Introduction

In medical education, the clinical education has a strong relationship with the quality of the clinical learning environment i.e. the theoretical knowledge that transfers into clinical practice (1). Assessment of student performance in clinical settings is one of the most difficult tasks of faculty members and health education specialists (2). In clinical evaluation, the student's exposure to the patient and student's progress in achieving the objectives of the desired skills must be assessed (3). Evaluation of education programs and identifying the strengths and weaknesses in training process reinforce the positive aspects and assist education decision makers to initiate meaningful change in education (4). A wide range of clinical assessment methods are currently available including observational measurement, rating scales, student writing portfolio report, systematic daily or hourly record of activities or logbook (5). One of the methods to solve clinical problems is to continuously evaluate the achievement with reference to a certain goals and objectives designed by education program using logbook (6). Logbook is one of the powerful positive steering assessment methods on learning and educational curriculum (7).

A logbook is a booklet of skills which describes some of the main tasks students are expected to perform. After completing each of the assignments and recording the details including date, time, and manner, the academic and clinical performance of students are monitored and approved by faculties using paper-based students’ logbook (8). So, recording the detailed data in the operational logbook avoids forgetting, pedagogical bias, and students' misunderstandings and misconceptions (9). Learning goals are already set in the logbook, and students receive equal educational opportunities (10). Logbooks can help teachers and students to achieve educational and clinical goals as they reduce the gap between theoretical knowledge and clinical practice (7). Various studies have shown that the use of logbooks is more effective than traditional evaluation methods (11, 12). Unfortunately, most evaluation methods evaluate professional knowledge, not professional competence (13). The results of some studies have shown that the contents of some logbooks are far from ideal educational pattern and do not provide feedback on students’ performance and adaptation of instruction, so they require some modification (14, 15). A study on Nottingham University students’ logbooks has shown improved overall trend; however, some faculties and students are not familiar with the purpose and importance of using logbooks. Also, some students were reluctant to record their actions and share their activities in order to receive signed consent from their faculties (16). There is a little evidence in the literature regarding the use of a clinical logbook to evaluate dental education. In a study conducted at School of Dentistry of Shiraz University, the findings showed that logbooks help teachers and students to achieve their educational and clinical goals due to the reduced gap between theoretical knowledge and clinical performance, despite the fact that the students were reluctant to fill their logbooks (17). The aim of the present study was to assess the effect of logbook on the clinical training aspects of oral medicine from the perspective of students and faculties of Department of Oral and Maxillofacial Medicine, School of Dentistry, Ahvaz Jundishapur University of Medical Sciences (AJUMS).

Methods

The present cross-sectional study was conducted in 2019 at the AJUMS School of dentistry. The participants included six (n=6) faculty members and 70 (n=70) dental students in the 8th semester who were registered and enrolled for a course of diagnosis of oral diseases (practical 2). The students participated in this study were all from the same entry; however, students with different entries were excluded from the study. All the students were qualified for the study and were at the high level of proficiency with the grade point average (GPA) of “15.66”.

 Data were collected using a written questionnaire and logbook. The logbook was designed and approved by a number of faculty members at the department of oral and maxillofacial medicine according to the chapters provided by the Ministry of Health in Iran. Application of designed logbook was approved by Department of Education Development Center (EDC), AJUMS.

The questionnaire was developed based on the previous relevant studies (18). The questionnaire validity was confirmed by faculties of oral and maxillofacial medicine department. The reliability of the questionnaire was determined by administering 10 dental students responded to the questionnaire twice in a 10-day interval. The coefficient of correlation between the two tests was 80% (the reliability of questionnaire was confirmed). The questionnaire was divided into two sections including demographic information and questions about the quality and necessity of using the logbook, as well as an open-ended question about participants' viewpoints. The first part of the questionnaire contained demographic information. The second part consisted of 42 questions that described the participants' views on the logbook in four domains as following: 1- The necessity of using the logbook including 8 questions on a 5-point Likert scale (0= strongly disagree, 1= disagree, 2= Neutral, 3= agree, and 4= strongly agree with the minimum and maximum scores of 0-32). 2- How to complete the logbook including 4 questions on a 5-point Likert scale (0= strongly disagree, 1= disagree, 2= Neutral, 3= agree, and 4= strongly agree with the minimum and maximum scores of 0-16). 3- Quality of the logbook content including 22 questions on a 5-point Likert scale (0= strongly disagree, 1= disagree, 2= Neutral, 3= agree, and 4= strongly agree with the minimum and maximum scores of 0-88). 4- Consequences of designing the form and process of logbook implementation including 8 questions on a 5-point Likert scale (0= strongly disagree, 1= disagree, 2= Neutral, 3= agree, and 4= strongly agree with the minimum and maximum scores of 0-32). The minimum and maximum scores in four domains were 0 and 169, respectively. The questionnaire also included an open-ended question. After course registration, students were provided with a logbook. Students were logged their attendance in details (date, time, student participation, quality of performance) in the logbook and their attendance signed off and approved at the end of the clinical tasks. At the end of the semester students were asked to complete the questionnaire. The detailed notes were explained to the students and informed consent was obtained. The students completed the questionnaire in the presence of the interviewer. Data were analyzed using descriptive statistics, independent t-test, and SPSS ver.18.

Results

In the present study, the data from the questionnaire were analyzed using descriptive statistics (mean and standard deviation) and independent t-test to compare participants' viewpoints.

The mean age of students and faculty members was 23.6 and 36.8 years, respectively. 66.6% of the faculties and 67.1% of the students were female. The faculties had specialized doctoral degrees in the field of oral diseases. The mean score of self-assessment of the faculty members and students are presented in Table 1.

The mean score of faculty members in the four domain of study (1-The necessity of using the logbook 2- How to complete the Logbook 3- Quality of Logbook content 4- Consequences of designing the form and process of logbook implementation) was more than those of the students. But, according to Table 2, this difference was not significant in any of the indices, i.e. no significant difference was observed between faculties’ and students’ viewpoints (p-value=0.451).

50.7% of the students and more than 50% of the faculties believed that using the logbook causes discipline and consistency in educational activities (Table 3). Over 66.7% of faculties believed that logbooks enhance students' ability to perform clinical tasks and also increase student's awareness of educational objectives, and over 45.7% of the students also agreed with them.

The students’ and faculties’ viewpoints on the quality of the logbook content are shown in Table 4. More than 66.7% of the faculties believed that the educational goals, the overall report of the number of clinical activities in each course, and students clinical evaluation item were included in the logbook and the clinical activities designs were consistent with the students’ ability. More than 69.2% of the students agreed with the faculties’ viewpoints.

The results of table 5 indicate that the format and implementation process designed in the logbook meet 50% of the needs and expectations from the viewpoint of students and faculties. Concerning how to fill the logbook, more than 56.3% of the students were interested in completing the logbook (Table 6).

The results of the study showed that 20% of the participants believed that using the electronic logbooks and correcting their appearance improve the quality of logbooks. Furthermore, assigning a higher score for filling the logbook in the final exam was recommended by participants.

Discussion

The aim of the present study was to evaluate the effect of logbook on the clinical training aspects of oral medicine from the perspective of students and faculties of AJUMS Department of Oral and Maxillofacial Medicine, School of Dentistry. The findings of the present study showed that faculty members and students both had positive views toward using a logbook. Faculties’ view of logbook was more positive than those of the students, but there was no statistically significant difference between the two groups. Regarding the necessity of using logbooks, faculties and students found it necessary to create discipline in educational activities, increase student's ability to perform clinical tasks, and raise student awareness of educational goals and theory related to clinical practice.

In this study, more than 60% of students and faculties considered logbooks necessary to enhance students' ability to perform clinical tasks.

The results of the study by Wendy et al. in 2001 on 74 medical students in California showed that students who used logbooks in the clinical experience had more ward rounds, higher-acuity patients, and performed more procedures compared to the other group (19). In the present study, the participants found logbooks necessary since it would make a better evaluation of the students (50%) and increase students’ motivation (44.3%).

Blake et al. (2002) in a study conducted in Canada showed that logbook can determine student-teacher roles and responsibilities, provide a means for teachers to select appropriate methods, and make it easier for teachers to evaluate the student performance especially at the end of the student's courses (20).

Mazareie et al. (2016)  showed that 60% of the students were satisfied with the logbook and believed that the logbook is a practical and useful assessment tool for evaluating the students and achieving learning objectives. Likewise, logbook was considerd as a practical tool that clearly states the educational objectives and clarifies the minimum requirements for each department (17).

Asgari et al. (2016) reported that logbooks provide educational motivation and increase student satisfaction (21). Cornwall and Doubtfire (2002) examined the use of the Royal College of Psychiatrists' trainee's logbook by a cross-sectional survey of psychiatric trainees and their consultant trainers. According to the results of the study, 80% of trainers believed that logbooks would improve the quality of training, while only 60% of trainees shared similar views which it was consistent with the results of the present study (22).

Najafi et al. (2017) in a study showed that 87.5% of faculties and 44% of the students believed that using logbooks was necessary in the practical courses. Regarding the quality of the logbook content, it was also showed that the educational objectives were included in the logbook and meet the student learning needs and ability which was consistent with the results of the present study (18).

Khorashadizadeh and Alavinia (2012) suggested that a logbook has the potential to become an objective assessment tool with the self-evaluation and better accountability which should provide valid, relevant, and reliable data (23).

Regarding the format and process of logbook implementation, the present study had a positive view of the items in this domain which was inconsistent with the results of Najafi et al.'s study (18).

The area of how to complete the log was evaluated only for the students and showed that the attitude of the female students towards the completion of the logbook was significantly more positive than that of the male students. As well as, the results of Najafi et al.'s study showed that a significant number of students cared about completing the logbook and they filled out the logbook everyday (18). But, in the study of Mazareie et al. students did not attach much importance to fill out the logbook due to the heavy workload of the clinical practice and the lack of emphasis on filling out the logbook by faculties (17).

Rees and Sheard (2004) in a study conducted in Nottingham university showed that despite improvement in the general trend, some students and educators are not familiar enough with the importance and objectives of the logbooks (24).

The results of the present study showed that in three areas of necessity, quality of logbook content, and format and its implementation process of logbook, faculties’ viewpoints were more positive than those of the students, but there was no significant difference in their viewpoints. However, in Najafi et al.'s study a significant difference was found between faculties’ and students' viewpoints and therefore they considered it necessary to revise the content of the logbook (17).

Murray et al. (2001) in a study concluded that, despite apparently similar timetables, individual students have very different experiences. Therefore, a review on the logbook was considered necessary (25).

  There are two major limitations in this study that could be addressed in future research. First, the study did not focus on alternative assessment methods and also the studied method was not compared with those using the traditional methods. Second, the performance thresholds were calculated regardless of students’ scores.

In the present study, revision of the prepared logbook was not considered necessary. However, holding workshops is essential to foster students’ learning and optimize students' use of logbooks, so that it can reinforce faculties in logbook assessment.

Faculty members and students showed a positive view on four domains of a logbook (the necessity of using the logbook, how to complete the logbook, quality of the logbook content, consequences of designing the form and process of logbook implementation); however, positive overall view of the faculty members was more than those of the students. Therefore, reviewing the logbooks is not necessary, but more familiarity with the logbook content and supplementary experimental workshops for students seem necessary.

Ethical considerations 

Ethical issues (Including plagiarism, informed consent, misconduct, data fabrication and/or falsification, double publication and/or submission, redundancy, etc.) have been completely observed by the authors.

Acknowledgement

The authors would like to thank the Vice-Chancellor for Research and all the students and faculties involved in this research project.

Financial Support

The present study was supported by AJUMS Medical Educational Development Center (EDC) with the code of EDC-9822 and ethical code of IR.AJUMS.REC.1398. 553.

Conflict of Interest: None declared.