Scaffolding Self-Regulated Learning in Operative Dentistry Through Self-Assessment Training.

OBJECTIVES: This study aimed to investigate how effective self-assessment training is in improving the self-regulated learning (SRL) ability of operative dentistry students. The secondary aim was to explore students' attitudes towards self-assessment in clinical settings. INTRODUCTION: Self-assessment has been the focus of dental education research for decades and has been claimed to be cornerstone in the SRL process. METHODS: This is quasi-experimental study conducted at Damascus University Faculty of Dental Medicine, Syria. A modified direct observation of procedural skills (DOPS) assessment protocol with a self-assessment component was applied to a convenience sample of students across five clinical encounters in 2022. Data were collected during clinical training on the DOPS form and at the end of the experiment using a structured questionnaire with a single open-ended question. The qualitative part of the study followed a deductive theory-informed content analysis approach, relying on Zimmerman SRL theory. RESULTS: A total number of 32 students participated in the study, eight of whom were male. During the experiment assessment, participants showed overwhelming positive attitudes towards the utility of self-assessment (m ≥ 3.5; max:4) and the overall assessment method (3.3 ≥ m ≥ 3.5; max:4). Cronbach's alpha for the post-experiment questionnaire was 0.888. A total of 84.4% of the participants strongly agreed that self-assessment is useful in clinical training. Data collected (qualitative and quantitative) from participants revealed the positive effects of self-assessment on all three phases of SRL, especially the reflection phase. CONCLUSION: Self-assessment practice and training showed positive results in terms of improving SRL and performance in a clinical context; SRL appeared to be affected by self-assessment in all phases (forethought, performance, and reflection). Participants' perceptions of self-assessment were generally very positive. These findings imply the potential benefits of applying self-assessment training interventions to foster the SRL ability of learners within the clinical context.

Evaluation of a workplace assessment method designed to improve self-assessment in operative dentistry: a quasi-experiment.

BACKGROUND: Dental education has placed continued emphasis on self-regulated learning (SRL) and its subprocess, self-assessment. This study set out to evaluate the effectiveness of a novel workplace assessment method in developing trainees' self-assessment of operative procedures. METHODS: A Direct Observation of Procedural Skills (DOPS) form was modified for the use and measurement of self-assessment. Participants were trained on how to conduct self-assessment using the designed assessment form and its grading rubric. Feedback and feedforward sessions were given to address self-assessment and performance issues. A P-value less than 0.10 was considered significant and the confidence level was set at 90%. RESULTS: Thirty-two Year 5 dental students with an age mean of 22.45 (SD = 0.8) completed five self DOPS encounters during the clinical operative dentistry module in 2022. The aggregated total deviation (absolute difference) between self-assessment and teacher assessment decreased consistently in the five assessment encounters with a significant mean difference and a medium effect size (P = 0.064, partial Eta squared = 0.069). Participants' self-assessment accuracy differed from one skill to another and their ability to identify areas of improvement as perceived by teachers improved significantly (P = 0.011, partial Eta squared = 0.099). Participants' attitudes towards the assessment method were positive. CONCLUSIONS: The findings suggest that the self DOPS method was effective in developing participants' ability to self-assess. Future research should explore the effectiveness of this assessment method in a wider range of clinical procedures.

Evaluation of the Undergraduate Learning Environment at Dental Schools in Syria.

OBJECTIVE: The learning environment plays a vital role in dental education. A positive learning environment could improve students' satisfaction, psychosocial well-being, and academic achievement. This study set out to measure the quality of the learning environment according to the Dundee Ready Educational Environment Measure (DREEM) at different dental schools in Syria. METHODS: The study included dental schools at Damascus University (DU), Tishreen University (TU), and University of Hama (HU). DU and TU are considered 2 of the largest universities in Syria. Students across all years of study were invited to complete an Arabic version of the DREEM questionnaire. RESULTS: In total, 1205 students completed the questionnaire: 650 were from DU, 309 from HU, and 243 from TU. Cronbach's alpha value of the DREEM instrument was 0.927. The total DREEM score for all universities was 108.8 ± 31.5 (n = 1205), which is 54.4% of the total score; DU scored the lowest on the DREEM scale (105.9 ± 28.5) followed by TU (111.1 ± 34.3) and HU (113.3 ± 34.4). There was a significant difference amongst the 3 universities (P = .001) with a small effect size (eta-squared = 0.01). At the subscale level, students' perception of learning (SPL) at DU and TU was perceived unfavourably, and the social self-perception of students (SSP) was negatively perceived across all universities. Clinical students scored significantly lower than their preclinical counterparts. No significant difference emerged between male and female students. CONCLUSIONS: This study provides a baseline data on the learning environment at dental schools in Syria. Although the study suggests a more positive than negative perception of the learning environment, Syrian dental schools scored considerably lower than their Arab and international counterparts. Aspects related to SPL and SSP were the most serious areas requiring improvement, and future research should focus on designing proper interventions to address them.

Revealing the significant shortcomings in the learning environment at the three largest medical schools in Syria: what's next?

BACKGROUND: Medical education in Syria still adopts a traditional, teacher-centered curriculum to this day. These elements imply the existence of issues in the learning environment (LE). This study aims to provide the first evaluation of the LE at the largest medical schools in Syria using the DREEM inventory. METHODS: The three largest medical schools in Syria are the ones at Damascus University (DU), University of Aleppo (AU), Tishreen University (TU). The Arabic version of the DREEM questionnaire was used. Students across all years of study except year 1 were approached. Both paper-based and electronic surveys were conducted. RESULTS: A total of 1774 questionnaire forms were completed (DU:941, AU:533, TU: 300). The overall DREEM score at DU, AU, and TU were 100.8 ± 28.7, 101.3 ± 31.7, and 97.8 ± 35.7 respectively with no significant difference (P = 0.254) between the three universities. DREEM subscales concerning Learning, Atmosphere, Academic Self-perception and Social Self-perception had a low score across all universities. Clinical-stage students reported significantly lower perception (P ≤ 0.001) of the LE in comparison to their pre-clinical counterparts across all subscales. CONCLUSIONS: The findings of this study highlight the significant shortcomings of the medical LE in Syria. If not addressed properly, the academic, clinical, and professional competence of the healthcare workforce will continue to deteriorate. Moreover, the negative LE might be a predisposing factor for medical students' exodus. The Syrian medical education system requires leaders who are willing to defy the status quo to achieve a true educational transformation.

Gauging the learning environment at Damascus University Pharmacy School in Syria using the DREEM questionnaire: A cross-sectional study.

Introduction: This study was undertaken to provide the first record of evaluation of the educational environment of the Bachelor of Pharmacy program at Damascus University (DU), Syria using the internationally adopted Dundee Ready Education Environment Measure (DREEM) tool and compare it with other pharmacy schools around the world. Methods: A cross-sectional study was conducted at DU Pharmacy School in 2022. The validated DREEM 50-item inventory was added to Google Forms and used to collect data electronically. River sampling and snowball sampling methods were used. Data was collected during the second term between April 2022 and June 2022. Students from all years were included. Results: A total of 269 students completed the questionnaire; that is about 6.7% of the total population. The Cronbach's alpha of the DREEM questionnaire was 0.94. The total DREEM score was 89.8±32.1/200. Senior students scored significantly less on the DREEM scale than their younger counterparts. DU Pharmacy School scored significantly less on the total DREEM score than its other counterparts around the world with a large effect size (d>0.80). All subscales scored below 50% and the lowest scoring subscales were students' perception of learning (SPL=41.8%) and students' perception of the social environment (SSP=42.5%). Conclusions: The findings implied that the educational environment is in need of major improvement, especially in areas related to teaching and learning practices and the general social environment; failure to address the current issues in the learning environment might hinder learning and clinical practice of the future generation of pharmacists. This study provides a quality improvement map which could be used preciously address the areas that need most attention at DU Pharmacy School.

Induction of apoptosis and necrosis in human peripheral blood mononuclear cells by fatty acid ethyl esters.

BACKGROUND: Fatty acid ethyl esters (FAEE), nonoxidative products of ethanol metabolism, are formed by the esterification of fatty acids and ethanol. Alcoholic subjects have high levels of FAEE in the circulation as well as in organs and tissues, especially those most often damaged by ethanol abuse. Our previous studies showed a significant synthesis of FAEE by human mononuclear cells within seconds of exposure to physiologic doses of ethanol. In addition, FAEE inhibited phytohemagglutinin (PHA)-stimulated interleukin-2 production and calcium (Ca(2+)) influx into human mononuclear cells. FAEE also caused a rapid increase in the intracellular cAMP. The mechanism by which alcohol suppresses the immune system remains undetermined. OBJECTIVES: To evaluate the morphological and physiological effects of FAEE on human mononuclear cells and to study the impact of FAEE on cell viability. METHODS: Mononuclear cell fractions of human white blood cells (WBC) were incubated with physiological doses (25 and 50 microM) of ethyl oleate, a representative FAEE, for 15, 30, 60, 120 or 180 minutes. Morphological changes were evaluated by light and transmission electron microscopy (TEM). Lactate dehydrogenase (LDH) release was measured as a physiological indicator of necrosis. Physiological changes were also evaluated by western blots performed on whole-cell lysates of treated and untreated cells and by DNA electrophoresis. RESULTS: Significant morphological changes were detected in cells exposed to FAEE by both light and TEM. Concentration and time-dependent increases in the rates of apoptosis and necrosis were found by light microscopy and by LDH release, respectively, following 60 minutes exposure to 25 or 50 microM FAEE. One-hour 50 microM FAEE exposure caused activation of the caspase cascade, as demonstrated by Poly (ADP-ribose) Polymerase (PARP) cleavage, and significant DNA damage as a result of necrosis in human mononuclear cells. CONCLUSIONS: These studies provide evidence to support the toxic effects of FAEE on intact human mononuclear cells. The results from our studies also show that both apoptosis and necrosis are modes of cell death in FAEE-treated human mononuclear cells. This may be an important mechanism in alcohol-induced immunosuppression.

Fatty acid ethyl ester effects on interleukin-2 production, cyclic AMP synthesis, and calcium influx in human mononuclear cells.

BACKGROUND: Fatty acid ethyl esters (FAEE), nonoxidative ethanol metabolites, are produced by the esterification of fatty acids and ethanol. Plasma and serum FAEE correlate linearly with blood ethanol levels and are present in organs most commonly damaged by ethanol abuse. Our previous studies have shown that there is significant synthesis of FAEE by human mononuclear cells within seconds of exposure to physiologic doses of ethanol. OBJECTIVES: We studied the effects of FAEE on selected early events of mononuclear cell activation that follow stimulation with phytohemagglutinin (PHA). Fatty acid ethyl esters induced changes in cytosolic free calcium ([Ca2+]) levels, the production and secretion of interleukin-2 (IL-2) by the cells, and intracellular cAMP concentrations. METHODS: A mononuclear fraction of human white blood cells (WBC) was incubated with physiologic doses of FAEE. For experiments involving IL-2 production and calcium influx, PHA-stimulated cells were incubated with 10, 25, 50, or 100 microM ethyl oleate, a representative FAEE species, for 60 minutes. Interleukin-2 was measured by enzyme immunometeric assay and maximum levels of Ca2+ were monitored by spectrofluorimetry. In other experiments, mononuclear cells were incubated with 10, 25, and 50 microM ethyl oleate for 0.08 to 120 minutes, and then the concentration of cAMP was determined by a cAMP competitive enzyme immunoassay system. RESULTS: Fatty acid ethyl esters inhibited the PHA-induced IL-2 production and secretion in activated human mononuclear cells. Fatty acid ethyl esters also inhibited PHA-induced [Ca2+] influx into cells in a dose-dependent fashion. There was a rapid increase in the intracellular cAMP concentration of mononuclear cells induced by FAEE, with FAEE dose dependence. The cAMP concentration decreased as the incubation time with FAEE was increased. CONCLUSIONS: Fatty acid ethyl esters inhibited PHA-stimulated IL-2 production and Ca2+ influx into human mononuclear cells and elevated intracellular cAMP concentration. These changes in mononuclear cell signaling may be associated with the immunosuppression associated with alcohol abuse.

Fatty acid ethyl esters in human mononuclear cells: Production by endogenous synthesis greatly exceeds the uptake of preformed ethyl esters.

BACKGROUND: Fatty acid ethyl esters (FAEE) are nonoxidative metabolites of ethanol. They are esterification products of ethanol and fatty acids. Fatty acid ethyl esters have been implicated as important mediators of ethanol-induced cytotoxicity, organ damage, and disease. In addition, they serve as specific and sensitive biomarkers for ethanol intake. Following ethanol consumption, FAEE are found in circulating blood bound to albumin or/and lipoproteins. OBJECTIVES: Using a mononuclear fraction of white blood cells (WBC) exposed to ethanol, we investigated FAEE synthesis. We then determined the amount of uptake of preformed FAEE presented to the cells and compared the amounts of FAEE within the cells that were derived from endogenous synthesis with the amount derived from uptake of exposure FAEE. We also measured the persistence of FAEE within these cells and assessed the fate of the FAEE-associated fatty acid upon FAEE hydrolysis. METHODS: A mononuclear fraction of human WBC was incubated with 25, 50, or 100 mM ethanol for 0.08 to 120 minutes, and FAEE synthesis was measured by gas chromatography/mass spectrometry. In other experiments, mononuclear cells were incubated with 25, 50, and/or 100 microM [3H]ethyl oleate, a representative FAEE species, for 0.08-120 minutes, and FAEE uptake and hydrolysis were measured. RESULTS: The total FAEE formed by treating the cells with 25 mM ethanol, which represents a physiologic dose achievable with excess alcohol intake, greatly exceeded the FAEE within cells derived from uptake of 100 microM ethyl oleate, which represents a supraphysiologic dose. There was hydrolysis of FAEE by human mononuclear cells, with free fatty acids as major metabolites of FAEE hydrolysis. Unlike any other cell type or homogenate studied, the only ethyl ester formed by human mononuclear cells exposed to ethanol was ethyl oleate. CONCLUSIONS: There is significant synthesis of FAEE by human mononuclear cells within seconds of exposure to physiologic doses of ethanol. The amount of FAEE in these cells derived from endogenous synthesis greatly exceeds the amount acquired by exogenous uptake.