Objectives: This pilot study aimed to determine the effect of the addition of an assessment to online course material on performance and self-efficacy of pre-doctoral students tasked with recognizing and diagnosing malocclusions on patients in the orthodontic screening clinic. Methods: Third year dental students completed an online module to reinforce concepts from the didactic curriculum prior to examining orthodontic patients. The experimental group (n=60) completed online case-based assessments before and after viewing an online module and then screened orthodontic patients. The control group (n=60) only viewed the online module prior to screening patients. The two groups were compared based on their average performance scores for diagnosis of various malocclusions, including but not limited to: dental developmental stage, crossbites, Angle molar classification, deep versus open bites, arch perimeter discrepancies, skeletal classification, and recommendation for orthodontic management. Additionally, differences in self-efficacy were assessed using a 5 question survey before and after screening orthodontic patients. Orthodontic residents were calibrated twice to ensure inter-rater reliability of student performance. Results: Performance: Results of a t-test showed a statistically significant increase in total assessment score in the experimental group when compared with the control group (p=0.047). Three out of ten questions had statistically significantly higher mean scores in the experimental group compared to the control group: vertical bite dimension (p=0.004), crowding and spacing in the mandibular arch (p=0.049), and vertical skeletal type (p=0.023). Self-Efficacy: The mean self-efficacy scores increased after completion of clinical requirements in both groups, with a pre-screening mean of 3.39 (SD=0.64) and post-screening mean of 4.39 (SD=0.41) in the control group and a pre-screening mean of 3.08 (SD=0.56) and post-screening mean of 4.28 (SD=0.37) in the experimental group. The self-efficacy scores were lower in the experimental group overall. The increase in self-efficacy was greater in the experimental group. Conclusions: The assessments added to online course content in this pilot study produced a statistically significant improvement in overall performance scores. Students demonstrated improved performance in the areas of diagnosis of vertical bite dimension, vertical skeletal type, and crowding and spacing in the mandibular arch. This study illustrates that the addition of an assessment to online course content could improve student learning outcomes related to diagnosis of dental and skeletal malocclusions and arch perimeter discrepancies. This pilot study shows that the addition of an online assessment lead to a greater improvement in self-efficacy scores. The addition of an online assessment also lead to lower self-efficacy scores overall. Qualitative follow up suggests that the students in the experimental group were more aware of the gaps in their knowledge. The creation of online assessments by orthodontic faculty can be used to overcome the faculty shortage in the field. / Oral Biology

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