December 2006 ■ Journal of Dental Education 1339 Effectiveness of an Electronic Histology Tutorial for First-Year Dental Students and Improvement in “Normalized” Test Scores Harold Rosenberg, D.D.S.; Jaffer Kermalli, B.Sc.; Eric Freeman, D.D.S., M.Sc.D., Dip.Perio.; Howard Tenenbaum, D.D.S., Dip.Perio., Ph.D., FRCD(C); David Locker, B.D.S., Ph.D.; Howard Cohen, Ph.D., D.D.S. Abstract: The effectiveness of an electronic histology tutorial (EHT) as a mode of learning was assessed by comparing per- formance on two term tests for an EHT class of sixty-nine students and five prior classes (n=347) who learned by traditional methods. The aims of this study were to 1) develop and introduce a self-instructional, computer-aided approach to guide student learning in the first-year histology course at the University of Toronto Faculty of Dentistry; 2) evaluate the effectiveness of the self-study electronic histology tutorial by comparing students’ test scores for the EHT group to students’ scores in previous years; and 3) evaluate students’ acceptance of this novel mode of learning by means of a satisfaction questionnaire. The EHT group per- formed significantly better on both the general histology and oral histology term tests than the five prior control years (p<0.001), yet there were no significant differences in overall GPA between the groups, suggesting that the improvement was specific to the EHT/histology course grades (p=0.1 to 0.47). A statistically significant improvement in performance per unit overall GPA was noted in the test group, which demonstrated an increase in this test score normalized ratio (TSNR) of 3-18 percent in the general histology term test and 7-21 percent in the oral histology term test over the control groups. In addition to determining the effects of the EHT on grade performance, this study sought to evaluate students’ acceptance of this alternative mode of learning in com- parison to the standard teaching model by means of a satisfaction questionnaire. Overall, students’ responses to the questionnaire were positive with an overall mean level of agreement for all ten responses of 4.5 out of 5 (90 percent). Dr. Rosenberg is a Graduate Orthodontic Resident; Mr. Kermalli is a Junior D.D.S. Student; Dr. Freeman is Professor of Histol- ogy and Periodontics; Dr. Tenenbaum is Professor of Periodontology, Laboratory Medicine, and Pathobiology, Associate Dean of Biological and Diagnostic Sciences, and Head of Periodontics at Mount Sinai Hospital; Dr. Locker is Professor, Department of Community of Dentistry, and Associate Dean of Graduate and Postgraduate Studies; and Dr. Cohen is Assistant Professor, Biologi- cal and Diagnostic Sciences—all at the Faculty of Dentistry, University of Toronto. Direct correspondence and requests for reprints to Dr. Harold Rosenberg, University of Toronto, Faculty of Dentistry, Department of Orthodontics, Room 320, 124 Ed- ward St., Toronto, Ontario, M5G 1G6 Canada; 416-979-4750, ext. 3017 phone; 416-979-4763 fax; harold.rosenberg@utoronto.ca. harold.rosenberg@utoronto.ca. This work was funded by Dentistry Canada Fund, in the form of a start-up grant, and the NORTH Research program. Key words: computer-aided learning, dental education, electronic histology tutorial, test score normalized ratio Submitted for publication 12/24/05; accepted 8/28/06 S everal studies have documented changes in student grades in histology when the approach for teaching this topic was modified from tra- ditional utilization of microscopes to computer-aided learning (CAL) that essentially represents a “virtual” histology course. 1-8 Most of these studies 3-5,7-8 focused their evaluation of the educational units by measur- ing students’ attitudes toward CAL via responses to questionnaires. One study 4 also utilized academic performance as an outcome measure, reporting no difference in academic performance between the computer group and the control group. Overall, these studies have demonstrated positive changes in stu- dents’ responses towards this new mode of learning. Similarly, in a review of the literature on the effec- tiveness of CAL in dental education, results showed that CAL can be used as a means of self-instruction, thereby providing a more flexible approach to learn- ing while at the same time motivating students to learn more than they might have otherwise. 9 Yet this review also suggested that data reported in controlled trials of CAL in dental education show effects rang- ing from none (i.e., no difference between CAL and traditional methods) to significant advantages of CAL over conventional teaching modalities in terms of knowledge gained by the students. 9 At the University of Toronto Faculty of Dentist- ry, first-year histology has traditionally been taught by means of lectures in which students are shown Kodachrome™ slide reproductions of prepared histo- logical sections and directed to areas of interest by the instructors. To reinforce learning, students participate in histology laboratories following lectures, in which they use microscopes to study the actual slides under