524 Journal of Dental Education ■ Volume 67, Number 5 The Effectiveness of Computer-Aided, Self- Instructional Programs in Dental Education: A Systematic Review of the Literature Harold Rosenberg, B.Sc.; Helen A. Grad, M.Sc.Phm.; David W. Matear, D.D.S., M.Sc. Abstract: Computer-aided learning (CAL), self-instructional programs provide an accessible, interactive, and flexible way of presenting curriculum material. In order to assess the effectiveness of CAL programs in dental education, a systematic review of the published literature comparing CAL with other teaching methods was performed. A systematic search of the published literature was performed. Articles formally assessed for inclusion had to meet the following criteria: randomized controlled trials comparing CAL with any other method of instruction, and the use of academically homogeneous dental students or dental professionals with objective, predefined outcome criteria measuring performance, time spent, and attitudes. The searches located a total of 1,042 articles; of these, only twenty-seven articles met the inclusion criteria. Further quality assessment identified twelve studies that were included in the final review. Five of the studies documented statistically significant differences in outcome measures (scores on multiple choice, written or oral tests, and clinical performance) favoring CAL over comparison group(s), while six revealed no statistically significant differences. One study documented a greater improvement in test scores in the seminar group over the CAL group. Participants’ attitudes towards CAL in the included studies are also discussed. Our study concluded that CAL is as effective as other methods of teaching and can be used as an adjunct to traditional education or as a means of self-instruction. Mr. Rosenberg is a Senior D.D.S. Student, Ms. Grad is a Senior Lecturer, Department of Pharmacology, and Dr. Matear is Associate Professor, Department of Community Dentistry and Dean of Clinical Affairs, all at the Faculty of Dentistry, University of Toronto. Direct correspondence and requests for reprints to Ms. Helen A. Grad, Faculty of Dentistry, University of Toronto, 124 Edward St., Room 252, Toronto, Ontario, Canada M5G1G8; 416-979-4909, ext. 4360 phone; 416-979-4936 fax; helen.grad@utoronto.ca. This work was funded by the Network for Oral Research Training and Health, CIHR. Key words: computer-assisted learning, computer-based instruction, dental education, self-study, systematic review Submitted for publication 12/3/02; accepted 3/3/03 S elf-instruction has been shown to be an effec- tive method of learning in dental education. A meta-analysis of self-instruction in dental edu- cation by Dacanay, integrating findings from thirty- four comparative studies, showed that educators who individualize their classes could expect, on average, a small to moderate positive effect on achievement. 1 Their conclusions were in accordance with a study by Williams where it was found that self-instruction was capable of increasing cognitive knowledge sig- nificantly in a shorter period of time and with greater student satisfaction over conventional methods. 2 One such means of providing self-instruction is through computer-based instructional programs. Computer-based, self-instructional programs provide an accessible, interactive, and flexible way of giving multimedia presentations that utilize textual materi- als, visuals, sound, and motion. Since the development of the personal computer in 1981, computers have been used extensively in educational settings. Computer programs complement conventional teaching while providing a means for students to learn at their own pace. Computer-based instruction (CBI) in the health profession, also known as Computer-Aided Learning (CAL) or Computer-Aided Instruction (CAI), is be- coming a popular vehicle to provide information to students, patients, and practitioners alike. A meta-analysis of 254 controlled evaluation studies of Computer-Based Instruction (CBI) by Kulik and Kulik revealed a positive effect on stu- dents. 3 The study revealed that CBI programs raised student examination scores by 0.3 standard devia- tions, produced positive changes in student attitudes toward teaching and computers, and decreased the amount of time needed for instruction. CAL in den- tistry first emerged in 1971 with its introduction at the University of Kentucky. 4 In the past two decades, the progress of com- munication technology and the wide use of the Internet have made CAL programs readily available, while their availability without time constraints makes them an attractive alternative to conventional learning. There are CAL programs on the market in various dental disciplines, including: oral and gross anatomy, orthodontics, endodontics, restorative den- tistry, radiology, oral pathology, geriatrics, prosth-