Incorporation of a Cellphone App to Improve Students' Learning Experiences

Histology, the study of microscopic tissue structure, is a core component of health professional education, yet it frequently fails to engage students [1]. Reported challenges in learning histology include the abstract nature of the topic, the cognitive load of learning new terminology, insufficient teaching time, and lack of suitable teaching strategies to stimulate students' interest [2]. Traditionally, histology is taught through a lecture–laboratory model, where microscopy labs provide hands-on experience to reinforce classroom instructions. Although limited instructional time has been identified as a key factor contributing to reduced student motivation, recent curricular reforms have further decreased contact hours to create more integrated medical and dental curricula [3]. We implemented an augmented reality (AR)-based cellphone app named Tooth ARcademy [4] as a teaching and learning tool at the Mike Petryk School of Dentistry, University of Alberta. The app has three modes: learn, practice, and quiz (Figure 1). The AR-based learn mode is designed so that when users view an unannotated target histological image through their device's camera, the annotations are revealed to them. The practice mode allows students to independently access a large collection of annotated and unannotated histology sections outside of classroom hours. Using the quiz mode, students can self-assess and reinforce learning at their own pace. Tooth ARcademy was introduced to first-year doctor of dental surgery (DDS) students as a required tool for the oral biology lab. During part of the lab activity, students were divided into small groups, provided with worksheets, digital slides, and static images of histological sections. The activities included identifying different microanatomical structures on a target histological slide and answering follow-up questions. After completing these tasks, students were asked to verify their work using the learn mode of Tooth ARcademy, followed by a debriefing session with an instructor. Students were also introduced to the app's practice and quiz modes as additional learning resources. A voluntary, author-developed, non-validated survey was administered to gather students' perceptions of using the app. Incorporating the app made the labs more interactive and reduced the need for one-on-one discussions with the instructor. In total, 61% of the class (n = 20) responded to the survey. Notably, 100% of participants agreed or strongly agreed that the app made learning easier and more enjoyable and helped clarify concepts. In addition, 85% of participants would like to use a similar app in other areas of their studies. Most participants (65%) reported using the app 5–10 times. Specifically, 42% of participants found the app's quiz mode most beneficial (Figure 2). Students’ written responses to open-ended questions also showed their positive attitude towards Tooth ARcademy (Table 1). • ToothAR was extremely helpful in solidifying my knowledge by using the quiz function [sic]. • It helped me practice histology slides, although I haven't used it as much as I probably should have in order to study. Definitely a useful tool, though, and I appreciate having it. • I love that it is a mobile app that I can use when on public transit! • I thought this app was very helpful for self-testing of identification in histological slides. • I only used it during labs and forgot that the other features (e.g., quiz mode) exist. If we were reminded they exist or were given a more detailed walk-through during class/lab, I probably would've used it more • I enjoyed this app and felt like it was helpful. The only reason I used it 5–10 times was because we learn so many other things in this program, so I had to study on other content as well. • I found that when learning the materials, I typically didn't think of using Tooth ARcademy to learn, but rather to clarify structure in histological sections. I also often simply searched up an image of a histological section rather than go through the application. Its main use for me was during the Oral Biology lab. • Quiz mode is very effective for consolidating and testing our knowledge. I did not feel that practice mode was contributing too much to my knowledge, but maybe I did not use it at the right time in my learning [sic]. • Good interface and helpful • Worked great, no complaints • App was intuitive and helpful in labeling certain structures. • I think a helpful improvement would be increasing the amount of different or irregularly stained slides seen—it is easier to go through the same few slides and identify different structures when they are very clear. • Having even more questions for practice • Interface is slightly large, but still functional • More questions would be nice • More interactiveness, whether that is we can slide and adjust the images in learn mode. • I wish there were more quiz questions available • The last time I used it, I had issues with it crashing. I had to delete and redownload the app, and then it worked [sic]. Today's health professions students are primarily from Generation Z (born 1995–2009), a tech-savvy, fast-paced generation. We have learned that incorporating such apps can engage Generation Z students and provide additional resources for self-paced learning. It can reduce extraneous cognitive load by providing an alternative scaffold for learning [5]. This study has a small sample size and lacks long-term outcome data. Future research can focus on larger populations, long-term impact of the app, and compare app-based and traditional teaching. This study was supported by School of Dentistry Education Research Fund (SDERF-FALL2023-01). This study has been approved by the Research Ethics Board of the University of Alberta (ID: Pro00144212). The authors declare no conflicts of interest.

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