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Year : 2020  |  Volume : 31  |  Issue : 1  |  Page : 48-52
Comparison of routine teaching with fishbowl and 1-min preceptor for dental undergraduate students: An interventional study

Department of Public Health Dentistry, KLE Academy of Higher Education and Research (KLE University's) KLE VK Institute of Dental Sciences, Belagavi, Karnataka, India

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Date of Submission14-Mar-2018
Date of Decision15-May-2018
Date of Acceptance16-Jul-2018
Date of Web Publication02-Apr-2020


Aim: To compare routine teaching method with fishbowl and a one-minute preceptor for undergraduate students. Objectives: 1. Evaluation of theoretical knowledge for WHO dentition status and treatment need by fish bowl and routine teaching. 2. Effectiveness of the combination of fish bowl and one-minute preceptor in understanding WHO dentition status and treatment need. Materials and Methods: This study was conducted on 38 third year undergraduate students, which was divided into two groups (Group A: Fishbowl, Group B: One-minute preceptor). Routine lecture for WHO dentition status and treatment need was taken, followed by baseline evaluation which was done by giving 10 sets of clinical images to students and asked them to give WHO score. Furthermore, fish bowl and one-minute preceptor method were performed and students were subjected with the same set of clinical images again. At the end of the session, feedback was taken from the students by means of five open-ended questions about their views on fish bowl and one-minute preceptor. Data were analyzed with SPSS version 20 (Chicago IL). Wilcoxon Sign Rank test and Mann Whitney 'U' test was performed for intragroup and intergroup comparison respectively. Results: Combination of fishbowl and one-minute preceptor shows statistically significant result over routine teaching method with P value of .000. Conclusion: Combination of Fish Bowl and OMP could be used for better teaching method for students, as the students are actively involved and more learning takes place; the deficiencies of one method would be compensated by the other.

Keywords: 1-min preceptor, dental education, Fishbowl, treatment need, undergraduate, WHO dentition status

How to cite this article:
Priyam S, Sankeshwari RM, Vyavahare S, Ankola AV. Comparison of routine teaching with fishbowl and 1-min preceptor for dental undergraduate students: An interventional study. Indian J Dent Res 2020;31:48-52

How to cite this URL:
Priyam S, Sankeshwari RM, Vyavahare S, Ankola AV. Comparison of routine teaching with fishbowl and 1-min preceptor for dental undergraduate students: An interventional study. Indian J Dent Res [serial online] 2020 [cited 2021 May 11];31:48-52. Available from:

   Introduction Top

Education has come a long way over the past few decades. It has evolved greatly from the once blackboard-oriented, teacher-centered approach to the use of various techniques that enhance the ability of undergraduate students to think in all the directions.[1] In dental education, self-assessment is widely accepted as a best practice and is performed after preclinical projects or clinical procedures, for both formative and summative activities, in the form of daily laboratory exercises, laboratory practical examinations, clinical treatment, and clinical competencies.[2]

Oral health is a part of general health. Dental diseases are the most prevalent and the most neglected of all chronic diseases affecting mankind. Prevention of disease rests on knowledge of the disease occurrence, distribution, etiology and other related factors[3] and hence it is imperative that students be well trained in recording dental caries. Quantitative measurement of disease most commonly relies on “index” as dental index is the main tool of epidemiological studies in dental diseases to measure prevalence, incidence, and severity.[3]

A critical element of the learning environment is its effect on student well-being.[4] There are various indices to record caries severity and one of the index which is internationally accepted is WHO index. To simplify the concept of index, two emerging pedagogical approaches— Fishbowl and One-Minute preceptor—are used in this study which has gained popularity in this era of general education.

Fish bowl technique can be used after the lecture class.[5] There are two circles:

  1. Inner circle: Students are called “fishes;” they may be 2–11 in number, depending on the strength of classroom.
  2. Outer circle: The rest of the students in class will form the outer circle and they are called “fish watchers”

According to the one-minute preceptor (OMP) model which is a clinical supervision technique, teaching-learning occurs in a short duration, in a realistic setting with the patient on the dental chair, providing experiential learning to the students for future practice.[6] The one-minute preceptor consists of five “micro skills” [7],[8]

  1. Getting a commitment
  2. Probe for supporting evidence
  3. Teach the general rules
  4. Reinforce what was done right
  5. Correct mistakes.

Combining both the classroom and clinical supervision approach will enhance the ability of students to understand the topic in a better way. Although there have been few studies of one-minute preceptor for undergraduate medical students, the literature available is limited for dental students.[5],[8] There is paucity of literature for the above-mentioned technique in dental education and this study is the first of its kind which has combined both the techniques.

The aim of the present study is evaluation of theoretical knowledge for WHO dentition status and treatment need by fish bowl and routine teaching and effectiveness of the combination of fish bowl and one-minute preceptor in understanding WHO dentition status and treatment need.

   Materials and Methods Top

An interventional study was conducted among third year undergraduate students (n = 38) in the Department of Public Health Dentistry of the institute. Ethical approval was obtained from the review board of the institution. Students those who were willing to participate, present on the day of study and gave informed consent were included in the study, those who were absent on the day of study were excluded.

Third year undergraduate students were recruited. The total sample size was 38. Each student was informed regarding study design and protocol. A 22-minute lecture for WHO dentition status and treatment need were taken for the students and base line knowledge was checked providing them 10 different clinical scenarios and asking them to give WHO score.

The class were divided into two groups, i.e., intervention group (21 students) and comparison group (17 students) in group A and group B, respectively. Intervention group students were explained about fish bowl and one-minute preceptor.

The study was completed in three weeks; the lecture was given in the first week, during the second week, the class was randomly divided into two groups with the lottery method. Group A was fishbowl + one-minute preceptor and the steps step and rules were explained to them. Group B was routine teaching group.

Further, the chairs in the class were arranged for the fishbowl method in two circles—an inner circle and an outer circle. Inner circle students with four members were instructed to hold a discussion on the allotted topic with the representative member among them in time limit of 20 minute. One chair was left open for the outer circle students to share their own aspects about the discussion and after sharing, they must go back to their original places. This is done to achieve maximum participation, and rest of the students in group A were asked to arrange themselves in the outer circle. The outer circle students were asked to focus and listen carefully to the discussion, they need to note examples of when their peers in the discussion group are following the rubric and when they are not. The observers need to record anything else important they see and be ready to share it.

However, at the end of the discussion, a plenary session was conducted by the modulator and all the missed important points were added and mistakes during discussion were corrected. A similar topic was also given to the routine group and they were also instructed to discuss among themselves.

Further, both the groups were again evaluated with the same set of clinical images which were shown at the time of baseline evaluation. In the third week, group A and group B were allotted with patients for clinical evaluation. Group A was asked to record WHO score according to one-minute preceptor steps as the sequence of micro skills fosters learner ownership of the clinical problem. At the same time, learner's knowledge is assessed and critical thinking is promoted, whereas Group B was instructed to record the score as a routine standard protocol. At the end, both the groups were compared and evaluated.

Feedback was taken from the students by means of five open-ended questions about their views and experience with fish bowl and one-minute preceptor [Table 1].
Table 1: Questions was given to all the 38 students having the following questions

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Intra-group and inter-group comparison was done with Wilcoxon signed rank test and Mann–Whitney U-test. Data were analyzed with SPSS version 20 (Chicago IL).

   Results Top

In relation to age, level of previous knowledge and training, there was no difference amongst the comparison and intervention groups as all the participants were students of third year of BDS. The minimum score in pre-fish and post-fish was 0 and 2, respectively, whereas in pre-routine and post-routine, it was 0 and 1, respectively, as shown in [Table 2].
Table 2: Change in magnitude between pre- and post-score of comparison and intervention group

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Intragroup comparison for baseline evaluation between pre-fishbowl and post-fishbowl was done with Wilcoxon signed ranked test, showing statistically significant difference with Z value of -4.026 and P value of.000, as among 21 students, all were found to give the correct answer for the given clinical images, showing that post-fishbowl was better scored than pre-fishbowl.

Pre-routine and post-routine did not show statistically significant difference with Z value of − 1.536 and P value of 0.125, as out of 17 students, five were found to have given incorrect answers both at the time of pre-routine and post-routine, one student's answer was the same at both the times, and only 11 students gave the correct answer [Table 3].
Table 3: Intragroup comparison for baseline evaluation

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nItergroup comparison with Mann–Whitney U-test between post-fishbowl and post-routine with z-value of −4.533 and P value of 0.000 showed statistically significant result, manifesting post-fishbowl better than post-routine [Table 4].
Table 4: Intergroup comparison between post-fishbowl and post-routine

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Intergroup comparison between a combination of one-minute preceptor and fishbowl with routine group again showed a statistically significant difference with Z value of −4.533 and P value of 0.000 [Table 5].
Table 5: Intergroup comparison between 1-min preceptor + fishbowl and routine

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Post-study feedback was taken from all the students of fishbowl and one-minute preceptor by means of five open-ended questions [Table 1], in which out of 21 students, 18 students shared their views with positive response with all the questions and accepted both the techniques to be better over the traditional method. In answer to question 2, only three students were confused with the topic and expressed their views that they faced some difficulties in a few cases.

   Discussion Top

The common and the greatest challenge faced by the teacher in a professional college is attentiveness of students and their involvement as well as participation in the classes.[9] Moreover, the teaching-learning process enforces a great deal of expectations from the teacher, equivalent participation from students and effective classroom management.[10]

As per Bloom's taxonomy, developed by a team of American educators led by Benjamin S. Bloom, the purpose of education was “to change the thoughts, feelings and actions of students.” Bloom and his team suggested that students should also be taught to apply the acquired knowledge along with higher-order thinking skills.[11]

His committee designed a hierarchical framework of learning statements based on the six major categories of cognitive thought, beginning with knowledge, followed by comprehension, application, analysis, synthesis and evaluation.[11]

Keeping these steps in mind, in our study, it was thought to begin with the idea to first instill the knowledge by taking a lecture for the topic, i.e., the WHO dentition status and treatment need, which was followed by comprehending the knowledge by asking students to discuss the topic and critically think to build up their thoughts by fishbowl method. Further to apply their piece of knowledge, the students were given various simulated cases so that they should understand and are trained well to give proper and correct score for the given case scenario.

After collecting their answer sheets, the correct score for each image was discussed with them and they were asked to rethink if any of their answers was incorrect so that they can analyze how to think to give the correct score. Further plenary session was given by the facilitator so that students can synthesize their knowledge and the second technique, namely the one-minute preceptor test was used to evaluate each student by allotting them patients and they had to record the WHO score in patients (real-life scenario).

The WHO dentition status and treatment need are internationally accepted methods to record dental caries. The index has three segments—crown, root and treatment need. A patient can present with dental caries and the treatment need will change as per the severity of the disease. Students need to understand the concept and apply it, which could be a difficult task for new learners as the pattern of the disease changes from one person to another. Thus, this index was selected in the present study and we evaluated if fishbowl, along with one-minute preceptor, can help students understand the concept in a better and easier way.

The tough curriculum in a professional college must be made interesting by implementation of new teaching learning strategies.[12] Lecture with fishbowl discussions and clinical reasoning with one-minute preceptor instilled interest in the class in majority (95%) of the students. Lectures interspersed with discussions have always inculcated interest in students as seen by Baetty et al.,[13] which was similar in our study.

The teacher in fishbowl method acts more like a facilitator, organizing friendly and favorable environment to thrive internal motivation towards learning and thereby inculcating interest. Moreover, lecture with fishbowl is more student-centered, whereas lecture alone is more teacher-centered.[14]

Approximately 95% of students were able to retain information better in “lecture with fishbowl” [15] However, only 5% students felt that they were having some confusion regarding some clinical scenario. When compared to lecture alone method, all students in fishbowl group found this technique to be more effective and innovative way of learning, and this was also appreciated by Gibbs et al. who found that interactive discussions before or after a lecture always led to retain information better.[16]

Students need to retain information from classes for interpretation and application of information with respect to importance of the content which gave the idea to add one-minute preceptor technique for clinical reasoning into the study.

The students in the intervention group, post one-minute preceptor training, had revealed a significant improvement in scoring the tooth with the appropriate WHO score with Z-value of-4.533, leading to high accuracy in understanding the condition. This is essential for successful treatment outcome, which was similar to the study done by Naik et al., which shows a statistically significant difference in performance of students of both the groups, and demonstrates that there was a positive impact on learning of the students, by either traditional or using the one-minute preceptor model.[6] The findings are in contradiction to a study by Saunderset al.[17]

It was found by Aagaardet al.[18] in his study that preceptors using the one-minute preceptor approach were equally or better able to diagnose the patient's condition correctly, in comparison to those using a routine approach, and student abilities and knowledge were better assessed with the one-minute preceptor. The preceptors rated the one-minute preceptor approach as more efficient and more effective.

Stheemanet al. showed that as the diagnostic confidence of dentists increases, there is an increase in diagnostic accuracy, and they suggested that methods should be devised to improve the diagnostic confidence.[19] The sample of the study was a limitation due to restricted number of students involved in specified duration and, further studies with larger sample size and a follow-up study to determine the retention of the knowledge for correct scoring system amongst the students is the need of the hour.

   Conclusion Top

The present study concluded the use of fishbowl and one-minute preceptor model to inculcate interest in majority of the students. The students were able to retain information better with both the techniques.

A combination of fish bowl and one-minute preceptor could be used for a satisfactory teaching technique for students, because students are actively involved, and the deficiencies of one method would be compensated by the other.


The authors wish to thank the students who participated in this study.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

1. Zhao Y. The use of a constructivist teaching model in environmental science at Beijing normal university. China Pap 2003;10:78-84.  Back to cited text no. 1
Mays KA, Branch-Mays GL. A systematic review of the use of self-assessment in preclinical and clinical dental education. J Dent Educ 2016;80:902-13.  Back to cited text no. 2
Dental Indices. 2-4. Available from: class community dentistry/1 Dental Indices.pdf. [Last accessed on 2017 Jul 04].  Back to cited text no. 3
Wasson LT, Cusmano A, Meli L, Louh I, Falzon L, Hampsey M, et al. Association between learning environment interventions and medical student well-being: A systematic review. JAMA 2016;316:2237-52.  Back to cited text no. 4
Souza MD, Chaturvedula L. Improving Listening Activity and Student's Active Participation in Group Discussion in Pharmacology Lecture (theory) Class in Para Clinical M.B.B.S. Students using Fish Bowl (group dynamics) N.T.T.C.; 2007. p. 1-10.  Back to cited text no. 5
Zameera Naik MU. 'One minutepreceptor'a teaching-learning model for oral radiographic interpretation skill. J Contemp Med Educ 2015;3:73.  Back to cited text no. 6
Neher JO, Gordon KC, Meyer B, Stevens N. A five-step “microskills” model of clinical teaching. J Am Board Fam Pract 1992;5:419-24.  Back to cited text no. 7
Neher JO, Stevens NG. The one-minute preceptor: Shaping the teaching conversation. Fam Med 2003;35:391-3.  Back to cited text no. 8
Rehman R, Afzal K, Kamran A. Interactive lectures: A perspective of students and lecturers. J Postgrad Med Institute (Peshawar Pakistan) 2013;27:152-6.  Back to cited text no. 9
Kamran A, Rehman R, Iqbal A. Importance of clinically oriented problem solving tutorials (COPST) in teaching of physiology. Rawal Med J 2011;36:232-6.  Back to cited text no. 10
Objectives E. How to use Bloom's Taxonomy in the Classroom. p. 1-19. Available from:'s_Taxonomy_and_its_Use_in_Classroom_Assessment. [Last accessed on 2017 Jul 05].  Back to cited text no. 11
Singh V, Kharb P. SciVerse ScienceDirect Review article A paradigm shift from teaching to learning gross anatomy: Meta-analysis of implications for instructional methods. J Anat Soc India 2013;62:84-9.  Back to cited text no. 12
Beatty I. Transforming Student Learning with Classroom Communication Systems; 2004. Available from: [Last accessed on 2017 Nov 17].  Back to cited text no. 13
Brophy J. Synthesis of research on strategies for motivating students to learn. Educ Leadersh 1987;45:40-8.  Back to cited text no. 14
Pavani G. Fish bowl teaching technique for 2nd year MBBS students in AIMSR. J Evol Med Dent Sci 2016;5:1713-5.  Back to cited text no. 15
Gibbs G, Habeshaw S, Habeshaw T. Improving student learning during lectures. Med Teach 1987;9:11-20.  Back to cited text no. 16
Furney SL, Orsini AN, Orsetti KE, Stern DT, Gruppen LD, Irby DM, et al. Teaching the one-minute preceptor. A randomized controlled trial. J Gen Intern Med 2001;16:620-4.  Back to cited text no. 17
Aagaard E, Teherani A, Irby DM. Effectiveness of the one-minute preceptor model for diagnosing the patient and the learner: Proof of concept. Acad Med 2004;79:42-9.  Back to cited text no. 18
Stheeman SE, Mileman PA, van 't Hof MA, van der Stelt PF. Diagnostic confidence and the accuracy of treatment decisions for radiopaque periapical lesions. Int Endod J 1995;28:121-8.  Back to cited text no. 19

Correspondence Address:
Shefalika Priyam
Department of Public Health Dentistry, KLE Academy of Higher Education and Research (KLE University's) KLE VK Institute of Dental Sciences, Belagavi, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijdr.IJDR_231_18

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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]


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