| Summary: | This phenomenological study investigates the interactivity taking place when students use computer-assisted-learning (CAL) in orthodontics and what can be inferred about why these interactions occur. CAL has been proposed in orthodontics because it provides an opportunity to follow a case through to completion. This training is needed if only to give all dentists sufficient knowledge to identify and refer cases for treatment. Two programs have been developed for the pilot: an introductory e-book and a narrative case study based on real records that takes students through a series of decisions relating to case assessment, treatment planning and appliance design. The mixed-methodology approach of the main study uses activity theory to provide a. framework combining qualitative and quantitative data to analyse the interactivity of 48 students as they work through the case study. Observations and transcripts of recordings of conversations between pairs of students, together with post-session interviews, facilitate a deeper understanding of students' conceptions of orthodontics particularly when they explain their reasoning in negotiations over answers, clarified where necessary by data recorded by computer activity log-files. The linear sequence of questions in the program allows students'interactions to be compared on a "like-for-like" basis. Activity systems are used to identify various tensions in students' responses whilst using CAL, facilitating a deeper understanding of the observed interactivity. A phenomenological profile of the students has been developed based on these interactions, particularly in response to the unexpected caused by the complex reality of the case. Further supporting quantitative data is obtained from a questionnaire survey and end-of-year examination results used to provide contextual background material particularly when presenting the results to a domain heavily dominated by a scientific epistemology. Throughout the program many students seem to ignore features not in their immediate focus. Students' reactions to the unexpected (extraction of 7s) indicates about half of the students are so reliant on simplified taught procedure they are unable to relate the extractions to these "hidden" features. Other students adopt a deeper approach and are able to identify reasons why the unexpected occurs. The program has been found to promote an active approach to learning in most students, whether their approach is surface or deep. Most students learn from the feedback provided by the program, even when this feedback is not explicit on a point. Students also benefit from working with a partner. The deeper understanding of students' misconceptions afforded by the adopted research methodology enables the development of guidelines for the future design of CAL in dentistry.
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