Performance)) OR ALL=(Grades)) OR ALL=(Assessment )) OR ALL=(Educational Measurement)) OR ALL=(Clinical Competence)) OR ALL=(Competency) 5: (((ALL=(satisfaction)) OR ALL=(feedback)) OR ALL=(Surveys and Questionnaires)) OR ALL=(Feedback) 6: ((ALL=(Student)) OR ALL=(dental student)) OR ALL=(dental undergraduate) 7: #6 AND #5 AND #4 AND #3 AND #2 AND #1

Scopus (8/1/2024)

( TITLE-ABS-KEY ( "dental education" OR "Teaching materials" OR "Teaching methods" ) AND TITLE-ABS-KEY ( "Live demonstration" OR "Live presentation" OR "Instruction" OR "Dental demonstration" ) AND TITLE-ABS-KEY ( "Video demonstration" OR "Video recording" OR "Instructional video" OR "Computer-Assisted Instruction" ) AND TITLE-ABS-KEY ( "Academic Performance" OR "grade" OR "Assessment" OR "Educational Measurement " OR "Clinical Competence" OR "Competency" ) AND TITLE-ABS-KEY ( "satisfaction" OR "Feedback" OR "Surveys" OR "Questionnaires" ) )

Ovid (8/1/2024)

1 exp Education, Dental/ 20,397

2 dental education$.mp. 5,901

3 exp Teaching/ 93,673

4 teaching methods$.mp. 3,780

5 exp Teaching Materials/ 124,445

6 Teaching Materials$.mp. 7,211

7 1 or 2 or 3 or 4 or 5 or 6 230,829

8 Live demonstration$.mp. 168

9 live presentation$.mp. 43

10 dental demonstration$.mp. 6

11 instruction$.mp. 80,173

12 8 or 9 or 10 or 11 80,351

13 Video demonstration$.mp. 422

14 exp Video Recording/ 44,899

15 video recording$.mp. 32,252

16 (Instructional film and video).mp. [mp=title, book title, abstract, original title, name of substance word, subject heading word, floating sub-heading word, keyword heading word, organism supplementary concept word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms, population supplementary concept word, anatomy supplementary concept word] 11

17 exp Computer-Assisted Instruction/ 12,619

18 Computer-Assisted Instruction$.mp. 12,770

19 13 or 14 or 15 or 16 or 17 or 18 61,108

20 exp Academic Performance/ 4,214

21 academic performance$.mp. 7,688

22 grades$.mp. 58,940

23 exp Educational Measurement/ 167,328

24 assessment$.mp. 1,639,817

25 exp Clinical Competence/ 106,336

26 Clinical competence$.mp. 107,054

27 exp Competency-Based Education/ 4,666

28 Competency$.mp. 40,891

29 20 or 21 or 22 or 23 or 24 or 25 or 26 or 27 or 28 1,844,261

30 exp Personal Satisfaction/ 25,166

31 satisfaction$.mp. 227,869

32 exp Feedback/ 34,467

33 feedback$.mp. 164,082

34 exp "Surveys and Questionnaires"/ 1,226,017

35 (Surveys and Questionnaires$).mp. [mp=title, book title, abstract, original title, name of substance word, subject heading word, floating sub-heading word, keyword heading word, organism supplementary concept word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms, population supplementary concept word, anatomy supplementary concept word] 577,649

36 30 or 31 or 32 or 33 or 34 or 35 1,538,698

37 7 and 12 and 19 and 29 and 36 1,586

Eligibility criteria

No limit on the time of publication was set, and the last search was made in March 2024. Publications in English-language were included in this systematic review according to the inclusion/exclusion criteria (Table 2). The inclusion/exclusion criteria were formulated according to the PICOS approach (Population, Intervention, Comparison, Outcomes and Study Design).

Table 2.

Inclusion/exclusion criteria formulated according to the PICOS approach

	Inclusion	Exclusion
Population	Undergraduate Dental students	Post-graduate dental students Non-dental students
Intervention	- Recorded video demonstration of psychomotor clinical skill	- Online lecture - Live-video demonstration - Written scripts, slideshow, 3D models, online modules, AND any other method for psychomotor demonstration.
Comparison	Live demonstration	Live lectures
Outcomes	- Quantitative evaluation of student performance (grades). - Quantitative evaluation of student satisfaction scores.	- Qualitative evaluation of student performance. - Qualitative evaluation of student satisfaction scores.
Study Design	- Randomised controlled trials (RCT) - Quasi-experimental trials (QET) - Full text articles - Published in English-language	- Studies other than RCT or QET. - Publications not in English. - Published abstracts.

Study selection

The literature was identified and screened using the following keywords combined with the Boolean operators (“AND” and “OR”): “Dental education” OR “Teaching materials” OR “Teaching methods” AND “Live demonstration” OR “Live presentation” OR “instruction” OR “Dental demonstration” AND “Video demonstration” OR “Video recording” OR “Instructional video” OR “Computer-Assisted Instruction” AND “Academic performance” OR “Grades” OR “Assessments” OR “Competency” OR Clinical Competence” AND “Satisfaction” OR “Feedback” OR “Surveys” OR “Questionnaires”. Following duplicate removal, titles and abstracts were screened based on the inclusion/exclusion criteria. The full text of the selected articles was then comprehensively reviewed for eligibility. Disagreements regarding inclusion/exclusion decisions between reviewers (RNA and SM. AlJudaibi) were resolve by an independent investigator (BMA). There was no appraisal of agreement frequencies between reviewers.

Data collection and analysis

Two reviewer authors (RNA and SM. AlJudaibi) independently extracted data from the 10 selected studies. Data extracted included citation details, study design, sample size and distribution, sampling method, participants characteristics (e.g., level of education, gender, and location), intervention details (e.g., live vs. video demonstration and procedure being taught), outcome measures (e.g., students practical grades, knowledge grades, and feedback scores) and assessment results (statistical method used, p values, and effect size).

Quality assessment

The quality of selected studies was assessed using the modified Downs and Black quality assessment tool [19]. Question 27 of the assessment tool was modified by awarding a score of 1 if a power analysis was conducted and a zero if no power analysis was performed, based on previous recommendations [20]. Studies were assessed according to the quality of reporting, external validity, internal validity, selection bias, and power. Disagreements regarding quality assessment decisions between reviewers (RNA and SM. AlJudaibi) was resolve by an independent investigator (BMA). Meta-analysis was undertaken on studies in which student performance and/or satisfaction scores could be extracted and calculated.

Results

Study selection

A total of 3686 studies were identified (Fig. 1), of which 2222 studies remained following duplicate removal. Based on title and abstract screening 2188 studies were excluded and full text of 34 studies were comprehensively appraised for eligibility. This resulted in the inclusion of 10 studies in the systematic review.

Fig. 1.

Prisma flow diagram

Study characteristics

Characteristics of included studies are listed in (Table 3). Studies were quasi-experimental and randomized controlled trials, and all included a practical assessment as an outcome measure except the study conducted by Hila Hajizadeh et al. [21], where student’s knowledge and feedback were assessed.

Table 3.

Summary of included studies

No.	Study ID	Methodology						Participants Charecteristics
	(First author and year)	Study Design	Sample size		Sampling method	Procedure	Assessment	Level	Gender	Location
			Control Group	Intervention Group
1	Acosta 2023 [22]	Stratified Randomized Controlled Trial	14	14	Randomised	Class II Cavity Preparation mandibular 1st molar	Practical assessment using standard objective scoring rubric	Restorative Dentistry 1	n.r.	University of Baguio- Philippines
2	Alizadeh 2022 [15]	Quasi-experiment	23	21	Randomised	Orthodontic Dental Cast Trimming	1- Knowledge assessment through a written exam (MCQ) 2- Practical Assessment using a 20-item standard objective scoring checklist 3- Student Feedback using the standard Individual Development and Education Assessment (IDEA) questionnaire	8th Semester Students	Control group: 11 M/12F Intervention group: 9 M/12F	Zanjan University Dental School-Iran
3	Almohareb 2016 [23]	Randomized Controlled Trial	36	36	Randomised	1-Class I cavity preparation for amalgam restoration on tooth # 46 2- Class II (occlusal-mesial) preparation for amalgam restoration on a second tooth # 46.	Practical assessment using a 4-item standard objective scoring checklist	2nd Year	Male	King Saud University, Kingdom of Saudi Arabia
4	Alqahtani 2015 [24]	Randomized Controlled Trial	26	23	Randomised	fabricating the Adam’s Clasp	1- Practical assessment using using a 10-item standard objective scoring checklist 2- Student feedback using an 8-item questionnaire	4th Year	Male	King Saud University, Kingdom of Saudi Arabia
5	Al-Zain 2021 [25]	Stratified Randomized Controlled Trial	60	60	Randomised	light-curing technique	1- Practical assessment using an 8-item standard objective scoring checklist 2- Student Feedback using a 7-item questionnaire	3rd Year	114 F/88 M	King Abdul-Aziz University, Kingdom of Saudi Arabia
6	Atik 2020 [6]	Randomized Controlled Trial	58	58	Randomised	Orthodontic wire bending	1- Practical assessment using a 10-stage rubric 2- Student Feedback using an 11-item questionnaire	4th year	79 F/37 M	Hacettepe University, Turkey
7	Hajizadeh 2014 [21]	Randomized Controlled Trial	35	35	Randomised	Instruction of Fiber-Reinforced Composite (FRC) post restorations.	1- Knowledge assessment using a written exam 2- Student Feedback using a questionnaire	5th year	n.r.	Mashhad University, Iran
8	Packer 2001 [26]	Randomized Controlled Trial	30	31	Randomised	Altered cast procedure	1- Practical assessment using a 5-item rubric 2- Student Feedback using a questionnaire	n.r.	n.r.	n.r.
9	Hanuksornnarong 2019 [5]	Stratified Randomized Controlled Trial	31	32	Randomised	Working Length Determination Using Electronic Apex Locator	1- Knowledge assessment using a written test. 2- Practical Assessment using a 12-item rubric 3- Student Feedback using a 5-item questionnaire	4th year	Live9M/22F Vid10M/22F	Chulalongkorn University, Thailand
10	Thilakumara 2018 [14]	Randomized Controlled Trial	36	40	Randomised	Arranging artificial teeth	1- Knowledge assessment through a written exam 2- Practical Assessment using a rubric 3- Student Feedback using a 10-item questionnaire	3rd Year	26 M/50F	University of Peradeniya, Sri Lanka

n.r. not reported

One study is quasi-experimental [15], and the remaining nine are randomised control trials [5, 6, 14, 21–26]. Three studies compared live to video demonstrations of pre-clinical dental procedures in orthodontics: orthodontic dental cast trimming [15], fabricating the Adam’s clasp [24], and orthodontic wire bending [6]. Three studies evaluated student performance in operative dentistry: tooth preparation and restoration [22, 23] and light curing technique [25]. Three prosthodontic procedures were assessed: fiber re-enforced composite post restorations [21], altered cast procedure [26], and arranging artificial denture teeth [14]. One study in endodontics: working length determination using electronic apex locator was assessed [5].

The sample size in all studies ranged from 28 [22] to 120 participants [25]. In two of the ten studies, participants were only male [23, 24]; in five studies, females predominated [5, 6, 14, 15, 25]. Three studies did not report this information [21, 22, 26].

Assessment of the risk of bias/quality assessment

The quality of ten studies were assessed using the modified Downs and Black quality assessment tool (Table 4) [19]. Based on total scores, studies were considered excellent [22, 27, 28]; good [20, 21, 23–26]; fair [15–19]; and poor (≤ 14) [27]. Nine studies were classified as good [5, 6, 14, 15, 21–25]; and one study was fair [26].

Table 4.

Quality assessment using downs and black assessment tool

Downs and Black quality assessment tool	Acosta 2023 [22]	Alizadeh 2022 [15]	Almohareb 2016 [23]	Alqahtani 2015 [24]	Al-Zain 2021 [25]	Atik 2020 [6]	Hajizadeh 2014 [21]	Packer 2001 [26]	Hanuksornnarong 2019 [5]	Thilakumara 2018 [14]
Reporting (0–11)
Q1. Objectives	1	1	1	1	1	1	1	1	1	1
Q2. Outcomes	1	1	1	1	1	1	1	1	1	1
Q3. Participants	1	1	1	1	1	1	1	0	1	1
Q4. Intervention	1	1	1	1	1	1	1	1	1	1
Q5. Confounders	1	0	1	0	1	0	0	0	1	0
Q6. Findings	1	1	1	1	1	1	1	1	1	1
Q7. Variability	1	1	1	1	1	1	1	1	1	1
Q8. Adverse events	1	1	1	1	1	1	1	1	1	1
Q9. Lost to follow-up	1	1	1	1	1	1	1	1	1	1
Q10. Probability	1	1	1	1	1	1	1	1	1	1
External Validity (0–3)
Q11.Subject selection	1	1	1	1	1	1	1	1	1	1
Q12.Subject participation	1	1	1	1	1	1	1	1	1	1
Q13. Assessments	1	1	1	1	1	1	1	1	1	1
Internal Validity (0–7)
Q14. Intervention	0	0	0	0	0	0	0	0	0	0
Q15. Blinding	0	1	0	0	0	0	0	1	1	1
Q16. Results	1	1	1	1	1	1	1	1	1	1
Q17. Follow-up	1	1	1	1	1	1	0	0	1	1
Q18. Statistics	1	1	1	1	1	1	1	1	1	1
Q19. Compliance	1	1	1	1	1	1	1	1	1	1
Q20.Outcome measures	1	1	1	1	1	1	1	1	1	1
Selection Bias (confounding) (0–6)
Q21. Participants	1	1	1	1	1	1	1	1	1	1
Q22.Time period	1	1	1	1	1	1	0	0	1	1
Q23.Randomization	1	1	1	0	1	1	1	1	1	1
Q24. Concealment	0	0	0	0	0	0	0	0	0	0
Q25. Analysis	1	0	1	0	0	0	0	0	0	0
Q26. Follow-up	1	1	1	1	1	1	1	1	1	1
Power (0–1)
Q27. Calculation	0	0	0	0	0	0	0	0	0	0
Overall Score (0–28)	22	22	22	21	22	21	21	19	23	22
Quality of study	Good	Good	Good	Good	Good	Good	Good	Fair	Good	Good

Total score: excellent [22, 27, 28]; good [20, 21, 23–26]; fair [15–19]; and poor (≤ 14)

Four studies partially accounted and adjusted for principle confounders such as student level of competence and student gender before the start of the study. Two studies adjusted based on student level of competence [22, 23]; one study accounted for student gender [25]; and one study adjusted for both confounders [5]. Remaining seven studies did not report on principle confounding variables [6, 14, 15, 21, 23, 24, 26].

In four studies, examiners were blinded when assessing student performance [5, 14, 15, 26]. All studies reported randomization of study groups and one study reported randomly assigning students based on their serial number which does not ensure random allocation [24].

Time period between intervention and outcome for intervention and control groups was unclear in studies where recruitment did not occur over the same period of time [21, 26]. One study reported that clinical demonstration was performed at different times [21]; one study reported that students were timetabled to attend in groups of 7 or 8, followed by random assignment to either the control or intervention groups [26].

Results of individual studies

All studies evaluated student psychomotor skills through a practical assessment rubric except the study by Hajizadeh et al. [21], who assessed theoretical knowledge and perspectives of students in relation to the educational method received, using a slide presentation and a questionnaire, respectively. Student knowledge was evaluated in four studies [5, 14, 15, 21], and feedback was collected through a questionnaire in all studies except [22, 23] where assessment was solely focused on student’s psychomotor skills.

Acosta et al. and Almohareb conducted studies focusing on evaluating students’ skills in amalgam cavity preparations as part of an introductory operative dentistry course [22, 23]. Acosta ensured competency levels were accounted for in the random distribution of students, while Almohareb compared outcomes between live and video demonstrations across two different practical projects. Notably, Almohareb ensured that students experienced live demonstrations in one project and video demonstrations in the other. However, in Almohareb’s study, students had four additional practice sessions, potentially influencing their performance beyond the instructional method itself.

Thilakumara et al. also allowed students to practice arranging denture teeth for a week post-instruction before their skills were evaluated in a practical exam [14]. In contrast, other studies included in this review had students perform tasks immediately after demonstrations, with assessments conducted by the end of the laboratory session [5, 6, 12, 15, 25, 26].

Synthesis of results (meta-analysis)

The meta-analysis included eight studies rated as good according to the Downs and Black quality assessment tool [5, 6, 12, 15, 21–23, 25]. The study by packer et al. [26] was excluded based on its “fair” quality rating. Additionally, studies were required to provide sufficient data to calculate standardized mean differences (SMD), including means, standard deviations, and sample sizes for assessed psychomotor skills, knowledge levels, or satisfaction outcomes. As a result, one study was additionally excluded due to insufficient data reported [14]; specifically, pre- and post-intervention grades for both the live and video demonstration groups were not provided. Consequently, direct comparisons with other studies in terms of effect size and outcome measures assessment were not possible.

A fixed effect model was used to pool data when there was no significant heterogeneity (I² ≤ 50%); otherwise, the random effects model was used when heterogeneity was present (I² > 50%). Heterogeneity was quantified using the I² statistics, with Tau² calculated to estimate study variance, and the Chi-squared test was used to measure the statistical significance of heterogeneity.

The standardized mean differences (SMD) were calculated using Cohen’s d with a 95% confidence interval (CI) to ensure standardization of outcomes amongst included studies using different measurement scales and statistics. Sensitivity Analyses were conducted by excluding studies contributing to significant heterogeneity. For example, the exclusion of the study by Al-Zain et al., has contributed to a significant reduction of heterogeneity from 96 to 0%, ensuring robust pooled results. All statistical analyses were conducted using SPSS (Statistical Package for the Social Sciences, version 21).

Data pertaining to psychomotor skills and knowledge acquisition scores were extracted and statistically analysed. However, student satisfaction scores collected through questionnaires in eight studies [5, 6, 12, 14, 15, 21, 25] could not be included in the meta-analysis as a result of variability in the questionnaire formats and questions administered to students across studies.

Student performance

This analysis was based on eight studies: five assessed the difference in students’ psychomotor skills [6, 12, 22, 23, 25], one reported differences in students’ knowledge levels [21], and two studies reported on both [5, 15]. The fixed effect model was used to pool data when there was no significant heterogeneity (I² ≤ 50%); otherwise, the random effects model was used when heterogeneity was present (I² > 50%).

Psychomotor skills

Seven studies were included in this analysis [5, 6, 12, 15, 22, 23, 25]. The standard mean difference (Cohen’s d) is 0.68, with a 95% confidence interval of -0.62; 1.98 (P < 0.01) (Fig. 2). Data were heterogeneous, (Tau² = 1.8926, X² test = 134.63, I² = 96%) indicating significant true differences or variability between the effect sizes of included studies, and a considerable amount of total variation in the effect sizes that cannot be explained by chance alone. Through a sensitivity analysis, the high heterogeneity of this outcome was caused by the study of Al-Zain et al. [25]. No significant heterogeneity was recorded following the exclusion of this study (P = 0.44, Tau² < 0.0001, X² test = 4.78, I² = 0%) (Fig. 3). Statistically significant differences between study groups could be identified in favour of video demonstrations [22]. Student’s scores indicate that psychomotor skills were significantly improved following video demonstrations in comparison to live demonstrations.

Fig. 2.

Forest plot of student’s scores in terms of psychomotor skills between the experimental group: video demonstration, and control group: live demonstration. Note the significant heterogeneity

Fig. 3.

Forest plot of student’s scores in terms of psychomotor skills between the experimental group: video demonstration, and control group: live demonstration. Note the non-significant heterogeneity

Knowledge level

Three studies were included in this analysis. The standard mean difference (Cohen’s d) is 0.28, with a 95% confidence interval of -0.83;1.39 (P = 0.05) (Fig. 4). Data were heterogeneous, (Tau² = 0.1362, X² test = 6.05, I² = 67%) indicating significant true differences or variability between the effect sizes of included studies, and a considerable amount of total variation in the effect sizes that cannot be explained by chance alone. Through a sensitivity analysis, the high heterogeneity of this outcome was caused by the study of Hanuksornnarong et al. [5]. No significant heterogeneity was recorded following the exclusion of this study (P = 0.54, Tau² = 0, X² test = 0.37, I² = 0%) (Fig. 5). Statistically significant differences between study groups could be identified in one study in favour of video demonstrations [21]. Knowledge scores were significantly improved following video demonstrations in comparison to live demonstrations.

Fig. 4.

Forest plot of student’s knowledge scores (significant heterogeneity) Forest plot of student’s knowledge scores between the experimental group: video demonstration, and control group: live demonstration. Note the significant heterogeneity

Fig. 5.

Forest plot of student’s knowledge scores (significant heterogeneity) Forest plot of student’s knowledge scores between the experimental group: video demonstration, and control group: live demonstration. Note the non-significant heterogeneity

Discussion

Teaching psychomotor skills often involves observing expert models, a process known as observational learning [28, 29]. This method, effective for learning both simple and complex skills, is enhanced when combined with physical practice [30]. According to Ram et al., observational learning exposes learners to external stimuli, such as live or video demonstrations, facilitating the formation of cognitive representations and skill execution [31]. This approach enhances student awareness, knowledge acquisition, and retention by enabling them to practice based on visual demonstrations rather than verbal instructions [29].

In today’s educational landscape, technology, particularly videos, plays a critical role across various sectors, including traditional and online classrooms [32]. Research indicates that video demonstrations are more effective than live demonstrations in teaching new psychomotor skills [33]. Students exhibit higher proficiency when learning from videos due to enhanced visualization, the ability to practice concurrently with viewing, and the flexibility to review demonstrations as needed [21, 22, 34–36].

In dental education, live interactive demonstrations of clinical procedures have traditionally been highly effective. However, there is a growing integration of video demonstrations to enhance teaching methods [5, 10]. The limited adoption of video demonstrations alone for teaching clinical skills stems from reduced interaction and engagement experienced by students in this mode. Interaction and engagement are crucial for enhancing understanding and boosting confidence among students. Nevertheless, video demonstrations offer distinct advantages such as consistent information delivery, detailed procedural views, the ability to mitigate staffing or time constraints, and enhancing learning opportunities throughout lab sessions.

A systematic search of the literature has been conducted to identify studies comparing live demonstrations to video demonstrations in dental education. These studies have investigated and analyzed undergraduate students’ performance scores in terms of their psychomotor skills, level of knowledge, and satisfaction scores reported through questionnaires. Studies were assessed using the modified Downs and Black tool [19], with nine out of ten studies classified as good and included in meta-analyses. Exclusions were due to insufficient data [14], fair quality ratings [26], or high outcome heterogeneity [5, 25].

In this study, findings vary among different research, with some indicating significant improvements with video-based learning, while others suggest negligible differences or slightly better outcomes for live demonstrations. However, the meta-analysis highlighted a substantial positive impact of video-based learning over live demonstrations, revealing a combined effect size (Cohen’s d) of 1.4597 and a 95% confidence interval. This suggests that video-based methods significantly enhance educational outcomes across various measures, including knowledge acquisition and practical skills.

Video-based demonstrations have been reported to significantly enhance students’ psychomotor skills, as highlighted by Acosta et al., and facilitate knowledge acquisition, as shown by Hajizadeh et al., when compared to live demonstrations [21, 22]. Other studies indicate that video demonstrations are equally as effective as live demonstrations in teaching dental clinical procedures in terms of practical skills and knowledge levels.

The preference for video demonstrations is particularly pronounced in conservative dentistry and endodontics compared to other dental disciplines, as noted in studies by Inquimbert et al. and Acosta et al. [22, 37]. These findings underscore the effectiveness and growing acceptance of video-based approaches in enhancing educational outcomes in specific dental specialties.

In this systematic review, students’ psychomotor skills were evaluated through practical assessments across various subjects. For instance, in orthodontics, assessments covered skills such as fabricating adam’s clasp, orthodontic wire bending, and cast trimming [6, 12, 15]. In operative dentistry, evaluations included practices such as light curing techniques and cavity preparations [22, 23, 25]. Endodontics assessments involved tasks such as determining working length using an electronic apex locator [5], while in prosthodontics, assessments encompassed skills like the altered cast technique and setting artificial denture teeth [14, 26].

Students’ feedback on instructional methods in dental education reveals distinct preferences and perceptions. Procedural videos are commended for their clarity, visibility of treatment steps, and the ability to pause, rewind, and review instructions multiple times [12, 14, 21, 25], along with their perceived educational adequacy [14, 21, 25]. However, students have also noted drawbacks such as the tendency for fast-forwarding through videos and missing minor details [5].

In contrast, live demonstrations are highly valued for their interactive nature, enabling students to directly engage with instructors, ask questions, and receive real-time tips and guidance [14, 25]. Students also appreciate the comprehensive observation of treatment steps facilitated by live demonstrations [5, 21, 25, 26].

Study limitations

The impact of variants such as different procedures, evaluation criteria, study durations, and other variables on the outcomes could not be analyzed through meta-regression in this study. This limitation arose due to the insufficient number of studies available and included in the meta-analysis. Meta-regression analyses generally require a minimum of 10 studies per predictor to draw robust conclusions [38]. Given the constraints, additional research with a larger sample size could provide a more comprehensive understanding of how these variables influence educational outcomes in dental education.

The high heterogeneity observed in this study can be attributed to several factors. Firstly, there is variability in the clinical procedures being investigated, each requiring different levels of skill and presenting unique challenges. Secondly, the sample sizes across studies vary significantly, ranging from 28 [22] to 120 participants [25], which can impact the statistical power and generalizability of findings. Additionally, differences in study durations and variations in the effectiveness of the instructional interventions further contribute to the heterogeneity observed.

Recommendations for future research

To address the aforementioned limitations and provide more robust conclusions, it is recommended that additional RCTs comparing video-based and live demonstrations be conducted. These trials should aim to systematically evaluate both techniques across various dental specialties and academic levels. By doing so, researchers can better understand how each instructional method impacts student performance and satisfaction scores. This approach will also help in tailoring educational experiences to maximize learning outcomes in dental education.

Conclusion

Within the scope of this study, video demonstrations emerge as viable alternatives to live demonstrations in dental education for teaching clinical procedures. Procedural videos are valued for their clarity, providing clear visibility of treatment steps, and offering students the flexibility to pause, rewind, and review instructions multiple times. However, students highly benefit from the interactive nature and engagement facilitated by live demonstrations. Integrating both methods strategically could optimize educational outcomes by leveraging their respective strengths.

Overall, further research with standardized methodologies and larger sample sizes will be essential to clarify the comparative effectiveness of video-based versus live demonstrations in dental education.

Abbreviations

RCT

Randomised Controlled Trials

QET

Quasi-Experimental Trials

n.r.

not reported

Authors' contributions

RNA was involved in study design, data collection, data analysis, and manuscript writing. SM.AlJudaibi was involved in study design and data collection. BMA was involved in study design, data collection. RSA, SM.Alnafaiy, and FME have contributed to the study design and the revision of the final version of the manuscript. All authors read and approved the final manuscript.

Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

This research was approved by the Institutional review board at Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia. IRB approval granted on March 17th, 2024 with approval no. 24–0616.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.