{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T09:27:23Z","timestamp":1787390843422,"version":"build-2736575974"},"reference-count":27,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T00:00:00Z","timestamp":1787356800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T00:00:00Z","timestamp":1787356800000},"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":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n Accurate diagnosis of oral mucosal lesions is a critical competency in dental education, yet traditional teaching may be insufficient for developing diagnostic reasoning. Evidence on adaptive learning strategies is limited. This study evaluated an adaptive audience response system (ARS) within a flipped classroom.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n A three\u2010arm parallel randomized controlled trial was conducted among 90 undergraduate dental students randomized to flipped classroom with standard ARS, flipped classroom with adaptive ARS, or lecture\u2010based instruction (\n n<\/jats:italic>\n = 30 per group). Diagnostic accuracy was assessed at baseline (T0), immediately post\u2010intervention (T1), and at 4\u2010week follow\u2010up (T2) using parallel image\u2010based tests. Secondary outcomes included learning gain (\u03941), retention (\u03942), pass rate (\u2265\u00a075%), cognitive load, and time on task. Data were analyzed using mixed\u2010design ANOVA with post hoc comparisons and multivariable linear regression.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Diagnostic accuracy improved over time across all groups (\n p<\/jats:italic>\n < 0.001), with a significant group \u00d7 time interaction (\n p<\/jats:italic>\n < 0.001). The adaptive ARS group showed greater learning gain than both standard ARS (\n p<\/jats:italic>\n = 0.016) and lecture groups (\n p<\/jats:italic>\n = 0.006), and higher pass rates (63.3%\u00a0vs. 30.0% and 10.0%, respectively;\n p<\/jats:italic>\n < 0.001). Multivariable regression analysis demonstrated that participation in the adaptive ARS group independently predicted higher post\u2010intervention diagnostic accuracy (\n p<\/jats:italic>\n < 0.001). No differences were observed in retention (\n p<\/jats:italic>\n = 0.636), cognitive load (\n p<\/jats:italic>\n = 0.427), or time on task (\n p<\/jats:italic>\n = 0.380).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Adaptive ARS within a flipped classroom was associated with improved diagnostic accuracy and higher competency attainment without increasing cognitive load or time burden. These findings support the use of adaptive, performance\u2010based learning approaches to enhance diagnostic training and educational preparedness in dental education.<\/jats:p>\n <\/jats:sec>\n \n Practical implications<\/jats:title>\n Adaptive, performance\u2010based learning strategies may enhance image\u2010based diagnostic reasoning and diagnostic preparedness among undergraduate dental students.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/jdd.70351","type":"journal-article","created":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T09:05:22Z","timestamp":1787389522000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Adaptive Audience Response Systems and Diagnostic Accuracy in Oral Mucosal Lesions: A Randomized Controlled Trial"],"prefix":"10.1002","author":[{"given":"Fatma E. A.","family":"Hassanein","sequence":"first","affiliation":[{"name":"Faculty of Dentistry King Salman International University El Tor Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,22]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u20102929.2005.02127.x"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u20102929.2004.01972.x"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.3389\/froh.2026.1748450"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1202451"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/00001888\u2010200603000\u201000002"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41415\u2010024\u20107576\u20104"},{"key":"e_1_2_12_8_1","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1055\/s-0045-1808101","article-title":"Curriculum Development and Teaching Strategies in Dental Education","volume":"14","author":"Elmalky W.","year":"2025","journal-title":"European Journal of General Dentistry"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jormas.2026.102788"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12903\u2010026\u201007665\u20104"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/medu.13272"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12909\u2010018\u20101144\u2010z"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.nedt.2015.12.010"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.3109\/0142159X.2012.671978"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.21815\/JDE.017.011"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/jdd.12026"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.compedu.2009.05.001"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.3109\/0142159X.2012.680938"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1187\/cbe.06\u201012\u20100205"},{"issue":"1","key":"e_1_2_12_20_1","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1111\/j.1365-2923.2009.03498.x","article-title":"Cognitive Load Theory in Health Professional Education: Design Principles and Strategies","volume":"44","author":"Van Merri\u00ebnboer J. 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