Multilevel factor analysis of flipped classroom in dental education: A 3-year randomized controlled trial.

PURPOSE: Previous studies have rarely attempted to test the confounding factors that may affect learning outcomes of the flipped classroom. The purpose of this study was to assess how flipped classrooms affect the acquisition of knowledge in clinical dental education based on multilevel factor analysis. METHOD: The authors conducted a 3-year (2017, 2018, and 2019) randomized controlled trial in a series of introductory prosthodontics courses in dental education. A total of 137 participants were randomly assigned to flipped classroom (n = 70, 51%) or lecture (n = 67, 49%) formats. The flipped group was instructed to self-learn knowledge-based content through online preparation materials, including videos and text, while the lecture group was given text only. Both groups were provided with the same study content and opportunities for different styles of learning. The session attendance rate and number of times the materials were accessed were monitored. Individual and team readiness assurance tests (IRAT/TRAT) were conducted to evaluate knowledge acquisition. A multilevel linear regression analysis was conducted on both instructional styles (flipped vs. lecture) as an intervention factor, and confounding factors that could affect the outcomes were implemented. RESULTS: The average number of online accesses was 2.5 times per session in the flipped group and 1.2 in the lecture group, with a significant difference (p < .05). The average IRAT score was significantly higher in the flipped than in the lecture group (effect size [ES] 0.58, p < .001). The number of online accesses was significantly and positively correlated with IRAT scores (0.6 [0.4, 0.8]). The instructional style was significantly and positively correlated with TRAT scores (coefficient [95% confidence interval]: 4.6 [2.0, 7.3]), but it was not correlated with IRAT (4.3 [-0.45, 9.0]). CONCLUSIONS: The flipped classroom was more effective than the lecture format regarding knowledge acquisition; however, the decisive factor was not the instructional style but the number of individual learning occasions. The employment of the flipped classroom was the decisive factor for team-based learning outcomes.

Reform of a traditional clinical curriculum in Japan: experiences at Tokyo Medical and Dental University.

BACKGROUND: Until recently, Japanese legislative guidelines dictated that undergraduate clinical training consisted of students' observations of clinicians' work. In 2006, Tokyo Medical and Dental University initiated a reform of their traditional undergraduate clinical curriculum. The reform integrated students into patient care teams, and included the implementation of a clinical faculty 'tutor'. AIMS: This short communication describes a formative assessment of the reform work. METHOD: In 2007, students, residents, and tutors were surveyed to determine their perceptions of students' integration into clinical activities, and patients' acceptance of students in their medical care. An external consultant observed students' patient care activities, and assessed the methods of and perceived barriers to clinical teaching. RESULTS: Surveys indicated that students were most engaged in history-taking, procedures, and case presentations. Observations revealed students' activities and teaching to be focused on students' case presentations. Perceived barriers to teaching included insufficient time and personnel. Respondents felt that patients were accepting students in their clinical care. CONCLUSIONS: This clinical reform effort includes an increase in students' interactions with patients through history-taking, and teaching through case presentations.

Cake layer bacterial communities during different biofouling stages in full-scale membrane bioreactors.

A detailed understanding of the bacterial communities in the cake layers formed on the membrane surface is required to control biofouling in a membrane bioreactor (MBR). This study aimed to investigate the dynamics of the cake layer bacterial communities in full-scale MBRs operated in a wastewater treatment plant in Japan and to identify the key bacteria responsible for cake layer formation. The bacterial communities in the cake layer and the activated sludge were analyzed using 16S rRNA gene amplicon sequencing when biofouling occurred under different fouling conditions. The most dominant phyla in activated sludge were almost always Proteobacteria and Bacteroidetes. By contrast, when the cake layer had unique bacterial communities distinguishable from those in the activated sludge, members of Firmicutes were highly dominant in the cake layer, irrespective of the fouling conditions. This study reported for the first time that Firmicutes play an important role throughout the biofouling process.

Changes in bacterial community structure in a full-scale membrane bioreactor for municipal wastewater treatment.

This study investigated changes in the structure and metabolic capabilities of the bacterial community in a full-scale membrane bioreactor (MBR) treating municipal wastewater. Microbial monitoring was also conducted for a parallel-running conventional activated sludge (CAS) process treating the same influent. The mixed-liquor suspended solid concentration in the MBR reached a steady-state on day 73 after the start-up. Then the MBR maintained higher rates of removal of organic compounds and nitrogen than the CAS process did. Terminal restriction fragment length polymorphism analysis revealed that the bacterial community structure in the MBR was similar to that in the CAS process at the start-up, but it became very different from that in the CAS process in the steady state. The bacterial community structure of the MBR continued to change dynamically even after 20 months of the steady-state operation, while that of the CAS process was maintained in a stable condition. By contrast, Biolog assay revealed that the carbon source utilization potential of the MBR resembled that of the CAS process as a whole, although it declined transiently. Overall, the results indicate that the bacterial community of the MBR has flexibility in terms of its phylogenetic structure and metabolic activity to maintain the high wastewater treatment capability.