{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T17:04:36Z","timestamp":1791911076290,"version":"4.3.4"},"reference-count":45,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T00:00:00Z","timestamp":1776124800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T00:00:00Z","timestamp":1776124800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Dental Education"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Temporomandibular disorders (TMD) are common in dental practice, yet dental students report limited confidence and competence due to insufficient clinical exposure during predoctoral training. Virtual patient\u2010based learning (VPBL) may enhance experiential learning; however, its impact on clinically relevant educational outcomes remains underexplored. This study evaluated whether a TMD\u2010specific VPBL educational intervention improves dental students\u2019 diagnostic and management performance, self\u2010perceived confidence, and knowledge.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This quasi\u2010experimental pre\u2010post study included 83 fourth\u2010year dental students at Adams School of Dentistry, University of North Carolina. Participants completed pre\u2010 and post\u2010intervention assessments consisting of five Objective Structured Clinical Examination (OSCE)\u2010style case scenarios evaluating TMD\u2010related diagnostic and management skills. Between assessments, students reviewed 15 TMD virtual patient cases. Performance was scored using a predefined rubric across diagnostic accuracy, diagnostic reasoning, management appropriateness, justification for additional testing, and understanding of systemic\/local factors influencing TMD (0\u201310 scale, 10\u00a0=\u00a0\u201chigher performance\u201d). Secondary outcomes included confidence in 12 TMD\u2010related skills (0\u201310 scale) and retrospective pre\/post self\u2010perceived knowledge (1\u20134 scale, 4\u00a0=\u00a0\u201chigher knowledge\u201d). Changes were evaluated using paired\n                      <jats:italic>t<\/jats:italic>\n                      \u2010tests and Wilcoxon signed\u2010rank tests.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      100% of the students completed both assessments. Overall performance improved significantly post\u2010intervention (8.3\u00a0\u00b1\u00a01.4\u00a0vs. 9.4\u00a0\u00b1\u00a00.8,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001, effect size\u00a0=\u00a00.64), with gains observed across all domains (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2019s\u00a0&lt;\u00a00.05). Self\u2010perceived knowledge increased significantly (2.6\u00a0\u00b1\u00a00.7\u00a0vs. 2.9\u00a0\u00b1\u00a00.6,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001, effect size\u00a0=\u00a00.70). Overall confidence in TMD\u2010related skills was moderate (5.3\u00a0\u00b1\u00a01.7) and positively correlated with post\u2010intervention knowledge (\n                      <jats:italic>r<\/jats:italic>\n                      \u00a0=\u00a00.70,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A TMD\u2010specific VPBL educational intervention was associated with significant improvements in diagnostic and management performance and self\u2010perceived knowledge, supporting its utility as an educational strategy to enhance TMD predoctoral curricula.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jdd.70232","type":"journal-article","created":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T07:15:31Z","timestamp":1776150931000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Impact of Virtual Patient\u2010Based Learning on Temporomandibular Disorder Knowledge Among Dental Students: A Pre\u2010Post Study"],"prefix":"10.1002","author":[{"given":"Caroline M.","family":"Sawicki","sequence":"first","affiliation":[{"name":"Adams School of Dentistry University of North Carolina  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Sangalli","sequence":"additional","affiliation":[{"name":"College of Dental Medicine\u2013Illinois Midwestern University  Downers Grove Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,14]]},"reference":[{"key":"e_1_2_7_2_1","volume-title":"Orofacial Pain Guidelines for Assessment, Diagnosis, and Management","author":"The American Academy of Orofacial Pain","year":"2023"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00784\u2010020\u201003710\u2010w"},{"key":"e_1_2_7_4_1","unstructured":"\u201cFacial Pain \u201dNational Institute of Dental and Craniofacial Research (NIDCR) accessed January 20 2025 https:\/\/wwwnidcrnihgov\/research\/data\u2010statistics\/facial\u2010pain#:~:text=TMJDs%20are%20the%20second%20most TMJ%20disorders%20will%20seek%20treatment."},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0304\u20103959(98)00063\u20103"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1080\/0361073X.2015.1053770"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/pm\/pnae003"},{"key":"e_1_2_7_8_1","first-page":"15","article-title":"Comparison of Psychologic and Physiologic Functioning Between Patients With Masticatory Muscle Pain and Matched Controls","volume":"7","author":"Carlson C. R.","year":"1993","journal-title":"Journal of Oral Facial Pain"},{"key":"e_1_2_7_9_1","first-page":"547","article-title":"The Level of Self\u2010Perceived Knowledge Regarding Temporo\u2010Mandibular Disorders Among the Saudi Arabian Dental Professionals Working in Dental Institutes or Universities vs. Clinics or Hospitals","volume":"31","author":"Qamar Z.","year":"2022","journal-title":"Mymensingh Medical Journal"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/jdd.70000"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/eje.13138"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/j.0022\u20100337.2014.78.10.tb05811.x"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/eje.12117"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/ejp.1283"},{"key":"e_1_2_7_15_1","first-page":"1","article-title":"Current Status of Temporomandibular Disorders Education in U.S. Predoctoral Dental Curricula: A Nationwide Survey","volume":"44","author":"Sangalli L.","year":"2025","journal-title":"Cranio"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.14219\/jada.archive.2007.0142"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600\u20100579.2010.00648.x"},{"key":"e_1_2_7_18_1","article-title":"Testing an Educational Resource for Implementation in Temporomandibular Disorders Curriculum Through a Phase I Define and Refine Study","volume":"90","author":"Sangalli L.","year":"2025","journal-title":"Journal of Dental Education"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/jdd.70032"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1037\/hea0000161"},{"key":"e_1_2_7_21_1","volume-title":"Temporomandibular Disorders: Priorities for Research and Care","author":"National Academies of Sciences, Engineering, and Medicine","year":"2020"},{"key":"e_1_2_7_22_1","doi-asserted-by":"crossref","first-page":"1168","DOI":"10.3390\/children11101168","article-title":"Pediatric Dentists' Practice Patterns in the Screening, Diagnosis, and Management of Temporomandibular Disorders","volume":"11","author":"Sawicki C. M.","year":"2024","journal-title":"Children"},{"key":"e_1_2_7_23_1","unstructured":"D. C.Des Jarlais C.Lyles andN.Crepaz \u201cTREND Statement Checklist \u201dThe Trend Group published January 1 2004 https:\/\/stackscdcgov\/view\/cdc\/149677."},{"key":"e_1_2_7_24_1","doi-asserted-by":"crossref","first-page":"6","DOI":"10.11607\/jop.1151","article-title":"Diagnostic Criteria for Temporomandibular Disorders (DC\/TMD) for Clinical and Research Applications: Recommendations of the International RDC\/TMD Consortium Network* and Orofacial Pain Special Interest Group\u2020","volume":"28","author":"Schiffman E.","year":"2014","journal-title":"Journal of Oral & Facial Pain and Headache"},{"key":"e_1_2_7_25_1","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1177\/0333102419893823","article-title":"International Classification of Orofacial Pain, 1st Edition (ICOP)","volume":"40","year":"2020","journal-title":"Cephalalgia"},{"key":"e_1_2_7_26_1","unstructured":"D.LangandJ. A.Savageau \u201cStarting at the End: Measuring Learning Using Retrospective Pre\u2010Post Evaluations \u201d AEA365Blog published July 31 2017 https:\/\/aea365org\/blog\/starting\u2010at\u2010the\u2010end\u2010measuring\u2010learning\u2010using\u2010retrospective\u2010pre\u2010post\u2010evaluations\u2010by\u2010debi\u2010lang\u2010and\u2010judy\u2010savageau\/."},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1080\/02602930701773026"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.15766\/mep_2374\u20108265.11467"},{"key":"e_1_2_7_29_1","volume-title":"Statistical Power Analysis for the Behavioral Sciences","author":"Cohen J.","year":"1988"},{"key":"e_1_2_7_30_1","doi-asserted-by":"crossref","DOI":"10.11613\/BM.2026.010101","article-title":"Effect Sizes for Nonparametric Tests","volume":"36","author":"Fiel Peres F.","year":"2026","journal-title":"Biochemia Medica"},{"key":"e_1_2_7_31_1","doi-asserted-by":"publisher","DOI":"10.1080\/08869634.2020.1812816"},{"key":"e_1_2_7_32_1","doi-asserted-by":"publisher","DOI":"10.1111\/eje.12260"},{"key":"e_1_2_7_33_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen\u20102020\u2010048497"},{"key":"e_1_2_7_34_1","doi-asserted-by":"publisher","DOI":"10.1111\/eje.12867"},{"key":"e_1_2_7_35_1","first-page":"1154","article-title":"Temporomandibular Disorders","volume":"350","author":"Durham J.","year":"2015","journal-title":"BMJ Open"},{"key":"e_1_2_7_36_1","article-title":"A Modern Web\u2010Based Virtual Learning Environment for Use in Dental Education","author":"Padilla M.","journal-title":"Journal of Dental Education"},{"key":"e_1_2_7_37_1","doi-asserted-by":"publisher","DOI":"10.1002\/j.0022\u20100337.2012.76.10.tb05392.x"},{"key":"e_1_2_7_38_1","doi-asserted-by":"publisher","DOI":"10.1002\/jdd.70184"},{"key":"e_1_2_7_39_1","doi-asserted-by":"publisher","DOI":"10.1111\/eje.70118"},{"key":"e_1_2_7_40_1","doi-asserted-by":"publisher","DOI":"10.14219\/jada.archive.1993.0121"},{"key":"e_1_2_7_41_1","doi-asserted-by":"publisher","DOI":"10.1177\/205016841800700413"},{"key":"e_1_2_7_42_1","doi-asserted-by":"publisher","DOI":"10.14219\/jada.archive.2010.0337"},{"key":"e_1_2_7_43_1","doi-asserted-by":"publisher","DOI":"10.1111\/joor.12448"},{"key":"e_1_2_7_44_1","doi-asserted-by":"publisher","DOI":"10.1097\/ACM.0b013e31813e6755"},{"key":"e_1_2_7_45_1","doi-asserted-by":"publisher","DOI":"10.1097\/ACM.0b013e31828ffdcf"},{"key":"e_1_2_7_46_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2011.1234"}],"container-title":["Journal of Dental Education"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jdd.70232","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jdd.70232","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jdd.70232","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T07:15:35Z","timestamp":1776150935000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jdd.70232"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,14]]},"references-count":45,"alternative-id":["10.1002\/jdd.70232"],"URL":"https:\/\/doi.org\/10.1002\/jdd.70232","archive":["Portico"],"relation":{},"ISSN":["0022-0337","1930-7837"],"issn-type":[{"value":"0022-0337","type":"print"},{"value":"1930-7837","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,14]]},"assertion":[{"value":"2026-01-14","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-23","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-14","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"jdd.70232"}}