Self-Directed Learning Activities Implemented by Undergraduate Dental Students in King Saud University, Saudi Arabia: A Cross-Sectional Study

Introduction

Nowadays, health fields, are rapidly evolving at a very fast pace, and health practitioners, including dentists are expected to seek knowledge constantly after graduation to stay updated.^1–5 This requires practitioners to take responsibility for their own learning and be able to develop critical thinking to adapt to the new challenges developing throughout their practice. Educational institutions, should equip their graduate with not merely the knowledge of today, but also with self-directed learning skill sets to be able to grow and succeed in this ever-changing world after graduation.^1–5

Self-directed learning was defined by Knowles as a process by which individuals take the initiative in diagnosing their learning needs, formulating goals, identifying resources, and evaluating their progress.⁶ This approach empowers students to engage actively in their education, enhancing their knowledge retention and self-confidence.^1,4–7 Literature indicated that self-directed learning skills are positively associated with high academic achievement, success in clinical skills and mental health.^3,8

While it may seem obvious that self-learning should be encouraged and fostered in health fields curriculum including dental schools education, current status shows the opposite.^2,8,9 It has been shown that health fields students preparedness to self-directed learning, decrease after first to second year of school, and remain at that level until graduation.^2,8,9 This indicates that current curriculums are highly instructor-led, and overly structured, with little room left for self-learning or student-led learning tasks. To foster self-learning, more flexible less-structured learning environment should be implemented.^1,4 Newer teaching strategies like flipped/blended classrooms were associated with active learning practices among students.¹⁰

In our school, there is no formal training on self-directed learning skills. However, in many courses, students are required to perform some forms of self-directed learning projects which are mainly in the form of topic presentation prepared solely by the students with minimum or no guidance from instructors. Additionally, for most of the courses, extra resources for self-directed learning are listed in the course outline, however there is no intentional support or encouragement to students to pursue self-directed learning. Program learning outcomes of the undergraduate curriculum does not include self-directed learning as a required skill outcome of the program, and this probably the same as other dental programs in Saudi Arabia.

With the advent of technology, more flexible and versatile learning materials are now available at no or low cost to everyone, including students.^11–13 Available learning resources vary, and could include textual and audiovisual resources.¹⁴ Additionally, more sophisticated interactive learning resources are becoming increasingly available which include artificial intelligence guides, virtual reality and digital immersive tools to help engage students in self-directed learning.^15–17 Studies showed that dental students worldwide are using open access learning resources to gain knowledge, and support their learning.^11,12,18 More than ninety percent of dental student surveyed in the US considered YouTube videos on clinical procedures to be a helpful learning tool, and the majority reported that they refer to a YouTube video to prepare for a procedure that they have never done.¹⁸

In Saudi Arabia, few studies assessed the utilization of social media by dental students for learning purposes.^13,19,20 All dental students surveyed in three major universities in the western region in Saudi Arabia reported using social media, and the majority indicated willingness to use it for learning.¹³ In another study of dental students in three major cities in Saudi Arabia, results showed that finding dental information and watching clinical procedures for learning were the major reasons for using social media.²⁰ Considerable number of the students were using Facebook for educational purposes (66%), and they perceived Facebook as a source of inspiration and motivation (40%).¹⁹ However, to the best of the authors knowledge, there is no data currently on the students perception and utilization of the different available self-directed learning resources and activities, other than the social media. Learning about self-directed activities used by the students could help dental educators to plan effective self-directed learning activities that can enhance students learning experience. Thus, the aim of this study was to investigate the utilization of self-directed learning activities and resources by undergraduate students to support their learning, and to determine the effect of gender and academic level on students’ engagement with certain self-directed learning resources.

Methodology

Study Design

A cross-sectional study was implemented on dental students at King Saud University, Riyadh, Saudi Arabia in October 2021. The study was granted approval by the Institutional Review Board of the College of Medicine, King Saud University (IRB Project No. E-21-6220).

All fourth-year dental students (N = 130), fifth-year (N = 137), interns (N = 128) and recent graduate students within 6 months of their graduation (N = 129) were invited to participate voluntarily in a 16-item questionnaire, uploaded on an online survey platform (SurveyMonkey). The questionnaire was made in English language, as it is the language of instructions in this school, and the students are very proficient in English. The link was sent to participants individually via social media platform (WhatsApp messages) and reminders were sent weekly to encourage participation. The online survey was open for participants for a period of one month.

Questionnaire Format

Published literature on self-directed learning activities and resources used by dental students was reviewed by the research group to help in developing of the first draft of the questionnaire items, in addition to a list of self-directed learning activities crafted by the research group. This draft was further reviewed and tailored to our sample using data collected from a focus group discussion. This discussion was held virtually, and included 5 male and female students of our sample representing all included levels of education, who were randomly selected and invited for the focus group discussion. The meeting was guided by one investigator asking five open-ended questions formulated to capture the students experience on self-directed learning. Questions were discussed in a thoughtful permissive atmosphere. Based on these results, two items were added to the questionnaire. Questionnaire was further checked for clarity and specificity by two faculty members and some items were edited.

The questionnaire had an introduction that explained the aim of the study, the study procedures and approximate time required to fill the questionnaire, confidentiality of the participants information, and contact information of the research supervisor in case participants would like to inquire about the study. It also indicated that participation in this study is strictly voluntary. The questionnaire was anonymous and no personal identifying information were sought from participants. By clicking next, participants consented that they were voluntarily willing to participate in the study.

The questionnaire was divided into three sections: the first section had questions on demographic data, including age, gender and level of education. The second section was designed to gather information regarding self-directed learning activities and resources implemented by the students using 5-points frequency scale from always to never. The third section includes two questions; the first one is a question about students perception of self-directed learning on a 5 points agreement scale. The second question is an open-ended question about any additional self-directed learning resources or activities, that participants engaged in. This question was included to allow participants to elaborate on their learning experiences to enrich the results and cover the topic more comprehensively. The final questionnaire is available in the Supplementary Material.

Statistical Analysis

The responses were captured in a database entered to IBM SPSS statistic software (version 28.0.1.0 IBM Corp., Armonk, NY, USA), and 5-points likert frequency scale responses were coded from 1–5, where “1” indicates “always”, and “5” indicates “never”. Proportion tables, graphs, and descriptive data of means and standard deviations were obtained. Differences in utilization of different self-directed learning activities and resources among different academic levels and between gender were tested using nonparametric Kruskal Wallis and Mann Whitney test, respectively. Alpha was set at 0.05, and p-value less than 0.05 was considered statistically significant. Answers to the open-ended question were coded manually to look for any additional themes that were not included in the self-directed learning resources and activities of the quantitative part of the survey.

Results

A total of 392 responses were received out of 542 surveys sent. However, 17 of these responses were initiated but did not answer any research questions, resulting in a total of 375 usable surveys. This yielded a response rate of 71.5%.

Demographic Data

The distribution of participants included 111 (29.6%) fourth-year students, 92 (24.5%) fifth-year students, 114 (30.4%) interns, and 58 (15.5%) recent graduates, illustrated in Figure 1. The gender distribution consisted of 173 (46.2%) female and 202 (53.8%) male participants. The majority of responses (49.7%) were from participants aged 24–26 years.

Figure 1 Percentages of academic levels of participants (n=392).

Self-Directed Learning Activities

Most of the students (94%) reported learning from presentation slides made by the lecturer, followed by learning from YouTube videos and other social media accounts for educational purposes (75.6%), searching several search engines (68.5%) and learning from clinical manuals (65.2%), as illustrated in Figure 2, and Table 1.

Table 1 Frequency of Participants Utilization of Self-Directed Learning Resources and Activities

Figure 2 Percentages of Utilized Self-directed Learning Activities and Resources.

Other self-directed learning activities were implemented relatively less frequently by the students, for instance; joining small group discussions with peers (56.4%), learning from authorized organizations websites (40.1%), creating clinical procedures summaries (33.9%), attending educational events (32.9%) and learning from published scientific articles (26.6%). The least commonly used resources were joining online study clubs (16%) and learning from textbooks (14.9%), as illustrated in Figure 2, and Table 1.

There were significant differences between different academic levels in their frequency of using self-directed learning activities, illustrated in Table 2. Recent graduates learned significantly more frequently from published scientific articles (2.6 ± 1.1), and attended scientific events (2.6 ± 1.1), compared to other academic levels p < 0.001, p < 0.001, respectively. Interns significantly less frequently learned from YouTube and educational social media (2.2 ± 0.9) compared to other academic levels, p < 0.010. Fifth year significantly more frequently used clinical manuals and created clinical procedures summaries compared to other academic levels (p = 0.02, p = 0.01, respectively).

Table 2 Mean and Standard Deviation of Student Utilization of Self-Directed Learning Resources Among Different Academic Levels

Gender differences also were noticed and illustrated in Table 3. Female significantly more frequently (2.7 ± 1.2) created clinical procedures summaries, used (2.9 ± 1.1) scientific published literature to learn, and used search engine (1.9 ± 1.1) compared to male, p < 0.001, p = 0.001, p = 0.02, respectively. On the other hand, male significantly more frequently (3.4 ± 1.1) studied from textbooks not required by the curriculum, compared to female (3.7 ± 1.0), (p = 0.005).

Table 3 Mean and Standard Deviation of Student Utilization of Self-Directed Learning Resources Among Male and Female

Students’ Perception of Self-Directed Learning

More than half of the participants (59.3%) reported that they engaged actively in self-directed learning activities and resources, and educational challenges encouraged them to actively pursue self-directed learning, with no significant differences observed among academic levels or gender (p>0.05).

Open-Ended Question: Students’ Voices

The open-ended questions were asked to allow students to elaborate on their self-learning activities and resources not mentioned in the survey. However, all comments they have mentioned were already stated in the statements of the questionnaire.

Discussion

Self-directed learning is essential for fostering lifelong learning, and should be encouraged in dental schools to help future dentists remain current in an ever-evolving field. In medical education, interventions such as coaching, learning plans, and supportive tools have demonstrated positive effects on promoting self-directed learning.⁴ Dental schools should consider implementing similar strategies to cultivate these vital skills among future practitioners.

Available learning materials for self-directed learning are various including textual, and audiovisual resources.¹⁴ Textual resources including textbooks, and slides printouts, could be portable, easy to use without the need for technology or equipment, and can present topics in depth. However, these resources may have limited ability to explain hands-on procedures, and processes, and therefore result in limited student engagement.¹⁴ On the other side, audiovisual learning materials can explain hands-on processes more effectively and help students better visualize the material, but needs equipment, and may cause some distractions.^13,14,18 The authenticity of the available resources must be checked before utilizing that for self-directed learning.^13,14,18

Among the various self-directed learning activities, learning from presentation slides prepared by lecturers was the most commonly reported method, confirming the results of a previous study.²¹ These slides typically provide a clear and focused overview of the assigned material, making it easier for students to review and comprehend the content.²¹

The second most utilized resources were educational social media accounts, particularly YouTube videos, which came in agreement with previous studies.^11,18 These highly accessible visually appealing resources are likely to enhance students understanding, particularly for complex clinical procedures.^11,18 However, the open-access nature of social media content raises concerns about the reliability of information, as it often lacks peer review. Only a small percentage of the most viewed YouTube videos on dental procedures are produced by accredited dental schools,²² highlighting the need for educational institutions to create valid and reliable online resources.

Other self-directed learning activities, such as participating in small group discussions, creating clinical procedure summaries, and utilizing resources from authorized organizations and published scientific literature, were less frequently employed. Around (56.4%) of participants reported engaging with small group discussions, where collaborative learning experiences can occur.²³ Previous research has shown that small group discussions can positively impact educational outcomes.²³ Encouraging faculty to promote small group learning can enhance students’ educational experiences and foster self-directed learning. In this study, factors such as busy schedules and a lack of faculty encouragement may have limited students’ participation in group discussions.

Creating clinical procedures summaries would require students to employ effective cognitive learning strategies including rehearsal, elaboration and reorganization of information, which are components of self-directed learning.¹ These summaries could then help with knowledge retention that would help students to easily apply this knowledge in clinical settings.³ In this sample, only (33.9%) proactively created summaries to help themselves, apart from course requirements.

It should be noted that most of the commonly utilized resources are digital resources, which are easily accessible, highly interactive and engaging, which made them popular among students.^11,13,18,23 Future dental educational plans should consider investment in various electronic study materials, artificial intelligence guides, virtual reality and digital immersive tools to help engage students in self-directed learning.^15–17 In a study, dental students were provided with electronic interactive guide in lab sessions, and that made a positive impact on the student self-paced learning experience and engagement in simulated environment.²⁴

While published scientific literature is a valid and peer-reviewed source of knowledge that can empower students learning, limited students’ exposure to literature during undergraduate program resulted in limited use among students in this sample. Previous findings have indicated low utilization rates of academic databases among students (26.6%).²² Interestingly, interns reported higher engagement with scientific literature compared to undergraduate students, likely due to their increased familiarity with research, which is a requirement during their internship.

Gender differences in utilization of self-directed learning resources were observed, as female students were significantly more likely to create clinical procedure summaries and utilize published literature for learning compared to males, while male students were significantly more likely to learn from textbooks. This may indicate differing approaches to self-directed learning based on gender. Further studies are recommended to explore how such differences could inform tailored educational strategies.²

There were significant differences between different academic levels in utilization of different self-directed learning resources. Recent graduates significantly utilized scientific published literature, and attended scientific events more than other academic levels, which could be attributed to their advanced level and experience, which would make these resources very beneficial for them to stay updated, compared to students, and interns. On the other side, fifth year students significantly more frequently used clinical manuals and created clinical procedures summaries compared to other academic levels, which is in agreement with previous study that showed an upward trend in students’ utilization of self-directed learning resources from lower to upper academic levels.¹³ This could be related to the fact that fifth year students are required to manage advanced more comprehensive clinical cases, for which they need more resources.¹³

While the open-ended responses allowed for personal reflections, the lack of new insights suggests that the structured questionnaire effectively captured the primary experiences and resources utilized by students.

This study showed that more than half of the participants (59.3%) reported engaging proactively in self-directed learning activities. This enthusiasm by students could be related to the various educational challenges posed by the COVID pandemic in the previous year, which hinders students learning in many ways.^25–29 This finding is consistent with previous studies indicating that students often take charge of their education and become motivated to pursue self-directed learning when faced with obstacles.^25,27,30

This study has several strengths, including a good response rate, diverse representation across academic levels and genders and a comprehensive survey for data collection. However, there are limitations to consider. The findings may not be generalizable as the study was conducted in a single public institution. Additionally, recall bias may affect survey responses, and the online nature of the survey may have influenced participants’ answers based on peer perceptions.

As dental education continues to evolve, curriculum should be carefully reviewed to foster self-directed learning through innovative and reliable resources, which are essential in preparing competent lifelong learners dental professionals. Future research should explore the identified trends across various institutions and settings to gain a comprehensive understanding of self-directed learning in dental education. Factors enhancing self-directed learning practice among students could be further assessed in future studies.

Conclusions

The study highlights the willingness of the majority of students to support their learning and the diverse self-directed learning activities employed. Learning from presentation slides, YouTube videos and looking for information on search engines were the most commonly implemented activities among students to support their learning, suggesting a shift towards digital learning modalities. These activities can be further encouraged in dental curriculum to enhance students learning experience. Gender and academic level differences in self-directed learning activities utilized were observed and can be used to customize recommended resources on planning educational activities.