Effectiveness of an educational application on dental students prescription knowledge: a quasi-experimental study

Abstract

Background

Today, with the increase of new technologies and the development of digital devices, new methods can be used for better and more efficient education. Therefore, this study was carried out to explore the effect of a Windows based application on dental students’ prescription knowledge.

Methods

This quasi-experimental study was conducted on 21 dental students of Guilan University of Medical Sceinces, Iran in 2024 using a prescription writing training software containing 24 valid researcher-made clinical senarios. Before and after using the application, the students participated in a 10-question valid test made by the researcher with the same taxonomy. Satisfaction Survey Questionnaire for Software containing 25 questions was given to each student. Then, a questionnaire containing demographic characteristics, hours of software usage, and pre-and post-test scores was completed by the students online via a virtual link. Data analysis was done using SPSS 26 software, and the significance level was considered less than 0.05.

Results

Using this application, dental students achieved a significantly higher average post-test score in prescription knowledge compared to their pre-test score, 69.05 ± 19.97 vs. 41.43 ± 15.26, respectively (p < 0.001, effect size 1.8 [0.99–2.61]). Also, their overall level of satisfaction with this application has been high.

Conclusion

Given the study’s limitations, using medical prescription training software in the form of a serious game appears to be effective in enhancing dental students’ prescribing skills.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12909-025-08534-4.

Introduction

In the evolving landscape of dental education, the integration of technology has become increasingly essential to enhance learning outcomes and prepare students for the complexities of clinical practice [1]. Among the numerous areas requiring thorough understanding, prescription knowledge stands out as a critical component for safe and effective patient care. Prescribing medications appropriately is fundamental for dental professionals, as it directly impacts patient safety, treatment efficacy, and overall health outcomes [2]. However, despite its importance, many dental students face challenges in mastering pharmacology and safe prescribing practices [3], often due to traditional teaching methods that may not fully engage learners or support long-term retention of complex information [4].

Traditional pedagogical approaches, such as lectures, textbooks, and passive learning strategies, have limitations in engaging students actively and providing personalized, interactive learning experiences [5]. These methods often lack the flexibility and immediate feedback necessary to address individual learning paces and styles, which can hinder the effective acquisition and retention of essential knowledge. As a result, there is a growing interest in leveraging digital technologies and educational applications to supplement conventional teaching methods. Such innovations aim to create more engaging, accessible, and interactive learning environments that can reinforce core concepts and improve knowledge retention [6].

Recent advancements in mobile technology and educational apps have opened up new avenues for delivering pharmacology education to medical sciences students [7]. Mobile applications offer numerous advantages, including anytime-anywhere access, multimedia content, interactive quizzes, and real-time feedback, making them ideal tools for enhancing learning outside the traditional classroom setting. These apps can provide a more personalized educational experience, allowing students to practice and reinforce their knowledge at their own pace [8, 9]. Moreover, digital tools have the potential to simulate real-life prescribing scenarios, enabling students to develop their decision-making skills in a safe and controlled environment [10].

In addition to traditional mobile applications and digital simulations, serious games have emerged as a promising educational tool in pharmacology and clinical training. These games are designed to combine entertainment with learning objectives, engaging students in immersive scenarios that foster critical thinking and problem-solving skills. By simulating complex prescribing situations and ethical dilemmas, serious games can enhance learners’ clinical reasoning, improve retention of pharmacological knowledge, and increase motivation to engage with the material [11]. As an interactive and often competitive format, serious games also encourage repeated practice in a low-stakes environment, which can translate into better preparedness for real-world clinical practice.

Despite the promising potential of educational applications, their effectiveness in improving prescription knowledge among dental students remains an area requiring further investigation. While some studies suggest that technology-enhanced learning can lead to better understanding and increased confidence, others highlight the need for rigorous research to validate these benefits within specific educational contexts [12]. In particular, there is limited research focused on assessing how well such applications translate into improved clinical readiness and prescribing accuracy among dental students [13, 14].

This study aims to address this gap by evaluating the effectiveness of a specialized educational application designed to enhance prescription knowledge among dental students. Furthermore, this research seeks to contribute to the ongoing efforts to improve the quality and effectiveness of dental education, ensuring that future professionals are adequately prepared to prescribe safely and confidently in their clinical practice.

Methods

This quasi-experimental study was conducted on 21 dental students in their final two years of study at Bandar Anzali International Campus from March 2023 to January 2024. These eligible students, in their fifth or sixth year of dentistry, were recruited using the convenience sampling method. The inclusion criteria included having completed or being in the process of completing the Diagnostics 1, 2, and 3 courses, as well as the Pain and Medication courses, and expressing willingness to participate in the study. Participants who did not utilize the application or did not complete the post-test were considered for exclusion from the study. The study was approved by the ethical review committee at Guilan University of Medical Sciences, Iran, with the approval number: IR.GUMS.REC.1402.316.

To determine the minimum sample size using MedCalc 23.2.7, based on the results from a similar study by Rabiepoor [15] et al. (2016), with α = 0.05, β = 0.20, a mean difference of 2.1, and a standard deviation of differences of 3, a total of 18 students are needed for this study.

The implementation phases of this study were carried out in three stages. In the first stage, the educational goals of the course were established. Following consultations with expert professors and a review of the relevant texts and articles [16, 17], the course’s educational content was developed, consisting of 25 clinical scenarios with equal taxonomy. These scenarios underwent content validity assessment by eight dental experts. One scenario was removed, and the Content Validity Ratio (CVR) and Content Validity Index (CVI) of the remaining items were 0.75 and 0.87, respectively.

In the second stage, the software was developed as a serious game. This Windows-based application initially grants each user a starting total of 100 points. Ten pre-selected clinical scenarios, randomly chosen by researchers from a pool of 24 are presented to users. Each scenario appears on a separate page and describes a clinical case involving an oral disease. Users must select the correct medication to treat the condition. For each scenario, four options are displayed, of which only one is correct. To choose the right answer, users must pay attention to details such as the drug’s name, its form, the dosage, and the proper method of administration.

At the start, the software shows a life bar with 100 points. A wrong answer costs 10 points from the current total, and the screen displays the reason for the incorrect choice (Fig. 1).

Fig. 1.

A snapshot of the application showing the first case of study, with the initial score of 100 points displayed in a green bar, and the feedback provided to the examinee for an incorrect answer. In-image text presents the following case to the examinee: “A patient with diabetes managed on sulfonylureas presents with pain in the upper sixth tooth and a prior episode of hypoglycemic shock. What is the first-line analgesic for this patient?” The examinee selected B as the correct answer. The pop-up window displays the feedback:“Incorrect. Ibuprofen and other nonsteroidal anti-inflammatory (NSAIDs) may worsen hypoglycemia in patients managed with sulfonylureas.” In this case, the application will subtract 10 points from the initial 100 points when the user clicks the OK button to proceed to the next scenario

The user can pick one of the remaining three options; if that answer is also wrong, another 10 points are subtracted. If the correct answer is chosen, the next question appears. This continues, with 10 points deducted for every wrong answer. Users can keep trying until their life points reach zero; once it hits zero, they must restart the program from the beginning to improve their prescription-writing skills. Once the test is finished, the user’s total score will appear on a pop-up screen (Fig. 2).

Fig. 2.

A snapshot of the application showing a the final case of pre-test to the examinee: “A 61-year-old man with chronic renal failure, who wears complete dentures, presents with dry mouth and a burning sensation on the palate. Clinical examination reveals erythematous macules on the palate. What is the first-line treatment for this patient?” The examinee responded to the case and received appropriate feedback in the same manner shown in Fig. 1. Subsequently, the final pop-up window displays the examinee overall pre-test score: “Your pre-test score is 50. Please note this score.”

In the third phase of the study, known as the implementation phase, the software was given to 21 dental students who took part in this research. They were then asked to record their final score obtained from their first time using of software as pre-test. The students were instructed to use the software for a period of three weeks. After this, they were retested, as post-test, using ten clinical scenarios chosen from a pool of 24 scenarios, all of which shared the same taxonomy and had been selected by the researchers.

Additionally, the students completed a Satisfaction Survey Questionnaire. This self-administered questionnaire had previously undergone a validation and reliability process in a similar study [18]. Six software development engineers, each with more than five years of experience, assessed the content validity. Using a 4-point Likert scale, each expert evaluated content validity. The instrument’s content validity was deemed acceptable (CVI = 0.99; CVR = 0.6–1). The reliability was supported by a Cronbach’s alpha of 0.77 and an ICC of 0.88 in a two-week test–retest pilot study with 30 subjects. Furthermore, students completed an online questionnaire through a virtual link, which collected information such as gender, age, year of university enrollment, hours spent using the educational software, their scores before (pre-test) and after (post-test) using the software, and their satisfaction survey results. Since the participants’ language was Persian, all the content and research tools used in this study were in Persian. The data was then organized and analyzed statistically.

Descriptive statistics including frequency, percentage, mean, and standard deviation were employed to summarize the data. For data analysis, prior to paired sample t-test the Shapiro-Wilk test was performed to assess the normality of the distribution for the pre-test and post-test scores. The results indicated that both data sets follow a normal distribution. After confirming the other basic assumptions for paired samples t-tests, the test was used to compare pre-test and post-test scores in the subjects. These analyses were carried out using SPSS 26 and MedCalc 23.2.7 softwares. A significance level of 0.05 was considered for all tests.

Results

This research involved 21 dental students, all of whom completed both the pre- and post-tests, including 12 male (57.1%) and 9 females (42.9%). The average age of the participants was 26.1 years, with a standard deviation of 6 years. Their ages ranged from 22 to 50 years. 33.3% of the participants were aged 24, as shown in Fig. 3 and Fig. 4.

Fig. 3.

Frequency of dental students by age

Fig. 4.

The relative frequency of the research units based on the amount of hours spent using the educational software

The data on software usage indicates that most participants (38.1%) used the software for 4 h. The mean usage time of the educational software was 4.24 h, with a standard deviation of 1.37 h.

Table 1 presents the scores of the students involved in this study. The data indicates that both the minimum and maximum scores achieved by the students on the post-test have risen. The mean difference between students’ pre- and post-test scores is approximately one-fourth of the total score.

Table 1.

Comparison of the scores of dental students pre and post-test

Variable	N	Min	Max	Range	Mean	SD	P -Value	Effect Size
Pre-test	21	20	80	60	41.43	15.26	< 0.001	1.8(0.99–2.61
Post-test	21	30	100	70	69.05	19.97

Mean Difference: 27.61 (95% CI:18.19–37.04) SD: 20.71 DF = 20

To compate the pre and pos-test scores a paired samples t-test was performed. The results showed a significant difference (p < 0.001) between the mean scores of students in pre and post-test. Using the observed mean difference, standard deviation, alpha level, and sample size, a post-hoc power analysis was conducted [19] to estimate the probability of correctly rejecting the null hypothesis if it is false. The analysis indicated a power of > 0.99, suggesting that the study had a very high likelihood of detecting a true effect of the specified size.

Based on the students’ responses to the Satisfaction Survey Questionnaire, most participants were satisfied with nearly all aspects of the survey. However, according to item 3 in the questionnaire, 4 out of 21 dental students (19.05%) felt that the information on each page was poorly organized. This item received the highest number of “NO” responses compared to other survey items. While some students expressed dissatisfaction with the app’s color scheme and labeling, most were pleased with the speed of page navigation, the information provided on each page, and the scientific content of the software (such as drug forms and dosages). Only a small number of participants were dissatisfied with the speed at which educational content was found and displayed (Table 2).

Table 2.

Dental students’ satisfaction with prescription application

No	Items	Yes n (%)	No n (%)	Total n (%)
1	The font and font size on the application pages are appropriate	21(100%)	0(0%)	21(100%)
2	The size of the buttons, menus and screen of the application is appropriate.	19(90.48%)	2(9.52%)	21(100%)
3	The information presented on each page is organized.	17(80.95%)	4(19.05%)	21(100%)
4	Different parts of the application have appropriate colors and names.	18(85.71%)	3(14.29%)	21(100%)
5	This application has a suitable speed for navigating different pages and accessing educational topics.	19(90.48%)	2(9.52%)	21(100%)
6	The application is saved for reuse in the last pages you have read.	18(85.71%)	3(14.29%)	21(100%)
7	After choosing the educational topic, the relevant content will be displayed quickly.	20(95.24%)	1(4.76%)	21(100%)
8	The application allows you to find the desired topic quickly.	20(95.24%)	1(4.76%)	21(100%)
9	The information provided on each page is sufficient.	19(90.48%)	2(9.82%)	21(100%)
10	The scientific content of the application is sufficient to teach students about writing prescriptions for patients with common oral and dental problems.	21(100%)	0(0%)	21(100%)
11	The scientific content of the application is enough to teach students about the knowledge of each drug, such as the form, dosage, appropriate method of administration, and the number of times and duration of drug administration.	19(90.48%)	2(9.82%)	21(100%)
12	The scientific content of the application is suitable for training students in choosing the correct medicine.	21(100%)	0(0%)	21(100%)
13	The scientific content of the application is suitable for teaching students about the need to prescribe drugs with caution or the prohibition of prescribing drugs.	21(100%)	0(0%)	21(100%)
14	Additional explanations related to each drug help to teach the topics	20(95.24%)	1(4.76%)	21(100%)
15	The scientific content used in this application is easy to understand.	21(100%)	0(0%)	21(100%)
16	The application is easy to use.	21(100%)	0(0%)	21(100%)
17	The titles and messages in the application are simple and understandable	21(100%)	0(0%)	21(100%)
18	The application has a simple and understandable guide.	21(100%)	0(0%)	21(100%)
19	The application is simply able to increase students’ scientific knowledge.	21(100%)	0(0%)	21(100%)
20	The information provided about each drug is complete.	20(95.24%)	1(4.76%)	21(100%)
21	The information provided in the application is appropriate to the level of understanding and knowledge of general dentistry students	21(100%)	0(0%)	21(100%)
22	The information provided in the application meets all educational needs for writing prescriptions for patients with oral and dental problems	21(100%)	0(0%)	21(100%)
23	The information in the application is displayed regularly and concisely	21(100%)	0(0%)	21(100%)
24	The layout of the pages of this application is diverse and attractive	20(95.24%)	1(4.76%)	21(100%)
25	The general conditions of the application are acceptable	21(100%)	0(0%)	21(100%)

Discussion

In recent years, educational applications have gained significant popularity across various fields of education. The influence of modern teaching approaches, such as utilizing these software tools, on advancing the learning process has been recognized and established [20].

According to a number of studies, 6% of educational software was designed by medical professionals, 15% by associations or publishers and 63% of this software was designed by the users themselves. According to these studies, the involvement of medical professionals in the development and design of this software appears to be limited, particularly in areas such as quality evaluation, regulation, and safety [21–23]. Hence, further research is necessary to explore the impact of these software tools, and their design should be enhanced with high standards of quality to facilitate the transfer of learning to real-world settings and support changes in organizational procedures [23]. Medical educational software has the potential to guide practitioners in designing and assessing the quality of these tools. Moving forward, we can expect substantial advancements in the field of digital education.

Utilizing game-based approaches in designing educational software can significantly enhance learning outcomes. However, the availability of specialized games in dentistry appears to be limited. Gaming as an educational entertainment tool can encompass video games, puzzles, or card games played on computers, mobile devices, or in real life. Despite their potential, serious games remain underused, with only a few studies examining their effectiveness. Several research efforts have indicated that serious games are equally effective as other methods in achieving educational objectives [15, 16]. The escape game is a type of serious game that originated in Japan. It has been utilized in a study to teach endodontic skills, demonstrating potential to enhance critical thinking, the ability to work under pressure, and teamwork [24]. Serious games may also serve as a supplementary strategy to engage students and enhance learner satisfaction [24–26].

Patients visiting dental clinics may present not only with oral and dental issues but also with different systemic diseases. As a result, prescribing medication for these patients necessitates specialized skills and careful considerations [27]. Many studies have highlighted the high prevalence of prescription errors made by dentists, underscoring the necessity of improving educational approaches, such as incorporating educational software, to address this issue [28]. Dental students also require opportunities to revisit topics covered during their university education. To the best of our knowledge, there are no existing assessment tools for prescription games within dental education. Therefore, this study was conducted to develop, implement, and evaluate prescription writing skills for treating patients with oral and dental conditions. Additionally, some educational software incorporates artificial intelligence, and the integration of AI and digital technologies has ushered in a new era in dentistry [29].

In this study, we evaluated the impact of prescription writing training software on dental students at a university in northern Iran. The pre-test results indicated that the students’ prescribing skills were at a low level, scoring only 41 out of 100. Numerous studies have explored prescribing errors and have revealed a significant rate of errors committed by both doctors and dentists in medication prescribing, Hamian et al. [30], Nezafti et al. [31] and Kia et al. [32] reported 94%, 98%, and 97.2% of prescription errors, respectively.

Given that topics like drug form and dosage, drug interactions, and prescription writing are covered during education, these results indicate that current training methods are insufficient, and additional new approaches are needed alongside traditional teaching methods. Furthermore, there is a clear necessity for more comprehensive training of students in this field throughout their studies [33].

The post-test scores of the students in the study were significantly higher than their pre-test scores, indicating that the use of educational software had a notable positive impact on their prescription writing skills. This finding aligns with the study by Jalali et al. [34]which examined the effect of dental educational software—although prescribing was only a limited part of this software—on dental students in Tabriz. However, another study found that educational software did not effectively improve the diagnostic skills of dental students. This lack of effectiveness was attributed to the software being used under the supervision of professors from selected universities in another country, which may have caused a misalignment between the content and the students’ final exam materials. It emphasizes that educational software should be tailored to meet the specific needs of the target community, considering the cultural and social factors relevant to that region [35].

Studies have shown that the use of personal digital devices is well-accepted by medical, dental, and nursing students and offers benefits for learning [36, 37]. The use of educational software and smartphones by students for learning purposes has grown [38]. Wallace et al. [36], Chase et al. [39] indicated that educational software was advantageous for medical students. Additionally, it has been noted that the most commonly used educational software among medical students pertains to diagnosis and treatment planning [38, 40]. A study revealed that the use of mobile software enhanced the performance and skill scores of nursing students in South Korea [37].

In this study, the implementation of educational software yielded favorable outcomes, with the majority of dental students expressing satisfaction with its use. Similarly, Mladenovic et al. found that educational software on traumatic dental injuries resulted in over 90% satisfaction among dental students [41]. In a study, Gilavand et al. demonstrated that educational software enhanced students’ understanding of the symptoms of systemic diseases, oro-dental aspects, and potential complications associated with systemic conditions [42].

Limitations

The absence of a control arm, the potential pre-test learning effect, probable hawthorn effect, and likely volunteer-sampling bias despite scenario randomisation may limit the generalizability of the results to other contexts. However, we report the effect size and post-hoc power analysis to make the results more robust. Although the results of this study show the effectiveness of the application in enhancing the learning of drug prescription among dental students, we have no follow-up testing for knowledge retention associated with this method due to time constriants. We recommend further research with a robust design to evaluate this topic.

Conclusion

The findings from this study suggest that using computer applications may be associated with improvements in medication prescribing knowledge among dental students. The software’s design, which supports repeated practice and on-demand access to information, could potentially contribute to enhanced drug prescribing considerations for dental students and practicing dentists. However, given the study’s limitations and the preliminary nature of the data, further research with larger samples and robust designs is needed to confirm these effects and to determine their generalizability to broader populations and real-world clinical settings.

Abbreviations

SPSS

Statistical Package for Social Sciences

Authors’ contributions

M.B. and S.M.R. conceived the idea presented in this study. S.M.R. developed the theory and conducted the calculations. R.T and M.S. verified the analytical methods. M.B. supervised the overall work. All authors discussed the results and contributed to the final manuscript.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Data availability

Data that support the findings of this study are available from the corresponding author upon request.

Declarations

Ethics approval and consent to participate

This study received approval from the Institutional Review Board (IRB) at Guilan University of Medical Sciences (GUMS) in Rasht, Iran, under the authorization number IR.GUMS.REC.1402.316. It adheres to the ethical principles outlined in the 2013 Helsinki Declaration. A clear and comprehensive explanation of the study’s objectives was provided to all participants, who then gave their written informed consent voluntarily. Participant privacy and anonymity were preserved, with no personal information disclosed, and all individuals were treated equally. Participation was entirely voluntary, and individuals could withdraw at any time without penalty. The use of a coded questionnaire helped maintain confidentiality and address privacy concerns. Participants also had the right to benefit from the researchers’ knowledge and expertise.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.